Contents
[From the Council Chair] [Judith L. Swain] [CRCI Leading the Way in High-Tech Heart Devices] [New Technology Transforming Coronary Treatments] [Heartport Partnership Yields Innovative Heart Tool] [Medical Center Launches On-Line Resource Site]
Dear Friends,
Stanford's Center for Research in Cardiovascular Interventions (CRCI) is a
key player in the development and testing of today's most advanced techniques in
interventional cardiology. In this issue of Heart Update you will be
introduced to the talented faculty involved with the CRCI and learn about the
latest technological tools used to treat heart disease.
Dr. Judith Swain, chair-designate of the Department of Medicine (see
accompanying article), believes in making cardiovascular device development a
high priority for the medical center. Cognizant of the challenges facing
scientists today, such as the cost pressures forced by managed care and the
complexity of federal regulations, Dr. Swain is committed to facilitating the
translation of inventions to clinical treatments. The CRCI offers inventors
scientific, technological, and administrative expertise, as well as a central
site for clinical testing.
Crucial to the success of the CRCI is Stanford's expert team of
cardiologists. The center is directed by Drs. Paul Yock and Peter Fitzgerald,
both leaders in the development of advanced imaging techniques. Drs. Steven
Oesterle and Alan Yeung head the clinical interventional program and provide
expertise in device evaluation and clinical trials. Dr. Simon Stertzer adds
expertise in balloon angioplasty and coronary technology.
Stanford's CRCI is a central resource for scientists and companies involved
in developing advanced technology to treat heart disease. Private gifts are
essential to sustaining the high caliber of cardiovascular research at the
center, and I encourage you to lend your support. Thank you for your continued
interest in Stanford's research and treatment programs.
Sincerely,
Robert M. Halperin
Judith L. Swain to Head Department of Medicine
Dr. Judith L. Swain, one of the few women to reach the highest ranks of academic cardiology, promises to bring dynamic, progressive leadership to Stanford's Department of Medicine.
Dr. Swain, who officially becomes chair of the department on December 1, spent seventeen years on the faculty at Duke University and the past five years at the University of Pennsylvania, where she served as director of cardiovascular medicine, professor of genetics, and professor of medical sciences. Well known for her work as a molecular biologist, Dr. Swain also is respected as a talented clinician and academic administrator
At the University of Pennsylvania, Dr. Swain made it a priority to link basic research with clinical activities, and she will continue to emphasize the importance of translational medicine at Stanford. The development of new cardiovascular devices will play a key role in her efforts to encourage the conversion of research findings into clinical treatments.
"The cardiovascular device development program is really in the mainstream of translational research that goes from bench to bedside, and it is a high priority for me in the cardiovascular program," she said.
Dr. Swain added that she will be working closely with Dr. Paul Yock, director of the CRCI, and others at Stanford to recruit new faculty members who specialize in device development.
While at Duke, Dr. Swain trained in the cardiac catheterization laboratory, where she worked on high-technology approaches to treating heart disease, such as balloon angioplasty. An associate professor of medicine and of microbiology, she also served as codirector of the Transgenic Animal Facility at the Duke Comprehensive Cancer Center.
As a researcher, Dr. Swain is best known for her work in molecular biology. She decided to explore the field while on sabbatical from Duke, when she collaborated with Dr. Philip Leder, chair of the Department of Genetics at Harvard Medical School. Her work with Dr. Leder led to an important discovery: the first example of genetic imprinting, a process whereby the effects of a gene can be blocked based on whether the gene is passed on from the male or female. Investigators have since discovered several rare human diseases in which imprinting hides inheritance patterns, and researchers are studying whether imprinting is a factor in more common diseases such as congenital heart disease.
Dr. Swain's current research focuses on the developmental biology of the cardiovascular system and the possible genetic basis for heart disease. She and her colleagues work closely with the Institute of Human Gene Therapy at Penn.
A native of Southern California, Dr. Swain received her bachelor of science degree from the University of California, Los Angeles in 1970 and her medical degree from the University of California, San Diego in 1974. She completed her training in internal medicine and cardiovascular medicine at Duke.
CRCI Leading the Way in High-Tech Heart Devices
Stanford's CRCI is concentrating on ways of speeding the development of new devices for heart procedures.
"The lab is bringing together inventors, both at Stanford and in industry, to create new devices and provide a user-friendly environment for clinical
In the past, young inventors and their ideas tended to leave Stanford because the environment of start-up companies provided a more effective means of developing new devices, said Dr. Yock. The CRCI brings inventors back to the university by providing a center for clinical trials and offering the expertise of faculty with extensive backgrounds in design, patenting, preclinical evaluation of devices, and the Federal Drug Administration approval process, he said.
Device development has been hindered by pressures to contain spending on interventional procedures, triggered both by the explosion in managed care and declining clinical revenues at academic medical centers. In addition, the FDA's process for approving new devices is lengthy and unpredictable, said Dr. Yock.
Since many top inventors are clustered within a 20-mile radius of Stanford, the CRCI presents a convenient resource to develop new technologies.
"The CRCI allows cross-fertilization of ideas and acts as a catalyst for new inventions," said Dr. Yock. "Our goal is to develop appropriate technology that is both useful and cost-effective."
The CRCI includes two X-ray laboratories containing an inhalation anesthetic station, full physiologic monitoring, state-of-the-art intracoronary ultrasound and angioscopy, and an image processing facility.
