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Agnes Hollingsworth, 84, of Columbia, Md., was at "death's door" with cardiomyopathy and end-stage heart failure when she came to Hopkins in October 1999. "She was terribly short of breath, and large volumes of fluid had accumulated in her lungs. Her heart simply wasn’t working," says her cardiologist, Ronald Berger, M.D., Ph.D.
But when Berger implanted a pacemaker in Hollingsworth's heart, she began a dramatic turnaround. "My lips and face got color, my eyes unglazed, I was able to eat and walk up and down steps," Hollingsworth says. "Within a week, I stopped using my walker."
CARDIAC SURGERY WITHOUT
OPENING THE CHEST
Cardiac surgeon Scott Stuart, M.D., likens robotic surgery technology to the Nintendo and PlayStation games kids play. The technology is making it possible for him to do something that not too long ago he didn’t think possible—to operate on a patient’s heart without opening the patient’s chest. “Up to now, minimally invasive laparoscopic procedures usually involved taking something out or tying something off—not putting something together,” says Stuart. “That’s a quantum leap.” Surgeons in Europe already have taken that leap, repairing arteries and valves in the heart—and even performing coronary bypass surgery—with robots. But in the United States, robots have only been approved for “below the chest” procedures like gallbladder removal. Now Hopkins and a few other centers are beginning clinical trials using robots in cardiac cases, too. The benefits? Only a small incision, which means the patient may be up and walking around within a day or two of the operation and in very little pain. Also, by using heart-stabilizing devices with robotic technology, surgeons will be able to perform bypass operations without shutting down the heart with a heart-lung machine, thus reducing the risk of stroke, fever, infection and blood loss. For robotic surgery, Stuart notes, the future is now: “This machine has the potential to be used in the vast majority of cardiac surgeries. So if you’re talking about changing the face of American surgery, yeah, that will happen within five years.”
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Originally used to fix electrical abnormalities in people with slow heart rhythms, Berger and cardiologist David Kass, M.D., are finding that the pacemaker can successfully resynchronize weak and struggling hearts in heart failure patients whose only treatment options typically have been drugs or surgery. In a recent study by the two specialists of 22 heart failure patients, Berger and Kass found that attaching a pacing wire to the left ventricle improved the heart’s ability to contract and pump out blood by an average of 35 percent. (In the conventional pacemaker, the wire is attached to the right ventricle.) Patients whose hearts had the largest amount of timing discord, whose hearts were often the weakest, benefited the most from a pacemaker. "The problem we set out to solve was determining which heart failure patients would respond best to pacemakers," Kass says, since 400,000 new cases of the problem are diagnosed each year in this country. "The devices are expensive and permanent, and the patients are so sick we can’t afford to waste time." Because Hollingsworth responded well to an electrode placed on her left ventricle, Berger implanted a pacemaker under her collarbone and threaded a wire from the battery through veins to the surface of the ventricle. This electrode anticipates within 120 milliseconds when a heartbeat is about to start, and stimulates the region. Rather than wobbling and struggling to send blood out of the body because of a delay in contraction, Hollingsworth's heart, according to her pulse pressure, began to pump efficiently. And it’s been doing so for the past year. "Today, I'm doing everything a person can possibly do -- travel, go out to lunch, go to the movies," Hollingsworth says. "My life has really started over again." -- Gary Logan
Hopkins Medical News, Winter 2001
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