Myocardial infatuation: 14 Therapies for the heart
Heart disease is an umbrella term which encompasses a range of disorders such as heart attacks, congenital heart diseases, congestive heart failure and coronary artery disease. Heart disease is the number one cause for death in both men and women in the US. CT scans of mummies have shown that heart disease was frequent in Ancient Egypt which suggests that there are other causes to heart disease apart from smoking, fast food and inactivity.1
However, with the advancement of modern science, there are a variety of innovative drugs and medical devices to help those affected by heart disease and doctors are enthusiastic about the potential developments.
“We’re seeing really interesting developments in medical technology, especially advances in smart technology,” said Dr. Jawwad Azam, consultant in acute and internal medicine at The York Hospital.
“It’s only a matter of time before health professionals can monitor patients’ wellbeing via a smartphone or obtaining up to date and accurate health records by accessing a microchip implanted under the skin.
“We’re already seeing smartphones monitor health rates and oxygen saturation, it won’t be long before they can monitor heart rhythms, maybe even call for help when an arrhythmia is detected.”
“It’s only a matter of time before health professionals can monitor patients’ wellbeing via a smartphone or obtaining up to date and accurate health records by accessing a microchip implanted under the skin”Dr Jawwad Azam, The York Hospital
The Parachute DeviceSource: PatSnap
When patients suffer from left side heart failure, an enlargement of the left ventricle can cause a decrease in cardiac output which can have a range of effects such as shortness of breath. The Parachute Implant, designed by Cardiokinetix, is designed to partition the damaged muscle to isolate the non-functional muscle from the functional. This reduces the volume of the left ventricle and restores its function.
Novartis is the only company to sell Entresto, also known as LCZ696. It is a combination drug with Sacubitril and Valsartan.
Scubatril is a blood pressure medicine which increases levels of certain proteins to dilate blood vessels lower blood pressure. Valsartan is an angiotensin II receptor blocker and keeps blood vessels from narrowing which in turn lowers blood pressure. As a combination within Entresto, it helps the lower risk of heart failure.
Mitralign Percutaneous Annuplasty System
The mitral valve lets blood flow from the left atrium to the left ventricle but if the ventricle becomes enlarged, functional mitral regurgitation, the valve opening can become overly stretched. The valve leaflets cannot then close properly which causes blood to regurgitate back into the atrium resulting in rhythm problems and even heart failure.
Massachusetts firm Mitralign developed a solution consisting of a catheter positioned in the left ventricle and two wires placed in the mitral annulus which then have soft material known as pledgets placed over them. The pledgets are pulled together to reduce the circumference of the annulus to prevent regurgitation of blood.
The Aligisyl, developed by Lonestar Heart is used to prevent the progression of Advanced Heart Failure (AHF) in patients who have an enlarged left ventricle as a result of heart attacks or other disorders.
The device consists of a biopolymer called hydrogel which is administered directly into strategic areas of the left ventricle muscle. The hydrogel forms gel like bodies of polymer that remain permanently in the heart muscle as implants. This reduces the stress on the left ventricular wall, making the pumping of the blood more efficient which prevents enlargement of the left ventricle.
Lithoplasty technologySource: PatSnap
This technology is developed by Shockwave. It is used to treat coronary artery disease (CAD) which occurs when plaque builds up in the coronary arteries. This build up reduces the flow of blood to the arteries and as a result the heart cannot get the oxygen or the blood it needs which can lead to angina or heart attack.
Shockwave’s Lithoplasty Technology Balloon Catheter consists of a generator and connector cable which is used like an angioplasty balloon device. The catheter contains proximal and distal markers so that it can be positioned with the lesion. By pressing a button on the connector cable, miniaturised lithotripsy emitters apply a pulsating energy along the catheter and in the balloon. This disrupts the calcified lesions by creating small fractures in the plaque so that the vessel can be dilated using low pressures.
Also known by the trade name Praluent, Airocumab is used to lower blood cholesterol levels and help to reduce early and avoidable heart disease. Developed by Sanofi as a treatment option for patients with high cholesterol levels, it has been approved by the National Institute of Health and Care Excellence (NICE) and is currently the only drug available with the PSCK9 inhibitor.
The PSCK9 inhibitor is a protein which regulates several receptors for bad cholesterol on the liver’s surface. By reducing PCSK9, the treatment increases the availability of receptors for bad cholesterol and thereby reduces the level of cholesterol in the blood.
Watford based Medtronic developed the world’s smallest pacemaker Micra in 2015. The trans-catheter pacing system is delivered using a catheter into the right ventricle. The pacemaker is 93% smaller than conventional pacemakers.
Kengreal, or cangrelor, was first approved by the FDA in 2015 and is sold by The Medicines Company. It is the first and only intravenous reversible PSY12 platelet inhibitor and is used to reduce the risk of pre-procedural myocardial infarction, repeat revascularisation and stent thrombosis. Typically, it is used with patients who are undergoing percutaneous coronary intervention.
Low Intensity Collimated Ultrasound (LICU)Source:PatSnap
VytronUS developed this device to treat arterial fibrillation to give physicians better control over lesions and visualisation. The device incorporates ultrasound technology within the catheter.
The LICU, developed by VytronUS, is used to treat arterial fibrillation and allows for better visualisation reduction of resulting lesions. The device is used to create anatomical maps so that physicians can efficiently and strategically place the legions effectively without causing damage.
Low intensity collimated ultrasound is a narrow beam of energy at the tip of a catheter which, when the beam is swept across the tissue without coming into direct contact, the acoustic energy passes through the blood and into the tissue. The heat from the beam creates a highly controllable lesion.
Yosprala is a combination drug sold by Aralez Pharma which contains aspirin, a platelet aggregation inhibitor, and omeprazole, a proton inhibitor. The combination is used for patients whose need for aspirin for secondary prevention of cardiovascular diseases has to be counterbalanced by a prevention of the stomach ulcers which aspirin can cause.
Battery-less cardiac pacemaker
The concept of a battery-less pacemaker was developed by Adrian Zurbuchen, a PhD student at the University of Bern and takes its inspiration from the watchmakers of his compatriots.
Zurbuchen found the regular heartbeat could power the pacemaker by generating a constant electrical current; the mechanism could be used as a battery free pacemaker in the future however at present, it is not ready for human use.
Corindus CorpathSource: PatSnap
This is a percutaneous coronary intervention system assisted by 200 robots. Developed by Corindus Vascular Robotics, it incorporates robotic assisted control of coronary guidewires and balloon stent devices.
Controlled from a radiation-protected cockpit to manipulate the movement of the stent and guidewires, the bed unit acts as an engine for the system and translates commands from the console into precise movements for accuracy.
Ivabradine, also known by its tradename Corlanor, was approved in 2015 and is currently sold by Amgen. It helps reduce systolic heart failure, a weakness in the left ventricle of the heart which prevents enough blood being pumped. Ivabradine is the first drug to be approved for heart related diseases since 2005.
Ivabradine works to control heart rate by inhibiting the electrical current of the heart’s pacemaker. By binding to the “If-channels” which are responsible for generating electrical impulses throughout the heart, it slows the heart rate which reduces the heart’s demand for oxygen and in turn reduces the risk of an angina attack.
3D printed implantable devices
Mayo Clinic is currently investigating the use of 3D printing to create customisable implantable devices, including heart valves. The technology allows MRI image reconstructions of heart valves to be printed in plastic and rubber form. Mayo Clinic is looking at ways to use biocompatible printing material to print new heart valves.