1990's
The Miller Family Heart & Vascular Institute's Stephen Ellis, M.D., was priniciple investigator of the GUSTO trial.
Clinic surgeons become known for the repair of thoracic great vessel aneurysms and aortic dissections. In collaboration with cardiac perfusionists, Cleveland Clinic cardiothoracic surgeon Bruce W. Lytle, M.D. introduces and refines a technique that extends the safe interval of total circulatory arrest necessary to perform these complex surgeries without neurological complications.
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1991
A medical drawing of the interior component of an LVAD device, a mechanical heart pump used at the Miller Family Heart & Vascular Institute as a bridge to transplant.
Delos M. Cosgrove, M.D., pioneers aortic valvuloplasty, a procedure that allows surgeons to repair rather than replace, certain diseased heart valves. The procedure enables better blood flow, minimizes clotting and is especially appropriate for older patients.
The Cleveland Clinic joins a multicenter group using the HeartMate implantable left ventricular heart assist device (LVAD). The mechanical assist device is used in select patients awaiting heart transplants, and is known as the “bridge to transplant.” Without the device, the risk of death during the wait for a transplant is very high. The Clinic is a world leader in the development and use of mechanical heart assist devices.
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1992
Maze Procedure
Miller Family Heart & Vascular Institute surgeons perform the world's first combination mitral valve repair/Maze procedure. The Maze procedure, used to treat atrial fibrillation, creates new pathways for the electrical impulses that trigger the heartbeat.
Miller Family Heart & Vascular Institute surgeons perform Ohio's first heart/double lung transplant.
Intravascular ultrasound begins testing at the Miller Family Heart & Vascular Institute, enabling cardiologists to get an undistorted, cross-sectional image of the coronary artery wall during angioplasty.
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1993
Hiroaki Harasaki, M.D., holds a model of the experimental fully implantable artificial heart he helped develop at the Cleveland Clinic.
The National Institutes of Health names The Cleveland Clinic one of three centers selected to continue research toward developing a totally implantable artificial heart. The Miller Family Heart & Vascular Institute, in collaboration with the private sector, continues research on designing an implantable heart that can function inside the body without the aid of any external components.
Under the leadership of cardiothoracic surgeon Delos M. Cosgrove, M.D., the Miller Family Heart & Vascular Institute's Department of Thoracic and Cardiovascular Surgery performs 3,420 cardiac operations, making it the largest open-heart surgery center in the U.S.
The Cleveland Clinic reports results from one of the largest heart attack studies ever undertaken. Known as GUSTO, the study involved 1,081 hospitals in 15 nations, enrolled 41,000 patients, and was led by Eric Topol, M.D., chairman of the Tomsich Family Department of Cardiovascular Medicine. Study results showed that deaths from heart attacks can be reduced 14 percent using simultaneous administration of t-PA, a drug used to dissolve blood clots, and heparin, a drug used to prevent blood clot formation.
Plasminogen activators t-PA and r-PA were compared in GUSTO, a large national clinical trial led by Heart and Vasulcar Institute physicians.
The Miller Family Heart & Vascular Institute becomes the first hospital in the country to voluntarily release outcomes data and mortality statistics to the public. This information is critical to quality improvement, cost-improvement, and patient choice.
The inpatient cardiac rehabilitation program (CHIRP) is the biggest in Ohio.
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1994
More than 300 former heart transplant patients and donor families.
The Miller Family Heart & Vascular Institute performs its 300th heart transplant. To celebrate, more than 100 heart transplant recipients return to the Cleveland Clinic for a first-of-its-kind reunion.
Delos M. Cosgrove, M.D., receives an Innovation Award from Case Western Reserve University for modifications made to the aortic cannula, a device used to pump blood from and back to the heart during open heart surgery.
Photo of Dr. Delos Cosgrove receiving an award.
The Pediatric and Congenital Heart Disease Program at the Miller Family Heart & Vascular Institute treats a range of heart disorders in infants as young as one-day-old. During the prior 18 months, 180 infants underwent complex heart procedures. Overall, the procedures had a mortality rate of less than one percent.
New valve repair techniques, including an annuloplasty procedure, is proving to be a highly effective alternative to valve replacement.
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1995
Thomas Marwick, M.D., was principle investigator of a trial that proved exercise echocardiography is a more effective way of testing for coronary artery disease in women.
