Model of Care
Cleveland Clinic is a non-profit academic medical center led by doctors. As a “group practice” model, physicians at Cleveland Clinic are full-time, salaried employees. They get paid the same regardless of how many procedures they perform or patients they see. This practice eliminates incentives to perform unnecessary tests or procedures and encourages physicians to consult with colleagues and spend the time necessary to practice excellent medicine.
The Miller Family Heart & Vascular Institute is one of the largest cardiovascular practice in the U.S. No hospital in America sees more patients for heart and vascular conditions than Cleveland Clinic. Our caregivers have collectively seen it all and experienced it all.
What does that mean to you? It means that as a patient of Cleveland Clinic, you’ll have access to the broadest possible range of solutions from skilled, experienced doctors, nurses and technicians. Options you may not have in your home town – or anywhere else in America.
What makes one medical center better than another for cardiovascular care?
It makes a difference where you’re treated for heart and/or vascular disease. Government and university studies show that patients have the best outcomes at centers that have the most experience. By having your treatment at a center that treats a large number of patients and has a great deal of experience, you give yourself a better chance of having a good outcome. Cleveland Clinic has treated millions of patients, and has more experience, in more heart and vascular procedures, than any center in America. It also has some of the best outcomes for in the nation. The experienced caregivers at Cleveland Clinic give you the best chance for good results.
There are good doctors where I live. Why should I travel for cardiovascular care?
There are many excellent cardiologists, cardiac surgeons and vascular surgeons in America. But there are other factors to consider when choosing a center for your cardiovascular care. Cleveland Clinic cardiac surgery performs more surgeries each year than any center in America. Nothing surprises our caregivers. They have collectively seen and experienced everything that can happen to the human heart and vascular system, and are prepared for every situation. They know what you’re going through, and can assure that you will be as comfortable as possible that you have everything you will need for a quick recovery and successful follow through. There is special comfort in knowing that you can rely so fully on your caregivers at every stage of treatment. Finally, in the event of more complex disease, patients have access to the full resources of Cleveland Clinic – a medical center that is among the nation’s leaders in nearly every major medical specialty.
For our caregivers, communication and collaboration with your local physicians is essential to providing you with the best care. That is why Cleveland Clinic has instituted new tools and processes that ensure that local physicians are fully informed of the care their patients are receiving while they are here.
Where do doctors themselves choose to have their cardiovascular care?
Many doctors – including cardiovascular specialists – who have been diagnosed with heart disease travel to Cleveland Clinic for their treatment. Most doctors are familiar with the studies that indicate that they can expect better outcomes at a center like Cleveland Clinic. They also know that Cleveland Clinic is ranked number one in America for heart care year after year in U.S. News & World Report’s annual “Best Hospitals” survey.
The Heart & Vascular Institute combines all cardiac and vascular services at Cleveland Clinic under a unified leadership, at a single location. It includes the departments of Cardiovascular Medicine, Thoracic and Cardiovascular Surgery, and Vascular Surgery. This structure makes it easier for physicians, surgeons, nurses and technicians to focus on the patient's problem and collaborate on patient care. It also enhances our ability to perform research, provide education and adapt to meet the challenges of medicine for decades to come.
|Lars Svensson, MD, PhD - Chairman|
|Steven E. Nissen, MD - Chief Academic Officer|
|Samir Kapadia, MD - Chairman|
|Brian Griffin, MD - Vice Chairman|
|Umesh N. Khot, MD - Vice Chairman|
|A. Michael Lincoff, MD - Vice Chairman|
|John Bartholomew, MD - Interim Section Head, Vascular Medicine
|Venugopal (Venu) Menon, MD - Section Head, Clinical Cardiology|
|Leslie Cho, MD - Co-Section Head, Preventive Cardiology|
|Brian Griffin, MD - Section Head, Cardiovascular Imaging|
|Stanley Hazen, MD, PhD - Co-Section Head, Preventive Cardiology|
|Samir Kapadia, MD - Section Head Invasive/Interventional Cardiology|
|Oussama Wazni, MD - Section Head, Electrophysiology and Pacing|
|Jerry Estep, MD - Section Head, Kaufman Center for Heart Failure|
Thoracic and Cardiovascular Surgery
|A. Marc Gillinov, MD - Chairman|
|Gosta Pettersson, MD, PhD - Vice Chairman|
|Sudish Murthy, MD, PhD - Section Head, Thoracic Surgery|
|Eric Roselli, MD - Chief, Adult Cardiac Surgery|
|Doug Johnston, MD - Vice Chairman, Education|
|Sean Lyden, MD - Chairman|
|Lee Kirksey, MD - Vice Chairman|
|Christopher Smolock, MD - Quality Officer|
|Francis Caputo, MD - Program Director|
|Behzad Farivar, MD - Assistant Program Director|
|David Hardy, MD - Assistant Program Director|
Heart and Vascular Institute Nursing
Shannon Pengel, MSN, RN - Clinical Nursing Director
|Nikolaos Skubas, MD, DSc, FASE, FACC - Chairman|
A timeline of innovations that have made the Miller Family Heart & Vascular Institute number one for heart care.
