New heart disease treatment involves drilling holes in the heart

Heart disease is the leading cause of death in the United States.

There are stents, surgeries and transplants to help failing hearts recover, but some patients are too weak to survive the treatment.

Now a new approach for the sickest patients involves drilling holes in the heart.

"My teeth are good. My hearing is a little, leaves a little to be desired. My memory's terrible," says Marion Cook, who has heart disease.

But even at 89, not much can slow Marion down.

Competitive skating was his passion. Now, chest pains force him to use a different set of wheels to get around.

"My limitation is my heart arteries are not providing enough blood and I just can't physically do very much," he says.

Because Marion is weak, he is not a candidate for stents or surgery. Doctors now have another option.

Using a specially designed laser doctors drill holes in his heart.

"What these holes do is they deliver new blood flow to the heart muscle through these small channels, as well as those holes denervate the heart, meaning they numb or dampen the sensation of chest pain," says Dr. Grayson Wheatley, a cardiovascular surgeon at the Arizona Heart Institute in Phoenix.

The laser creates microscopic channels that stimulate the heart muscle.

"You think about drilling a hole in the heart and it might spring a leak, but they're small channels and we know that these small channels serve as a stimulus for the heart to try to repair itself," says Dr. Wheatley.

For patients, it means less pain within days after surgery. Now, Marion says he's ready to skate away...if only he had a little better balance.

"If it wasn't for that, I'd be going to start putting my skates back on," says Marion.

He'll settle for his other wheels as long as he can put his pain behind him.

The holes created during the surgery eventually close, but leave behind new cells and chemicals that regenerate the heart.

Dr. Wheatley says there is no risk of leaks since the holes are microscopic.

RESEARCH SUMMARY
TOPIC: HOLES FOR THE HEART
REPORT: MB #3023

PERSISTENT ANGINA: More than 150,000 people in the United States suffer from severe ischemic coronary artery disease that is not able to be treated with standard heart surgeries, angioplasty or stents. They often suffer from severe coronary problems and have already had some type of heart surgery. Despite medical procedures, patients sometimes continue to have unrelenting pain in their chests. This chronic chest pain leaves patients disabled due to symptoms of angina, shortness of breath and fatigue and are often unable to do even small tasks like going out and getting the mail.

DRILLING HOLES IN THE HEART: Transmyocardial revascularization (TMR) is a type of surgery used to ease severe angina or chest pain in people who cannot have a bypass surgery or angioplasty. TMR is a minimally invasive laser therapy surgery procedure in which holes are surgically drilled into the area of the heart muscle that isn't receiving enough blood flow. During the open-chest surgery, a specially designed laser drills about 20 to 60 small microscopic channels, or holes, into the heart muscle. The holes, in turn, deliver new blood flow to the heart muscle area that is not receiving adequate blood flow through the small channels. The holes also numb or damp the sensation of chest pain. Candidates for this surgery have had prior heart surgery and have experienced failed bypass grafts. In addition, they have made the most of their medical therapy, are on medications and are still experiencing chest pain. Immediately after TMR surgery, many patients report feeling a difference. After one to two days in the hospital, patients are able to go home. Most of the patients who receive TMR see an 80 to 90 percent improvement after about a year post-op.

OTHER TREATMENTS: Patients with chronic chest pain and angina do not have many options. Many of them are not candidates for another heart surgery, stents, or other heart or chest medications. Many of the patients take nitroglycerin everyday just to relieve the symptoms to enjoy their daily lives. Nitroglycerin works by relaxing a person's veins and reduces the amount of blood that returns to the heart, easing the heart's workload. Relaxation of the coronary arteries increases the heart's blood supply. A reduction in blood pressure can also help the heart's demand for oxygen. Drugs such as beta-blockers and calcium antagonists can also be used to reduce the heart's workload and need for oxygen.

FOR MORE INFORMATION, PLEASE CONTACT: Arizona Heart Institute (602) 266-2200


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