Smith

Cheney’s Heart Transplant Highlights Issues in Heart Transplantation

by Columbia Surgery on April 16, 2012

When he received a heart transplant March 24, 2012, former Vice President Dick Cheney joined about 2300 Americans who receive the lifesaving gift of a donor heart each year. After a 20-month wait on the organ waitlist, Cheney was fortunate; the shortage of donor organs remains an extreme problem, and many patients die before an organ becomes available.

Dick Cheney

Dick Cheney

Cheney’s weakened heart was supported since 2010 by a left ventricular assist device, an implantable mechanical heart pump. According to Craig Smith, MD, Chairman of the Department of Surgery at NewYork-Presbyterian/Columbia, “His transplant illustrates the increasing success of LVADs to bridge patients through extremely long waiting times.” Despite the risks associated with LVADs, their safety has been improving and they are gaining increasing use both as methods to sustain patients until a heart transplant is possible (‘bridge to transplant’), as well as to sustain people indefinitely, called ‘destination therapy.’

Cheney’s transplant has attracted criticism by some who advocate that rare donor hearts should be placed in patients who could potentially make use of them for more years than someone aged 71. However increasing numbers of older patients are now receiving transplants with excellent results. “If Mr. Cheney has good kidneys, liver, and lungs, no previous stroke, and is in good nutritional condition, his one-, three-, and five-year survival are similar to that of patients who are 18-65 years old,” says Yoshifumi Naka, MD, Director of the Cardiac Transplantation Program at NewYork-Presbyterian/Columbia.

At NewYork-Presbyterian/Columbia, the heart transplant program has implemented ‘extended criteria’ protocols for both organ donors and transplant recipients. Today, extended criteria organs are routinely utilized, and may be offered to patients over age 65 or those formerly considered too compromised to undergo transplantation. This approach is significantly widening the availability of organs and providing the option of transplantation to patients who would otherwise be denied treatment, with superior results. As a result of this strategy, waiting times to transplantation are lower at this center than at other centers in the New York tristate area — and the ability to transplant sooner translates into better post-transplant outcomes.

Learn more about LVADs and heart transplantation at the Department of Surgery web site.

Tagged as: cardiac, LVAD, Naka, Smith, transplant

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Transcatheter Aortic Valve Replacement as Good as Open Surgery, According to PARTNER Results

by Columbia Surgery on April 4, 2011

Craig R. Smith, MD, FACS

Craig R. Smith, MD, FACS

Approximately 300,000 patients in the United States have aortic stenosis (narrowing of the aortic heart valve), and about one third of these patients are too sick or too old to undergo surgical replacement. Under the leadership of NewYork-Presbyterian Hospital’s Division of Cardiothoracic Surgery, Transcatheter aortic valve implantation (TAVI) has been under study as a less invasive alternative for these patients.

According to to the most recent results of the landmark PARTNER study, TAVI is as good as open surgery in terms of long-term survival. Craig R. Smith, MD, Principal Investigator of the PARTNER study, presented long-awaited results of cohort A to the American College of Cardiology 2011 Scientific Summit in New Orleans April 3, 2011. This arm of the study compared long-term outcomes of traditional aortic valve replacement with the catheter-based method of replacing the aortic valve.

The study found the two methods equal in terms of long term survival. Patients who underwent transcatheter aortic valve replacement were at higher risk of stroke and vascular complications, while those undergoing open surgery were at greater risk of major bleeding.

Results of the first phase of the PARTNER trial, cohort B, were presented in December 2010. This phase found that compared with medical therapy (including balloon valvuloplasty), patients who were too sick or too old for surgery had a 20% improvement in survival after one year with transcatheter aortic valve replacement. In addition to living longer, patients also felt much better and experienced fewer hospitalizations.

Edwards SAPIEN transcatheter heart valve

Edwards SAPIEN transcatheter heart valve

The pivotal results from both cohorts of the PARTNER trial mean that patients with aortic disease now have a new therapeutic option that works exceedingly well. Craig R. Smith, MD, who presented the newest results at a special showcase session at the ACC summit, said in a statement that transcatheter aortic valve replacement “is the most exciting new treatment for aortic stenosis in the past two to three decades.”

At this time, transcatheter aortic valves are investigational devices in the US. Already approved and on the market in other countries, it is expected that TAVI may gain FDA approval as early as late 2011, at least for patients ineligible for surgery.

Dr. Smith is Chairman, Department of Surgery, Columbia University College of Physicians and Surgeons; Chief, Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center; and Surgeon-in-Chief, NewYork-Presbyterian Hospital/Columbia University Medical Center/ Vivian and Seymour Milstein Family Heart Center. Other PARTNER investigators at NewYork-Presbyterian Hospital include Martin Leon, MD, Jeffrey Moses, MD, Susheel Kodali, MD, and Mathew Williams, MD.

Related Link:
New England Journal of Medicine: Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery

Tagged as: aorta, aorticstenosis, clinicaltrials, Smith, Williams

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Placement of Aortic Transcatheter Valves Clinicial Trial Results Big News at Transcatheter Cardiovascular Therapeutics Conference

by Columbia Surgery on October 28, 2010

Craig R. Smith, MD, FACS

Craig R. Smith, MD, FACS

PARTNER (Placement of Aortic Transcatheter valves) clinical trial principal investigators, including Craig Smith, MD, FACS, presented groundbreaking one-year data at the 22nd Annual Transcatheter Cardiovascular Therapeutics scientific symposium, which took place on September 21-25, 2010 in Washington, DC.

Their results confirm that less-invasive heart valve replacements significantly lower rates of death in comparison to standard therapy for certain patients.

For more information, results of the study are on the New England Journal of Medicine site, Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery.

Tagged as: aorta, Smith, valvereplacement

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