Author: Jon Merz
Date: 07-18-04 21:25
Source: NYTimes
URL: http://nytimes.com/2004/07/19/science/19HEAR.html?hp
Date published: July 19th 2004
Putting a Weakened Heart in Experimental Hands
By DENISE GRADY
Published: July 19, 2004
COLUMBUS, Ohio — Lying on the operating table, his thin arms outstretched to either side, Ric Ray spoke little as doctors and nurses in masks and scrubs descended on him with needles, scalpels and intravenous lines. It was 7:35 a.m.
Shaving Mr. Ray's chest with a few quick razor strokes, an anesthesiologist asked, "When was your heart attack?"
"March 8, 1987," Mr. Ray replied.
"How old were you?"
"Thirty-five," Mr. Ray said softly.
The heart attack did so much damage that Mr. Ray's heart never recovered, but weakened steadily over the years. In 1990, when his daughters were 5, 12 and 15, he had to retire from his engineering career. By this year, his heart was pumping so little blood that he became short of breath just walking around the house, and his leg muscles, starved for oxygen, burned as if he were running a marathon. At 52, he had end-stage heart failure.
A few months ago, he began to think the time had come for a heart transplant, something he had tried to put off for as long as possible. A new heart might not buy him more than 10 years, he was told; he and his family hoped for more time.
A transplant surgeon suggested another possibility: a clinical trial, an experiment designed to find out whether medicines and certain types of heart surgery could help people with heart failure and blocked coronary arteries.
The experiment, at 90 centers around the world, is to include 2,800 patients who will be followed for seven years. Sponsored by the National Heart, Lung and Blood Institute, it is called Stich, for surgical treatments for ischemic heart failure. (The word ischemic refers to inadequate blood flow.)
Mr. Ray joined Stich and was assigned at random to undergo a risky operation at Ohio State University Medical Center, which would include bypass surgery to improve blood flow to his heart muscle as well as a more drastic procedure: cutting open his heart to reshape it, get rid of some scar tissue and help it pump more efficiently. For comparison purposes, others in the study will receive medicine alone, or medicine and bypass surgery.
Mr. Ray's surgeon, Dr. Robert E. Michler, chief of cardiothoracic surgery at Ohio State, said the study was being done because doctors did not know the best way to treat patients like Mr. Ray, with scarred, failing hearts and blockages in the arteries that feed blood to the heart muscle itself. Although there is a standard regimen of drugs, studies have not proved whether surgery can help. But some patients have surgery anyway.
"We truly do not know the answer as to which therapy is best for these patients," Dr. Michler said. "I have a personal feeling that surgery will prove better, but that's completely explainable by the fact that I'm a surgeon and this is what I do. But I also believe in trying to do things scientifically, in an evidence-based way."
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