Research by two Duke professors could improve treatment for people whose hearts are in need of mechanical assistance.
Dr. Roberto Manson and Dr. Mani Daneshmand—both assistant professors of surgery at the Duke School of Medicine—participated in the implantation of a new type of cardiac assist device in a calf in collaboration with researchers from the National Cheng Kung University in Taiwan. What made the researchers' approach novel was the use of a para-aortic blood pump, Daneshmand said.
“When the heart is contracting, the balloon fills and by filling… it lowers the work of the heart…" Daneshmand said about how the PABP works. "When the heart is resting, it pumps blood back into the system, raising blood pressure.”
He noted that the pump improves circulation throughout the body as well as circulation to the heart.
Currently, the researchers are looking to find funding to repeat the animal trials at Duke, Daneshmand said. He explained that the current economic situation limits availability of federal funds.
While the researchers face a financial challenge in continuing their research, they are motivated by the possibility of making cardiac treatment more economical.
“[PABP can be] accessible to a larger portion of the population, with less complications, in an affordable way,” Manson said.
The PABP could serve as an alternative for several current treatments, such as the intra-aortic balloon pump and left-ventricular assist devices, Daneshmand said.
The intra-aortic balloon pump—which involves a balloon inspired by the design of the PABP—is inserted in the groin. Patients who use an intra-aortic balloon pump are essentially bedridden, Daneshmand noted.
He added that patients waiting for heart transplants while using intra-aortic balloon pumps wait in the intensive care unit for weeks or months and can develop complications associated with a sedentary lifestyle.
“Their muscles atrophy. They get pneumonia. All these things happen to them, and if they were able to get up and walk around, they would not have these problems,” Daneshmand explained.
The PABP inserts the assisting device directly into the aorta, which might allow patients to be mobile.
Duke has been a leading enroller in clinical trials that led to the approval of many devices that combat heart failure, including the Thoratec Heartmate II and the Heartware HVAD, Daneshmand said. These devices are limited, however, by the invasiveness of their implantation procedures and associated complications.
The PABP seeks to prevent complications by being less invasive and cause less physiological trauma, Daneshmand explained.
The new PABP pump is also innovative in its relationship to the heart. Currently, the widespread devices “really replace the heart functions,” said Dr. Carmelo Milano, a heart transplant specialist.
“I think it is possible that some of the newer devices will be able to help us recover the natural heart,” said Laura Blue, the ventricular assist device program nurse coordinator.
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