All eyes were recently on the cardiovascular surgery unit at NewYork-Presbyterian Hospital/Columbia University Medical Center (NYPH/Columbia), where former President Bill Clinton underwent a successful triple bypass surgery.
During that experience, the public learned much about the expertise of the University's heart surgeons and its cardiovascular strength. What they may not know is that a series of medical milestones at Columbia paved the way for this lifesaving cardiac procedure.
If you scrape just below the surface, however, you will find that Columbia University Medical Center (CUMC) was the incubator of many of these breakthroughs. In research area after research area -- from treating arrhythmias to preventing restenosis or re-clogging of arteries after angioplasty, from clinical devices to heart transplant techniques -- CUMC's medical achievements have allowed for today's cardiovascular surgeons to routinely restore diseased hearts to health.
In particular, three milestones stand out. Horatio Williams introduced the first electrocardiography machine -- known as the ECG in the United States -- while he was at Columbia University in 1911. ECG tests are now performed on thousands of patients every day as a simple, non-invasive test for heart disease. The right cardiac catheter, an invaluable tool essential for the exploration, diagnosis and treatment of coronary heart problems, was developed by Andre Cournand and Dickinson Richards. The two Columbia researchers won the Nobel Prize in 1956 for their contributions to medicine and physiology. And in 1984, Columbia surgeons were also responsible for the first successful pediatric heart transplant.
Today, a series of technological advances in cardiovascular research at CUMC are continuing to improve the longevity and well-being of the millions of people affected by heart disease. One such discovery, the use of left ventricular assist devices – LVADs -- has dramatically lengthened and improved the lives of end-stage heart failure patients. In a landmark clinical trial, Eric Rose, associate dean for translational research and chairman of the Department of Surgery at CUMC, and his team proved that LVADs more than doubled one-year survival rates. As a result of this research, the Food and Drug Administration and Medicare and Medicaid Services have approved the devices for use in these terminally ill patients.
Until Michael Argenziano, assistant professor of medicine at Columbia and director of robotic cardiac surgery and arrhythmia surgery at NYPH/Columbia conducted the first robot-assisted coronary artery bypass graft (CABG), the operation had required open-chest surgery. Robot-assisted surgery requires only three small holes the size of a pencil tip made between the ribs, through which two robotic arms and an endoscope gain access to the heart, making surgery possible for some patients without having to open the chest at all.
One of the more frequent complications of heart surgery is the potential for bleeding during the surgery. Research currently being conducted by Eric Rose has uncovered an investigational anticoagulant. In recent trials, this "factor IX" appears to significantly reduce the bleeding during heart surgery that is associated with heparin, a commonly used anticoagulant.
Arrhythmias or irregular heartbeats are the cause of sudden death in half of all heart patients. Research at CUMC under the direction of Andrew Marks, has led to the discovery of a new medication that could potentially treat this condition by patching the leak in the heart's calcium channels.
The pioneering research continues today, with several large ongoing clinical trials leading the way to future breakthroughs in the treatment and prevention of cardiovascular disease.
For instance, CUMC and NYPH/Columbia are among seven centers participating in an international trial of a less-invasive alternative to open-heart surgery for the estimated 4 million Americans suffering from severe chronic mitral valve regurgitation (MR). MR is a defect in which the heart's mitral valve fails to close properly resulting in abnormal flow of blood, weakening of the heart, and potentially leading to congestive heart failure. The new treatment involves a small implant that helps the mitral valve to close properly. Allan Schwartz and Hal Wasserman are leading the CUMC team.
Research by Silviu Itescuis uses adult stem cells from bone marrow to build and repair blood vessels damaged during heart attacks. Michael Rose in a collaborative project with Stony Brook University and Guidant Corporation, is developing a biological pacemaker for humans using genetically engineered adult stem cells that mimic the natural rhythm of the heart.
Treating the disease is the second half of the battle; preventing it, first and foremost. In the largest national trial of its kind, researchers at CUMC led by Thomas Bigger, are studying and advancing strategies to prevent heart disease in the growing number of Americans with type 2 diabetes. Type 2 diabetes affects approximately 14 million Americans. The strategies used in the trial may ultimately help decrease the damage to blood vessels, heart, brain, eye and kidney caused by diabetes.
While this preventative work is encouraging, heart disease is still the nation's No. 1 killer. Cardiovascular experts at CUMC are in the forefront of those working to reduce its death toll. NYPH/Columbia's open-heart surgery program performs more than 1,500 open-heart procedures annually, and reports some of the lowest mortality rates for coronary bypass procedures in Manhattan and one of the lowest in the state. Columbia surgeons perform an unusually high percentage of valve procedures, and are recognized for innovation and expertise in valve repair.
CUMC is also widely known as a regional and national leader in congenital heart surgery under the direction of Jan M. Quaegebeur and Ralph Mosca. The New York State Database for complex congenital procedures shows an astounding 1.5 percent mortality rate at NYPH/Columbia, compared to 15 percent statewide.
NYPH/Columbia's current Heart Transplant Program, directed by Donna Mancini is one of the first in the nation. It has recently completed its 25th year of operation and has consistently been among the most active programs in the United States.