Illustration of mini-invasive heart surgery
The Miller Family Heart & Vascular Institute is named “number one in America” for the first time in U.S.News & World Report's annual “Best Hospitals” survey. It remains number one for every year hereafter.
Cardiothoracic surgeon Delos Cosgrove, M.D., receives his second Innovation Award, this time for inventing a ring that aids the repair of mitral valves.
The Mller Family Heart & Vascular Institute implants more HeartMate left-ventricular-assist devices than any other hospital in the world, dramatically demonstrating the pump's promise as a “permanent” implanted device.
Eric Topol, M.D., reports the results of EPIC, a large-scale, randomized trial showing that Abciximab (a monoclonal antibody) reduces the ischemic complications of coronary angioplasty and atherectomy better than the prior medications used prior to the procedure.
Miller Family Heart & Vascular Institute researchers demonstrate that exercise echocardiography is a more accurate first-line test for women with suspected coronary artery disease than the standard EKGs used in men.
The Joseph J. Jacobs Center for Thrombosis and Vascular Biology is dedicated. The multidisciplinary center at the Cleveland Clinic will study cardiovascular disease.
The Miller Family Heart & Vascular Institute surgeons perform minimally invasive heart surgery, including coronary artery bypass and aortic and mitral valve replacement and repair.
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1996
Minimally invasive heart surgery at the Cleveland Clinic.
Results from two important studies led by Eric J. Topol, M.D., are released. The EPILOG trial shows that combination use of the drugs abciximab and low-dose heparin markedly reduces the risk of ischemic complications in patients undergoing angioplasty, a procedure used for opening clogged arteries. This outcome was achieved without an increased risk of hemorrhage.
The GUSTO-II trial compared the effectiveness of the anticoagulants hirudin and heparin in reducing the risk of coronary events in high-risk patients (e.g., those with significant heart pain or heart attack). Results showed that hirudin was slightly more effective than heparin in reducing the risk of nonfatal heart attack.
Cardiothoracic surgeon Delos M. Cosgrove, M.D., performs the world's first minimally invasive heart valve surgery. Later that year, a demonstration of minimally invasive valve surgery procedure is broadcast live from the Clinic-via an interactive satellite hookup-to an audience of 4,000 surgeons gathered in 40 cities on five continents.
Patrick McCarthy, M.D., begins left-ventricular remodeling, a new procedure, developed by a Brazilian surgeon for the treatment of congestive heart failure. Dr. McCarthy performs the operation more successfully than at any hospital in America. Although its ultimate effectiveness is later proven to be less than desirable, lessons learned help refine new surgical procedures to treat heart failure.
A Miller Family Heart & Vascular Institute clinical trial testing implantable cardiac defibrillators in high-risk, post-heart attack patients with arrhythmias is stopped early. The defibrillation devices proved so successful, Clinic investigators immediately adapt their use in The Miller Family's Heart & Vascular Institute procedures for this patient group.
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1997
Valve surgery
The Miller Family Heart & Vascular Institute is the busiest cardiac surgery center in America, holding a commanding lead in the number of open heart surgeries it performs: 4,500.
The Clinic receives a multimillion-dollar gift to establish the George M. and Linda H. Kaufman Center for Heart Failure. The Kaufman Center will facilitate the Clinic's participation in clinical trials of investigational heart failure treatments and aid the development of innovative uses for standard heart failure therapies.
James Thomas, M.D. demonstrates digital echocardiography to NASA officials and astronaut Mary Ellen Weber (far right)
In preparation for an inhabited international space station, the Cleveland Clinic cardiovascular imaging specialists team up with National Aeronautics and Space Administration (NASA) personnel to monitor the cardiovascular effects of long-term space flight.
GUSTO-III, the first large-scale clinical trial (15,000 patients at 807 medical centers) to compare the effectiveness of two important clot dissolving drugs, releases new findings. Results show that in heart attack patients, use of either of two plasminogen activators-alteplase or reteplase-produces very similar survival outcomes.
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1998
The Miller Family Heart & Vascular Institute performs 113 heart transplants in a single year-a new world record. The survival rate for these patients is 95 percent, well above the national one-year survival rate of 83 percent.
The Miller Family Heart & Vascular Institute surgeons are among the nation's first to adapt a novel technique to the heart transplant procedure. The experimental procedure involves harvesting and transplanting not just a heart from a donor, but also bone marrow. Mixing the donor and recipient's bone marrows prevents rejection of the transplanted heart, eliminating the need for anti-rejection drugs.
