Innovating novel cardiac research and care
By Darby Kendall
Cardiovascular innovation has transformed what’s possible in modern medicine, improving both individual lives and global health. By embracing tools like AI and 3D modeling, the OHSU Knight Cardiovascular Institute is shaping the future of cardiovascular care and ensuring better, faster recoveries for patients.
At the forefront of this progress is Joaquin Cigarroa, M.D., division head and endowed Melvin Judkins professor of cardiology at the institute, leading with a vision rooted in history and driven by cutting-edge research.
This is an audio story featuring highlights from a conference Cigarroa spoke at in the spring of 2024.
Transcript
Imagine it is mid 1900s and the United States has survived several world wars and overcome many deaths due to infectious disease, but not those due to rheumatic fever and consequent rheumatic heart disease, which accounted at the time for 25 to 40% of all cardiovascular deaths. Unbeknownst to many, this intersection of the world wars, infectious disease and three individuals would lead to a collaboration that would forever change OHSU, cardiology, cardiothoracic surgery and what we as healthcare providers could provide for patients around the world.
Dr. Joaquin Cigarroa is the division head and endowed Melvin Judkins professor of cardiology and the director at the Knight Cardiovascular Institute. In March 2024 he spoke about the history of heart surgery and OHSU’s dedication to cardiovascular research at a conference. Here are some highlights from his talk.
Lowell Edwards was born in 1898 in Newberg, Oregon, and he actually developed rheumatic fever. At the time, rheumatic fever was endemic, and it impacted many individuals, leading to profound adverse effects on the heart valves, leading to heart failure and premature death in too many people in the United States and around the world. So fortunately, Lowell didn’t develop this. At the time, our hospitals had wards full of patients with rheumatic heart disease, where all we could do was provide palliative care. Lowell went to OSU and became an electrical engineer interested in hydraulics. His expertise in hydraulics led him to design many devices, including those used in the lumber industry to take bark off of trees. At the time, our country was involved in war, and he designed the centrifugal fuel pump that allowed the military aircraft to ascend very high altitudes at very quick periods without stalling, including the infamous B-17, which was so vital during World War Two.
Following the completion of the world war, Lowell turned his attention towards medicine. He considered himself incredibly fortunate to have had a career to design devices that helped the world. Now he wanted to turn to devices that helped individual patients, in part because he didn’t develop heart disease himself, and in part because he was so good at developing pumps, and he thought of the heart as a pump. Albert Starr was born in New York City in 1926, trained at Hopkins in Columbia, and during the war, operated on injured soldiers. By operating on our soldiers, he learned the importance of pace, precise technique and learning from prior experiences. He would bring that forward to patient care and to innovation in how he proceeded with research. Herb Griswold, then the chief of cardiology here at OHSU, recruited this young surgeon in his 30s to OHSU.
Lowell reached out to Albert and stated he was interested in developing an artificial heart. This is 1950s at the time. Albert responded that first we would have to develop heart valves. Lowell would work from his workshop off the Sandy River, Albert from the operating room and his laboratory in the animal lab. They communicated by mail and in person, and they developed the first artificial heart valve by materials that were already in use in humans. The valve was called the Starr-Edwards valve and consisted of a silastic ball and cage. When the heart pumped blood, the ball moved upward. And if you ever listened to one, it was like the coolest sound ever to hear the ball striking this metal cage. And when the blood stopped moving forward, the ball went down to the base and prevented the blood from returning to a chamber that it shouldn’t be in at the time.
Back in that time, patients were on a ventilator for a long time and in the hospital for one to two weeks, and four to eight weeks to recovery. And so, although helpful, we needed to continue to advance the care that we were providing. At the time, if you were 70 or older, that was considered too old to operate on somebody, and so if you had a narrowing of your aortic valve or your mitral valve, and you were 70, you were not offered a procedure. Today, we are able to replace aortic valves in awake patients without open heart surgery, often discharged the next day. It’s truly remarkable.
As we’ve developed this expertise in aortic and mitral valves, we’ve now expanded into innovations in the tricuspid valve with both clip devices and catheter-based valves. Disorders of this valve have often been ignored. I can now state that our approaches now allow so many more patients to receive treatment, whereas before none existed, and they were told to go home and enjoy their remaining time. Now, others who were not candidates for open heart surgery routinely receive catheter-based approaches and are discharged, as I said, one to two days later. This has allowed many people to improve their quality of life while recovering much quicker, in a matter of days, rather than weeks to months. They can now live longer and lead more productive lives while having this much more rapid recovery.
So given our success, we have committed over a million dollars into a learning lab. We’ll learn how to implant novel devices with new designs and determine the steps to safely implant them. We will be using artificial intelligence, CT scans and MRIs to design the procedures even before we are in the laboratory. We’ll know what size, what angle, where to place them, what type of device, and equally importantly, we’ll learn how I see it versus a surgeon versus one of our imagers. And so we will be able to, using 3D goggles, track our eyes and hands to give us insights as to, ‘What am I looking for? How am I responding? Is that response appropriate or not?’ And as we move along, all of that will be archived and analyzed so that we can learn what works, and equally important, learn from the failures. And this is the beauty of ideation that our university allows us to do. We have the experts, we have the structure, and we have the ability with our institute to reach across silos. Our ability to organize ourselves and to fund this work is dependent upon our wonderful supporters who contribute to OHSU and provide us with the means to invest in our people and our programs. Thank you.
