ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, September 15, 1996 TAG: 9609160068
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
NOTE: Below
TRANSMIOCARDIAL revascularization has given two men from the Roanoke area a new lease on life.
In the spring of 1993, Dick Hylton was working in the home-inspection business that he'd run for eight years.
He climbed into attics and scooted along crawl spaces to assess the structures and systems of houses so he could advise prospective buyers what, if any, repairs might be needed.
Because of the exertion required, Hylton rarely did more than two inspections a day. He kept watch on his health and was proud that he could jog a couple of miles at a time. Fifteen years before, he had a heart attack that required quadruple bypass surgery.
Then one day, just after he had finished the second home inspection, Hylton had the heart attack that turned him into an invalid.
Tests showed that his earlier bypass was no longer working and that he had more blockage that kept blood from flowing through his heart efficiently.
"The doctor said I could try another bypass, but he wasn't sure it would help," Hylton recalls. "I decided to look around."
In the meantime, Hylton, a Virginia Tech architecture graduate, had to give up his business and his golf. He couldn't jog. He couldn't mow the lawn. A walk to the mailbox at his Southwest County home was about his limit.
"I lost my ability to do all the fun things," he said.
Soon after, Hylton's adult daughter saw a television show about transmiocardial revascularization - or TMR - and called it to her father's attention. Hylton remembered that he had made a tape of another show on the same procedure long before he had his heart attack.
"I thought if someday I needed surgery, I'd look into it," he said. "I had a devil of a time finding that tape, though."
When he did find it and view it, he was led to Dr. Allan Lansing at Audubon Regional Medical Center in Louisville, Ky.
Shortly after, Lansing drilled 36 laser holes in Hylton's failing heart to restore some of its circulation.
Hylton's surgery was done in July 1994. He didn't play any golf that year, but he'd go out and ride around the course in a golf cart. Every three months for a year after the surgery, he had to go to Carilion Roanoke Memorial Hospital for a series of tests, including a stint on the treadmill and an echogram of his heart.
The results were forwarded to Lansing.
Hylton, 67, said the experimental surgery, which requires approval of the Food and Drug Administration, gave him back his life. He's one of two Roanoke area men who make that claim.
The other, Charles Dameron of Montvale, calls TMR "a miracle."
Lansing also did Dameron's surgery.
Dameron's health history was worse than Hylton's. In 1979, he had a stroke, but recovered. But only a year later, he suffered a massive heart attack. Triple bypass graft surgery followed, and then he had another heart attack a month after the surgery.
After several more attacks, Dameron had another triple bypass in 1990. It began to fail immediately, he said.
"I could hardly walk or breathe," he said.
Lansing shot 27 holes in Dameron's heart.
"He'd like to have got 35 to 38 holes, but I had so much dead tissue," Dameron said.
Now, at age 65, Dameron says he's "a better man than in the past 20 years."
He has limitations on the amount of weight he can lift, but he can do yard work and play golf. He also works part time for Bedford County Department of Solid Waste.
Dameron said he felt better from the moment he woke up after surgery.
The constant angina pain was gone, he said, and he hasn't had chest pain since.
Although it took Audubon 21/2 years to get approval to become a TMR center, and it was only the sixth center, there are now more than 30 hospitals doing the procedure, Lansing said. None of the hospitals is in Virginia.
Sites for laser surgery are proliferating, though, because a laser that used to cost $500,000 can now be leased for an installation cost and a per-case fee, Lansing said.
Lansing began doing the laser surgery in February 1994. As of a few weeks ago, he had done the procedure 183 times. He uses a laser made by PLC Medical Systems Inc. to do TMR at Audubon and is testing a new type of laser doing the same surgery at Jewish Hospital in Louisville. The new laser is made by Cardio-Genesis Corp. of Santa Clara, Calif.
TMR still is allowed only as an investigative procedure, but has been on what is called a "fast track" review by the FDA for a year and a half. PLC Medical Systems of Milford, Mass., last year gave the FDA data it had accumulated from surgeries performed with its laser since 1990.
It takes about a year for patients to get peak results from the TMR procedure, Lansing said.
Once a person is determined to be a candidate for the surgery, he or she must sign a consent before the doctor can start the process to get permission to do it.
Not everyone who asks for it gets the surgery. The TMR research is randomized, meaning some patients get the surgery and other patients become the control group.
"For some, it's a last hope, and then they get turned down," Lansing said.
Those patients get another chance at the surgery if they still are well enough in six months to a year, he said.
The most likely candidate for TMR is someone who has very severe angina or chest pain associated with coronary artery disease and who has exhausted other sources of treatment, such as medication, angioplasty and coronary artery bypass, and "who still has reasonable heart function left," Lansing said.
He defines "reasonable heart function" as a heart working about half the normal level.
"If you get down to one-third normal, the risk is high," Lansing said.
A candidate also can't have any other life-limiting disease such as advanced tumors or infections.
Currently, Medicare covers the surgery, and so do most private insurance companies after they have it explained to them, Lansing said.
"Most are actually pleased," he said. "It costs them less if we can operate on patients and they stay out of hospitals."
Thus far, the TMR study has shown that hospitalizations after TMR decrease 80 percent and visits to doctors also are reduced.
"These patients are so sick when we get them," he said.
A report given at a July meeting sponsored by the American Heart Association said TMR shows promising results in patients for whom other treatments have failed. The report said it won't replace bypass surgery or angioplasty as the most common method of treating coronary artery disease.
But it also pointed out that TMR is less invasive than bypass surgery, does not require that the circulation of the patient be supported by a heart-lung machine, and is less expensive than bypass surgery.
Estimates are that TMR costs a third to a half as much as a bypass.
In addition to helping heart-disease patients who can't be treated by medicine, surgery or the artery-widening procedure, angioplasty, the laser procedure also might increase the effectiveness of a bypass when used in conjunction with the operation, the report said.
Tests are beginning on that use, too, said the American Heart Association.
During the TMR procedure, surgeons cut an opening on the left side of the chest and apply the laser to the beating heart.
While the holes on the heart's surface leak blood at first, slight pressure makes them seal up. The idea is that the rest of each channel will remain open, letting oxygen-rich blood leave the heart's interior and reach the oxygen-starved heart muscle.
The strategy was inspired by reptiles, especially crocodiles and snakes, which get most blood to their heart muscles this way rather than through coronary arteries.
LENGTH: Long : 144 lines ILLUSTRATION: PHOTO: ERIC BRADY/Staff. Dick Hylton celebrates making par onby CNBhole 16 at Blue Hills Golf Course in Roanoke. icolor. 2. NHAT
MEYER/Staff Charles Dameron of Montvale underwent laser heart
surgery a year ago and believes he has fully recovered. Graphic by
staff (3): Boring holes to help a starving heart.