To mark American Heart Month, Stanford Hospital & Clinics writer
John Sanford sat down with Robert Robbins, MD, chair of the Department
of Cardiothoracic Surgery at Stanford University, to discuss
innovations in cardiac care and what the future holds.
What are some new minimally invasive procedures you're excited about?
I think what we're doing here with aortic valve replacement is a big
advance. For people who have aortic valve stenosis, a narrowing of the
valve through which blood passes from the left ventricle to the aorta,
replacing that valve has traditionally been done through open surgery.
This involves cutting through the sternum, putting the patient on a
cardiopulmonary bypass machine, stopping the heart and then removing
and replacing the valve. It's a procedure that can take as long as
four hours and require two to three months for recovery.
But as part of a clinical trial, we did more than 100 valve
replacements transfemorally, using a catheter to maneuver a new valve
through blood vessels to the heart. Only one small incision to the
femoral artery is needed, and the procedure generally takes little
more than an hour. Recovery time is a few days. Now that the FDA has
approved the artificial valve used in the trial, we've been able to
hit the ground running as far as offering the procedure to more
patients. It's especially useful for those who are high-risk for open
surgery, such as older patients and patients with multiple medical
problems. About 200,000 people in the United States need aortic valve
replacements each year.
Is this cheaper than the surgical approach?
It depends. The cost of the valve is more expensive, but the length
of time in the hospital will be reduced, as will recovery time. So I
think if you look at it overall, it should eventually reduce the cost
of aortic valve replacement.
You're director of the Stanford Cardiovascular Institute, one of
the nation's top heart-research centers. What are some areas of
research you think readers would find compelling?
Certainly, the ability to map the human genome has opened up a whole
new realm of possibilities. Much of the work in this area is being
done at Stanford, where we have a lot of strength not only in mapping
DNA but also interpreting the massive amount of data it produces. Our
researchers will be able to create algorithms and ways to manage and
interpret this data. One day you'll probably be able to walk into your
doctor's office and say, "Here's my genetic code. What does it mean?"
Another great hope is to customize drug therapy to specific
cardiovascular diseases, such as hypertension, based on your genetic
profile. If your genes make certain proteins or enzymes that
metabolize a certain class of drugs better than another class, then
doctors could use this so-called pharmacogenomic approach to customize treatments.
The Cardiovascular Institute is also focusing on long-term health.
In the future, physicians are going to be paid for delivering the
highest quality care at the lowest cost, so there's a transition under
way from diagnosing and treating conditions, which Stanford is very
good at, to predicting and preventing. One of the really important
areas is going to be how we can get people to change their behavior,
so the focus becomes promoting health rather than treating disease.
Does Stanford Hospital have any such prevention programs in the works?
We're developing a program called the Cardinal Commitment, which we
will likely roll out in phases. The basic principle is that we would
work with patients and leverage information and wireless technology to
help us manage their heart health. This might include biometrics, such
as checking their blood pressure and pulse, which could be transmitted
back to a central processing center for monitoring. If you can imagine
having a muse or a life coach tethered at the other end of the
electronic data fields, helping you to manage your cardiovascular
health—that's the idea.
What role could stem cells one day play in new therapies?
I think they hold huge promise, but we're not ready yet to employ
stem-cell therapies to treat end-stage heart failure. But I do believe
our group here at Stanford, one of the world's leaders in this area,
will be the first to put embryonic stem cells into the human heart.