The Miller Family Heart & Vascular Institute performs 1,448 valve surgeries, making it the largest valve surgery practice in America. The Miller Family Heart & Vascular Institute also continues to collaborate on or lead numerous multi-center trials testing various therapies for managing acute coronary artery blockage. These investigations include:
- EPISTENT, which demonstrated the reduction of mortality from heart disease with the use of stents and the antiplatelet antibody abciximab;
- GUSTO IV, a trial studying combination use of abciximab, which can prevent platelets from binding to one another during blood clot formation, and reteplase, which can help dissolve blood clot formations;
- VEGF, a study of the effectiveness of the direct injection into the heart of vascular endothelial growth factor (VEGF) as a means of stimulating new blood vessel growth in damaged hearts;
- Gamma 1, a study exploring the ability of radio isotope-emitting stents to prevent reblockage following successful angioplasty procedures;
- and GeneQuest, a nationwide search to identify the gene responsible for early onset coronary artery disease.
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1999
Radioisotope-emitting stenting devices, like this, are being investigated at the Miller Family Heart & Vascular Institute to prevent restenosis following successful angioplasty or atherectomy.
Steven Nissen, M.D., views intravascular ultrasound images in the Miller Family Heart & Vascular Institute's IVUS core lab.
Doreen Kray, (left) was kept alive by a left-ventricular assist device (external component, foreground) while awaiting a heart transplant. NBC medical reporter Tim Johnson, M.D., (right) interviews Surgeon Patrick McCarthy, M.D., about the Miller Family Heart and Vascular Institute's leadership in the use of these devices.
Artery blockages that recur in the wake of interventions such as balloon angioplasty and stenting can be treated with local delivery of gamma radiation. In two clinical trials, Cleveland Clinic researchers showed positive results by holding an irradiated wire inside the stent for 20 minutes.
The Cleveland Clinic also plays an instrumental role in developing a device that uses radiation to help restore blood flow in clogged arteries. The radiation is delivered via catheter to specific points inside an artery; the approach also results in minimal damage to the inner wall of the vessel.
Clinic research shows that pacemaker implantation may be the treatment of choice for vasovagal syncope, the most common type of fainting disorder.
In research published in JAMA, Cleveland Clinic investigators shed light on the implications of an abnormal cardiac response that occurs during exercise stress testing that includes nuclear imaging of the heart. Michael S. Lauer, M.D, and colleagues discovered that chronotropic incompetence-the inability of the heart to adequately increase its output during physical exertion-is an important and independent predictor of mortality in persons with known heart disease. The researchers also found that the combination of an inadequate heart response and abnormal imaging results identified patients at high risk for coronary events and that these patients should have aggressive care and treatment. The researchers believe that evaluation of chronotropic response can increase the prognostic power of exercise stress testing imaging results.
Intravascular ultrasound imaging provides real-time, cross-sectional views of the coronary artery vessel wall, giving cardiologists more accurate information about the extent of plaque accumulation in diseased coronary arteries. This information can be helpful for treating coronary artery disease.
The results of EPISTENT, the largest coronary stent versus balloon angioplasty trial ever conducted, were published in The New England Journal of Medicine. Led by the Miller Family Heart & Vascular Institute, the trial demonstrated that use of the anti-platelet antibody, ReoPro (abciximab), among patients undergoing coronary stenting reduces the risk of death or heart attacks by 53 percent after six months, compared to using stents alone.
The Miller Family Heart & Vascular Institute held the world's first online press conference to announce the results of a major medical study. The co-investigators of EPISTENT, the 2,399-patient trial measuring the effectiveness of stenting in combination with an anti-platelet agent, versus balloon angioplasty with the same agent, announced their results live on www.theheart.org, a website for heart care professionals.
The Cleveland Clinic implanted the 2,000th HeartMate left-ventricular assist device (LVAD). The LVAD served as a bridge for the patient, until he was able to receive a donor heart. Patients having received LVAD devices undergo post-acute care at Heather Hill Hospital in Chardon, Ohio. The Congestive Heart Failure Rehabilitation Program (located at Heather Hill Hospital in Chardon, Ohio), has the world's largest population of LVAD patients in post-acute care.
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