New Technology Transforming Coronary Treatments
Intravascular ultrasound is revolutionizing the way physicians
diagnose and treat coronary artery disease. Innovative ultrasound techniques are
improving on the effectiveness of catheter-based therapies and presenting novel
solutions to treating atherosclerosis.
The first intravascular ultrasound catheter designed for clinical use was
invented by Dr. Paul Yock. The catheter enables physicians to view a
cross-section of plaque from inside the artery, establishing a new standard for
the visualization and measurement of coronary atherosclerosis. The ability to
observe the disease process directly fosters innovative approaches to treating
atherosclerotic plaque both with drugs and with catheter-based techniques.
Others at Stanford who have helped advance intravascular ultrasound
technology include Dr. Peter Fitzgerald, who also holds a Ph.D. in electrical
engineering; Dr. Alan Yeung, who has made important discoveries in the area of
transplant coronary artery disease; and Dr. Richard Popp, a pioneer in the use
of noninvasive ultrasound techniques for the diagnosis of heart disease.
Ultrasound vs. Angiography
The coronary angiogram has been a standard method of diagnosing heart disease
since the late 1950s because it shows the location of narrowings in the artery
which indicate plaque accumulation. Angiography is performed by injecting a
contrast dye into a blood vessel in order to view its anatomy on X-ray.
Scientists now know that the composition of plaque, which angiography does not
show, is a more potent indicator of heart problems than is the extent of artery
narrowing.
The intravascular ultrasound catheter provides a detailed view of the inside
of an artery, allowing precise characterization of the location and extent of
plaque within the arterial wall. Angiography requires comparing a narrowed
segment of the artery to a reference segment, but ultrasound imaging shows that
the reference segment usually is diseased as well. Unlike ultrasound imaging,
angiography cannot reveal the true extent of plaque buildup.
Diagnosis and Treatment
Physicians now use ultrasound to monitor and guide catheter-based procedures,
particularly balloon angioplasty. Because ultrasound allows physicians to view
plaque from inside the artery, it has helped researchers identify previously
unknown causes of restenosis, or recurrence of atherosclerosis, following
surgery.
"The use of ultrasound means that we can differentiate good plaque from
bad plaque, the kind that can cause heart attacks," said Dr. Fitzgerald.
"Knowing what type of plaque we are viewing gives us more information about
the risk of heart disease and leads to earlier diagnosis."
Ultrasound also has influenced the development of intracoronary stenting,
another catheter-based therapy that often is complicated by thrombosis soon
after surgery. Ultrasound studies have revealed problems with the positioning of
the stent that prompted surgeons to try higher pressure inflations. Their
efforts have led to considerable reductions in the occurrences of thrombosis and
restenosis in patients undergoing the procedure.
Researchers now are working on combining ultrasound technology with
therapeutic tools, such as stents and directional cutting devices, said Dr.
Fitzgerald.
Heartport Partnership Yields Innovative Heart Tool
Developing minimally invasive heart surgery devices with
Heartport Inc. is an exciting area of collaboration for the CRCI. The Redwood
City-based medical device company worked with Stanford faculty to develop its
tools and later tested them in Stanford clinics.
"Our partnership with Heartport is the type of cooperative, symbiotic
relationship with industry that we are striving to foster," said Dr. Paul
Yock, who is also a member of Heartport's scientific advisory board.
Heartport was founded in 1991 by Dr. Wes Sterman (MD 1987), president and CEO
of the company, and Dr. John Stevens (MD 1987), assistant professor of
cardiothoracic surgery at Stanford. Drs. Sterman and Stevens discovered a way to
stop the heart during surgery and place the patient on cardiopulmonary bypass
without breaking the patient's breastbone to open the chest. The company's
system of novel, proprietary devices provide oxygenated blood to the body's
organs and deliver chemicals that stop and cool the heart during surgery. The
system enables physicians to insert miniaturized surgical devices through small
incisions, or "ports," which are located between the patient's ribs,
in order to perform heart operations.
Heartport's system recently received U.S. Federal Drug Administration
marketing approval a year ahead of schedule. Clinical trials of both its
Port-Access Coronary Artery Bypass Grafting System and its Port-Access Mitral
Valve Replacement System were completed at Stanford.
"Stanford was integral to our development and completion of clinical
trials," said Dr. Stevens. "We received praise from the FDA for our
scientifically rigorous methods and their respect for our affiliation with a
world-renowned cardiovascular and surgical group."
A pilot group of six medical centers across the country is currently using
the Heartport system. Besides Stanford, they include New York University, Johns
Hopkins University in Baltimore, the Cleveland Clinic, Washington University in
St. Louis, and Brigham and Women's Hospital located in Boston.
Heartport is now customizing its system for multivessel bypass grafting and
aortic valve replacement procedures, said Dr. Stevens.
"For those that must undergo surgery to prolong their lives, new devices
are making it less painful, safer, and allowing a more rapid return to normal,
active lifestyles," said Dr. Stevens.
Medical Center Launches On-Line Resource Site
Finding information on a specific disease or getting advice on choosing a doctor is now only a mouse click away, thanks to an on-line service recently started by the Medical Center News Bureau and Stanford Health Services .
Stanford HealthLink offers a variety of on-line help, including information about community health services available at Stanford's Health Library, a mix of news briefs and listings of health care services available at the Medical Center, in-depth medical features, and a health tip archive.
The service is designed to provide on-line users better access to the latest medical research at Stanford and health care information from around the world. For more information about supporting heart research programs at Stanford, please contact:
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