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Drug-and-pump therapy held to help failed hearts

Doctors are reporting surprising early success with a novel treatment they hope will one day cure congestive heart failure in thousands of dying patients: They shrink the bloated heart with drugs, while an artificial pump temporarily takes over the workload.

Though small, the British study reported that the usual recovery rate for patients with severe heart failure, a common killer, had more than tripled. Eight of 24 patients seemed fully recovered, though their dying hearts had once ballooned up to twice their normal size. And the benefit has lasted at least four years.

"Maybe, in some patients, the failing heart is not end-stage after all," Drs. Dale Renlund and Abdallah Kfoury of the Utah Transplantation Affiliated Hospitals declared in an editorial that accompanied the findings, published in today's New England Journal of Medicine.

The technique must now be confirmed in larger studies and probably will not spread anytime soon in the United States, since one of the drugs is not approved for general use here, doctors say. In addition, heart pumps can cost $200,000, including hospital care. The study was backed by a pump maker, Thoratec Corp. of Pleasanton, Calif.

Nevertheless, the findings excited doctors, because congestive heart failure afflicts about 5 million Americans and kills about 58,000 each year.

Some drugs and pacemakers treat its early forms, but it often gets worse. These damaged or overworked hearts ultimately pump so weakly that sufferers cannot perform simple daily tasks.

Once that happens, the only solution is either a transplant -- and donor hearts are scarce -- or an artificial heart pump. These implanted pumps can take over much of the heart's work, but they can cause clots or infections in the long run and can bring about recovery in no more than 10 percent of patients. Something else is needed.

The English team, at Harefield Hospital in Middlesex, got the idea of combining the heart drugs and the implanted pumps. The theory was that the devices would give the heart a working vacation while the drugs returned it to its normal size.

Since this rest can eventually weaken heart muscle, the researchers added one more drug, a heart strengthener called clenbuterol.

As the study began, the hospital put the pumping implants into 24 patients without a previous heart attack or infection. Nine were too sick or soon died, but 15 took all the drugs.

Eleven were well enough to remove the implants mostly within a year, and the treatment left eight fully recovered.

Dr. Gregg Fonarow, a heart failure specialist at UCLA, said that as many as 40,000 Americans might ultimately be candidates for such treatments each year, if the technique is proved by other studies.

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