Emerging Issues in Cardiac Health Technology
Living Heart Transplant
In Canada, the number of people requiring heart transplants far exceeds the number of available donors. And, at the same time, many hearts available for donation go unused.
There is now an emerging technology that is intended to improve the survival of transplanted patients, prevent transplanted hearts from decaying, and increase the availability of viable organs. The technology expands the window of transplant opportunity from four to six hours, to 12 hours or more. Organ damage during the transportation process is limited because a warm blood perfusion technology keeps the heart beating as it would inside the body.
This form of heart transplant is made possible with the TransMedics Organ Care System. The system integrates a perfusion module, a portable platform with wireless monitor, and a solution set.
Organ Care System. TransMedics, 2009: http://www.transmedics.com/wt/page/organ_care
Genetic Testing for Heart Failure Therapy
It is estimated that there are 400,000 Canadians living with congestive heart failure. Approximately 40% to 50% of newly diagnosed patients will die within five years of diagnosis, according to the Heart and Stroke Foundation.
Genetic testing aims to identify genes that can help predict risk factors for heart failure in asymptomatic patients. It can also help individualize pharmacologic treatment, by helping predict who might benefit or be harmed by therapy. An awareness of predispositions to heart disease can help physicians develop tailored health plans for risk reduction and prevention. This has the potential to reduce the prevalence of the disease and minimize health care costs associated with heart failure.
- Use of genetic testing to guide the initiation of Warfarin therapy. California Tech Asses Forum, 2008 http://www.ctaf.org/files/814_file_WarfarinGenetics_final_W.pdf
- Genetic testing and genetic counseling in cardiovascular genetic medicine: overview and preliminary recommendations. Congest Heart Fail, 2008;14(2):97-105 http://www.lejacq.com/Search_articleDetail.cfm?aid=chf_8217.pdf
- Genetic testing in cardiovascular disease. J Am Coll Card, 2007: 50(8):727-37 http://content.onlinejacc.org/cgi/reprint/50/8/727.pdf
3-D Cardiac Mapping
Heart rhythm disorders are a leading cause of heart disease, stroke, and sudden death, affecting approximately 200,000 to 250,000 Canadians.
There is a technology available that provides more precise visualization of heart arrhythmias; 3-D cardiac mapping locates heart rhythms by mapping the heart’s anatomy. This information is intended to make better-informed decisions on appropriate therapeutic courses of action.
The 3-D cardiac mapping is a minimally invasive procedure that involves the insertion of electrode catheters into the heart. The signals from the electrodes are translated into 3-D maps that are used to detect the originating site of an arrhythmia.
Catheter ablation, a popular non-surgical treatment for arrhythmias, can then be performed immediately following mapping.
Advanced electrophysiologic mapping and catheter ablation for the treatment of complex cardiac arrhythmias. OHTAC, 2005
http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_ep_121605.pdf
Navistar® Thermocool® for Atrial Fibrillation
The Navistar® RMT ThermoCOOL® Catheter was licensed for use in Canada for atrial fibrillation in February 2008. It uses a catheter ablation technique to destroy abnormal heart rhythms.
This procedure involves a catheter being threaded through to the heart via the femoral vein. An attachment on the tip of the catheter delivers radio frequency heat to the area of heart muscle giving off electrical signals that stimulate abnormal heart rhythms. This results in a localized burn that destroys the heart cells responsible for the arrhythmia.
This device is used with the NIOBE® Magnetic Navigation System, which helps steer a catheter remotely and guide ablation to targeted areas that require treatment.
Magnetically steered irrigated tip cardiac catheter for treatment of irregular heart rhythms now available throughout the European Union. Johnson & Johnson, 2008.
http://www.jnj.com/connect/news/all/20081118_080000
Circumferential pulmonary vein ablation. ASERNIPS, 2008
Percutaneous Aortic Valve Replacement
Over 13,000 Canadians undergo surgery every year to replace defective aortic valves. Seventy five to 80% of people who have damaged aortic valves will die within three to five years of diagnosis without a replacement valve.
Percutaneous valve replacement is a minimally invasive therapeutic alternative for aortic valve repair surgery. A guidewire catheter with a self-expanding stent is threaded through either the femoral artery or vein to the faulty heart valve. The replacement valve is inserted within the centre of a pre-distended existing damaged valve.
This procedure is intended to reduce surgical trauma, shortens hospital stays, and to be used with patients who are too sick for conventional open-heart surgery. It is usually performed under local anesthesia and light sedation.
Percutaneous aortic valve replacement. ANZHSN, 2007: http://www.horizonscanning.gov.au/internet/horizon/publishing.nsf/Content/C2D639B76DF71476CA2574C80007C02D