Congestive Heart Failure
The incidence of congestive heart failure continues to increase, with more than 550,000 new cases a year diagnosed in the United States. Allegheny General's multidisciplinary heart-failure management team — heart failure specialists, transplant surgeons, certified nurse coordinators and health professionals — has contributed to success rates that exceed national averages. The team partners with referring physicians to provide diagnostic evaluation and treatment options ranging from evidence-based medical therapy to transplantation or assist devices.Medical therapy
Patients have access to comprehensive tools and services — including assistance in making and maintaining lifestyle changes — to help manage heart failure:- Guidelines-based medication management
- Sophisticated diagnostic imaging tools
- Core measures monitoring to collect and analyze all key clinical data related to the care of each patient with heart failure, resulting in more efficient, effective treatment
- Outpatient intravenous infusion clinic for patients whose severe heart failure does not respond to oral medications
- Tele-monitoring, a novel program through which patients transmit data to Allegheny's heart-failure specialists via telephone or Internet-based Bluetooth technology; specialists can monitor the data and make adjustments to medications, as well as counsel patients on methods to control symptoms
- Specialty-trained home health care
- Access to investigational therapies for select patients
Device therapy
Allegheny General's cardiologists employ a host of sophisticated technologies — combined with novel interventional techniques — to reduce the workload of the heart by providing support to key areas weakened or compromised by congestive heart failure. AICDs and biventricular pacemakers — or cardiac resynchronization therapy — are routinely utilized with patients meeting indications. Sophisticated ultrafiltration devices, which mechanically remove excess fluid from the patient, are available in the Cardiac Care Unit's Advanced Heart Failure beds.Surgical Therapy and Mechanical Circulatory Support
Allegheny General is one of the region's preeminent resources for the most complex, high-risk heart surgery.Traditionally, surgical treatment options have not been the first option for patients with congestive heart failure because many invasive procedures purportedly carried high risks with minimal benefits. Extensive research and significant clinical experience on the part of Allegheny's surgeons show that many innovative surgical treatment approaches may actually lead to a better quality — and length — of life.
Allegheny surgeons and cardiologists are highly experienced in a complete range of sophisticated procedures for congestive heart failure, including:
Ventricular assist systems.
Allegheny General is among the nation's first cardiac centers to use a left-ventricular assist system (LVAS) as a long-term, permanent treatment for end-stage congestive heart failure patients who do not qualify for heart transplantation.
Left ventricular assist devices are designed to support the heart's left ventricle through an implanted pump that takes over most of the pumping function of the heart. Allegheny General was the only Pittsburgh hospital and one of 21 top medical facilities in the country to participate in the REMATCH trial. This landmark clinical trial demonstrated that the HeartMate SNAP-VE LVAS for Destination Therapy significantly improved survival and quality of life.
This device is currently used at Allegheny General both as a "bridge" to cardiac transplantation and as "destination therapy" for non-transplant candidates. New LVASs that are smaller, more efficient and more durable are currently undergoing testing at Allegheny General. In addition, several right ventricular assist systems are available to treat patients with right-sided heart failure.
Tandem Heart.
Allegheny cardiac surgeons and cardiologists pioneered the development of the world's first percutaneous LVAS, which can provide full left ventricular support without the need for an operation. This innovative technology was developed in the research laboratory at Allegheny General and now is in clinical use at the hospital, as well as many other leading heart centers in the United States. It is an optimal solution for patients who need full support for a few hours or days — due to reversible heart conditions such as cardiogenic shock, for example — until the heart improves.
Left ventricular remodeling surgery.
Allegheny cardiac surgeons are experienced in the use of left ventricular remodeling techniques such as the Dor procedure. These procedures are designed to improve heart function in failing, dilated hearts by surgically restoring the heart to the more normal shape and size needed for efficient pumping action.
Off-pump coronary artery bypass surgery (OPCAB).
OPCAB — a technique involving the use of the standard sternotomy incision followed by placement of one or more bypass grafts on the beating heart — is a particular specialty of Allegheny cardiac surgeons. The advantages of OPCAB include shorter hospital stays, less blood transfusion and a reduction in some types of postoperative complications. Our cardiac surgeons are among the most experienced and technically skilled in OPCAB surgery, as well as in selecting appropriate patients for this procedure.
Coronary artery bypass grafting (CABG) for ischemic cardiomyopathy.
Allegheny General surgeons are among the most experienced in the United States in CABG and handle the most complex, high-risk cases. Using sophisticated MRI imaging, ischemic but viable heart tissue can be identified precisely, thus permitting identification of those patients who can benefit from CABG.
High-risk mitral valve repair for dilated cardiomyopathy.
Dilatation of the left ventricle in heart failure can produce distortions in the mitral valve leading to significant mitral regurgitation. Allegheny cardiac surgeons are experienced in performing mitral valve procedures in these high risk patients, reducing the debilitating symptoms associated with mitral dysfunction.
Heart transplantation.
The CVI boasts a cohesive multidisciplinary Cardiac Transplant team comprisingspecialists from medical and surgical disciplines, nursing, social work, financial support, cardiac rehabilitation, immunopathology testing and biomedical engineering.
Transplantation is still the treatment of choice for those whose end-stage heart failure does not respond to other medical or surgical treatment. Allegheny's heart transplant program is considered one of the most active and advanced in the United States. Allegheny's cardiothoracic surgeons have performed more than 150 procedures with short- and long-term survival rates better than the national average — even for high-risk patients such as older adults, those with ischemic cardiomyopathies or individuals with previous open-heart surgery.
Enhanced operative techniques, improved anti-rejection drugs and the development of bridge-to-transplant devices have contributed to the success and expansion of Allegheny's program. As part of immunosuppression therapy to help minimize the risk of organ rejection, Allegheny offers state-of-the-art Allomap testing, a method to identify molecular changes that may signal the onset of tissue damage or rejection in hearttransplant patients. Requiring a simple blood sample from the patient, allomap testing helps physicians to manage patients' immunosuppression therapy on a more proactive basis without the need for traditional, more invasive testing in the cardiac catheterization laboratory.
Allegheny General also makes available intravascular ultrasound (IVUS) to evaluate the health of the transplanted heart; IVUS is a key tool physicians use to assess problems such as the development of coronary artery disease in the new heart.
Allegheny's Transplantation Service is an exceptional, comprehensive resource that coordinates each patient's clinical course of treatment — including assistance with medical-insurance issues, the psychosocial aspects of undergoing transplantation, post-transplant nutrition education and cardiac rehabilitation. The program's certified clinical transplant coordinators follow approximately 1,000 patients a year, from the onset of a referral through the course of the organ's life. In addition, Allegheny works closely with the Center for Organ Recovery and Education (CORE) to procure organs and is extremely active in patient education and general public awareness.
