Wednesday, December 3, 2003

Heart surgery holds promise


Method avoids open-heart operation

By Tim Bonfield
The Cincinnati Enquirer

The first time John Lippert felt the symptoms of atrial fibrillation, he thought he was about to die.

His heart raced as if he just finished sprinting down the hall, even though he was standing still. He couldn't catch his breath.

"When you don't know what's going on, you think, 'Oh gosh, here's the big one,'" said the 59-year-old man who lives near Mount Orab.

But now, after 12 years of trying numerous medications to control the problem, Lippert is working on home-improvement projects, has returned to his job, and says he feels great.

The difference: a new cardiac surgery technique performed by Dr. Randall Wolf, a leading advocate of minimally invasive surgery. This procedure also relies on a device made by AtriCure Inc., one of Greater Cincinnati's new biotech companies.

More than 2.5 million people nationwide suffer from atrial fibrillation, a condition that occurs when the upper and lower chambers of the heart start beating at mismatched rhythms.

Many barely know they have the problem while others suffer alarming and physically exhausting episodes in which the heart can race as fast as 150 to 200 beats a minute. Untreated, atrial fibrillation increases the risk of stroke and can lead to long-term heart failure.

On Nov. 7, Lippert became the third person in the United States whom Dr. Wolf treated with a procedure he calls the "Wolf mini-Maze procedure."

The technique is a variation on the Maze procedure, a form of open-heart surgery to treat atrial fibrillation developed in 1985 by researchers at the Washington University School of Medicine in St. Louis.

Atrial fibrillation is an electrical problem with the heart. Instead of electrical signals commanding heart muscle to beat in a synchronous rhythm, natural pacemaking signals from various parts of the heart clash with one another.

Most people with atrial fibrillation are treated with a wide variety of medications, including blood thinners, calcium-channel blockers, beta-blockers, sodium-channel blockers, potassium-channel blockers and digoxin.

Some also have been treated with mixed success with pacemakers. Some people need to get electric shocks at the hospital to force their heart back into a normal beat.

Some cases, however, can't be controlled with such treatments.

The Maze procedure involves making several incisions in the heart tissue. That creates scars that act as insulators to block unwanted electrical signals while allowing desired signals to flow.

The procedure cures 95 percent of cases, but is not performed often. The Cleveland Clinic, one of the nation's top heart centers, reports performing the operation 318 times in the past 11 years.

The main reason the surgery isn't used more widely is that the operation involves cutting the breastbone, spreading the ribs and putting a patient on a heart-lung machine for an operation that can last several hours.

The operation also costs about $40,000, according to Medicare data. A patient taking a high-end medication to control atrial fibrillation - costing about $300 a month -- would have to take the pill for 11 years to match the cost of the surgery.

"I wasn't ready for open-heart surgery. I had never had surgery before in my life," Lippert said.

In recent years, though, researchers have been working on ways to improve the Maze procedure.

Instead of using a scalpel, devices using microwaves, cryotherapy, lasers and high-frequency radio waves have been tried as ways of blocking unwanted electrical signals. Researchers also have learned that many patients can be cured with fewer scars than used in a traditional Maze surgery.

And for some, Dr. Wolf's minimally invasive procedure avoids an open-heart operation.

The advantages include shorter, less painful recovery, avoiding the need to use a heart-lung machine, and reducing side effects that can occur when taking medications for years at a time, Dr. Wolf said.

But some doctors say the mini-Maze procedure remains unproven.

"There is no evidence yet that minimally invasive procedures work as well (as the Maze procedure)," said Dr. Marc Moon, a cardiothoracic surgeon at Washington University.

So far, the procedure seems to be limited to those who have short flare-ups rather than long-lasting episodes of fibrillation. And it remains to be seen how many patients can stop taking medications, Dr. Moon said.

Dr. Wolf says he plans to perform two or three mini-Maze procedures a week at University Hospital - the only hospital in town that does the minimally invasive approach. In March 2003, doctors at Christ Hospital began using AtriCure's device, but only for the open-heart procedure.

If the technology catches on, it could be good news for a local company.

AtriCure, based in West Chester, was launched in 2000 as a spin-off from Enable Medical Corp., another West Chester-based medical device maker. Since forming, the 30-employee company has attracted more than $26 million in venture capital investment.

AtriCure reports that more doctors are using its device. More than 280 hospitals have bought the device nationwide, up from 45 about a year ago, said company spokesman Brandon Lorry.

For Lippert, it will take another few months to determine how many of his medications he can stop taking. But he was feeling good enough to return to work this week at DHL in Wilmington.

"Before the surgery, I could barely make it up a flight of stairs," Lippert said. "Now, I feel like things are getting back to normal."

E-mail tbonfield@enquirer.com.




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