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Wednesday, January 18, 2006

Byline: Jennifer Frazer

Jul. 14--CHEYENNE -- People with congestive heart failure now have a new treatment option here: a surgical procedure that tailors hearts so they pump more efficiently.

The procedure, called TRISVR Surgical Ventricular Restoration, offers a relatively inexpensive, simple and permanent solution to a problem -- misshapen, flaccid hearts that have suffered major heart attacks. In the past those would have required a temporary pump, a heart transplant or an artificial heart.

"Before (this) they gave you medicine and sent you home to live out the rest of your life, which wasn't very long," said Brent Curyea, the first patient to get the procedure at United Medical Center-West.

But seven hours after the operation Curyea was sitting up, and 12 hours later he was walking, "with no tubes in me, nothing," he said.

"They did cut my chest open," he added.

The new procedure makes flabby hearts heart-shaped again and restores enough pumping ability to potentially bring their owners back from death's doorstep.

Dr. Leonard Lapkin and his partner, Dr. David Silver, at the Cheyenne Heart Center are the first physicians in northern Colorado or Wyoming to offer the procedure.

Lapkin has performed two of the procedures in the last few months. Curyea was the first.

The procedure was created in 2001.

After a heart attack, part of a patient's heart may die. The dead part of the organ may balloon outward to form an aneurysm, causing a formerly taut, elliptical-shaped heart to become globular.

Because part of the heart muscle is dead, the rest of the heart has to work harder, enlarging it. This changes the shape of the heart, which makes it work less efficiently and causes the heart to further enlarge, feeding a vicious cycle and ultimately leading to failure.

In the past, heart surgeons had to guess how much of the dead heart to cut away when decreasing the size of the heart. Too much would yield a too-small heart that couldn't pump enough; too little, and the heart had long-term performance problems.

The new procedure eliminates the guess work.

The physician makes a calculation based on a patient's size and creates a plastic mold specifically for the patient. Like a dressmaker's dummy, the mold is inserted in the left ventricle and the surgeon can cut the heart to fit the mold.

The surgeon then sews a patch over the mold then deflates it, removing it through a small hole and suturing the rest of the heart together. Some of the aneurysm may be left behind, but the heart will be the right shape and size to get its job done.

Curyea's family has no history of heart disease, but in 1994 he suffered a heart attack that resulted in an aneurysm.

He was overweight, smoking and had high cholesterol. He had a hard time walking a lot and easily got short of breath. It limited his hunting and fishing.

He had several stents put in, but this March he suffered another heart attack.

A few weeks later, he got the TRISVR procedure. After it was over, he said, though his chest hurt from the surgery, he immediately could breathe easier.

"What a change, just boom!" he said. "You had this kind of tired feeling going on; you made it through your day every day. Not exhausted but tired.

Now I feel like a kid again."

Curyea also has undertaken a complete lifestyle change, giving up smoking, improving his diet and beginning to exercise. His cholesterol dropped; so did his blood pressure. Now he can push a lawn mower and lift 50 pounds.

"I've got the heart of a young man now," he said.

Although no randomized-controlled studies, generally thought of as the standard for testing new procedures, have yet proven long-term benefits for the procedure, recipients look good so far, Lapkin said, adding that the technique is promising.

"No one really knows how they're going to look in 5-7 years," he said. "(But it) offers an option to a desperate population."

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