MDNews - Minnesota

longest-running programs. "We have been around since 1978," Dr. Colv in-Ada ms says. "Ma ny of ou r t ra nspla nt co ord inators h ave been with us for much of that time. Faculty, surgeons and coordinators alike have developed this program over the decades." Advances in monitoring for rejection and other complications play a role in the program's excellent sur vival rates. Additionally, offering LVADs has allowed patients to live longer on the transplant list. "We are very proud of how well our patients do and have received national recognition for excellent outcomes," Dr. Colvin-Adams says. "Our one-year survival rate was more than 90 percent in 2013, compared to a national average of 88 percent. Our median survival is 14 years for those patients who sur- vive the first year, compared to 12.7 years nationwide." Tr a n s pl a nt pro g r a m le a der s at University of Minnesota Medical Center have devised ways to confront the chal- lenges associated with the complex procedure and help patients increase their chances of success. "A limited donor pool, as always, is a major barrier to transplantation," Dr. Colvin-Adams says. "As wait times have increased nationally, we have adjusted our strategy for listing patients in order to optimize their chances of receiving a donor heart when needed. Additionally, we are studying ways to deal with the effects of chronic immu- nosuppression, which every transplant recipient faces after transplant. Many heart transplant recipients live more than 10 years, and we have an increasing number who have survived greater than 20 years. Our longest survivor has lived more than three decades since receiving a donor heart. We strive to improve long-term outcomes for all our patients." Targeted Surgeries for Specific Heart Failures One option for improving the survival rate for patients who cannot live long enough to receive a donor heart is the total artificial heart. The total artificial heart is a technology that has been around many decades and recently underwent improvements. For a select group of patients with heart conditions likely to lead to biventricular heart failure, the total artificial heart can increase survival and help them live until a donor heart becomes available. Some patients with heart failure secondary to heart valve disease can benefit from valve repair or replacement surgery, which corrects a dis- eased valve and could allow a weakened heart to recover its function. Coronary artery bypass grafting is an additional procedure that can benefit high-risk patients, Dr. John says. In this surgery, the patients' own artery or vein will be used to bypass blocked coronary arteries and thereby improve the blood supply to damaged heart muscle. "Patients with coronary artery disease and a history of heart attacks which have resulted in low ejection fraction or severe left ventricular dysfunction may still have viable myocardium available," Dr. John says. "These patients can benefit from improved blood flow to the heart in the form of coronary revascularization procedures. While coronary artery bypass surgery has been around for more than 40 years, this group of patients with poor heart function traditionally has been considered high-risk. However, in centers with access to back-up mechanical circula- tory support options, we still perform coronary artery bypass grafting so these patients may avoid transplant or LVAD." A CORE of Caring University of Minnesota Physicians Heart faces a daunting task in the management of more than 100 patients "We want to let people in Minnesota and the tri-state area know that options are available for patients at high risk for heart failure, no matter their age or condition. Therapies include short- term assist devices, long-term implantable devices, total artificial heart and transplant surgery. The sooner we see patients, the better their survival rate is likely to be, so don't wait to seek expert care." — Ranjit John, MD, cardiothoracic surgeon, Associate Professor in the Department of Surgery at the University of Minnesota and Surgical Director of the LVAD Program for University of Minnesota Physicians Heart University of Minnesota Physicians Heart implants approximately 60 LVADs annually for a total of more than 700 since 1995. 1 2 | Minnesota MD NEWS ■ M D N E W S . CO M

• Cover