- Dr. George Crile, Sr., a founding father of Cleveland Clinic, invented a “pneumatic” suit, a special garment that could be used to help stabilize patients who had gone into shock. The suit helped ensure adequate blood flow to the brain. In the 1940s, Dr. Crile collaborated with the U.S. Navy and Goodyear Tire and Rubber Company to modify the pneumatic suit so military pilots could use it. The result was the first G-suit, a garment that helped prevent “blackouts” during rapid ascents. In 1961, Dr. Crile's suit was modified again to prevent blood loss during certain surgical procedures. Ultimately, the pneumatic suit concept was adapted for use by astronauts to protect the body from pressure changes associated with space travel.
- Dr. Crile and Dr. Harry Sloan perform the first successful human to human blood transfusion on the Miller brothers at St. Alexis Hospital.
- With the end of the World War I in 1918, Dr. George Crile Sr., Dr. Frank E. Bunts and Dr. William Lower returned to the United States, where they set about creating a new kind of hospital. Impressed with the efficiency they observed in military hospitals, where medical and surgical specialties worked as a team to save lives, they used this model as the basis for their new effort.
To round out their expertise—they were all surgeons—they recruited Dr. John Phillips, a renowned clinician and expert in internal medicine. Cleveland Clinic officially opened its doors on February 28, 1921.
- Cleveland Clinic officially opened its doors on February 26, 1921,
in a four-story building (now known as the T building) with 13 doctors and four clinic nurses.
- Cleveland Clinic opens its first hospital building.
- Cleveland Clinic establishes a Department of Cardiorespiratory Disease, the forerunner of today's Miller Family Heart & Vascular Institute. Dr. A. Carlton Ernstene is appointed chairman.
- Researcher Dr. Irvine Page led several teams that made major discoveries regarding high blood pressure and its link to heart disease. Prior to coming to the Cleveland Clinic, Dr. Page's team discovered the association between renin and high blood pressure, and isolated the peptide angiotensin. In 1948, he and his team, including Dr. Arta Green, isolated the neurotransmitter serotonin, another key player in the cause of hypertension.
- Dr. Donald E. Hale is appointed chairman of the Cleveland Clinic's newly created Department of Anesthesiology in the Division of Surgery. The move marks the Clinic's early recognition of the importance of anesthesiology as a medical specialty.
- In 1948, Donald B. Effler, MD, is appointed head of the new Department of Thoracic Surgery, forerunner of the current Department of Thoracic and Cardiovascular Surgery.
- Cleveland Clinic establishes its first Department of Pediatric Cardiology. Pediatric cardiologist Dr. F. Mason Sones Jr. is appointed chairman of the new department.
- Throughout Cleveland Clinic, nurses are organized into specialized services, including a “chest” service to help manage patients undergoing heart and lung surgery.
- Heart surgeons Dr. Donald B. Effler and Dr. Laurence Groves perform the world's first successful “stopped-heart” surgery, a procedure that involves stopping the heart so that it can undergo surgical repair. The procedure uses a heart-lung machine developed by Cleveland Clinic surgeon Dr. Willem E. Kolff.
- Drs. Page, Bumpus and Schwarz synthesize angiotensin II, a vasoconstrictor, that leads to high blood pressure. Their work with renin, angiotensin, serotonin, and angiotensin II led to the development of drugs, which are used in the treatment of high blood pressure, heart failure, migraine and psychological disorders.
- F. Mason Sones Jr., MD, performed the world’s first selective coronary angiography
- Specialized nursing care for Cleveland Clinic Hospital cardiac patients begins with the opening of the Constant Care Unit's “Heart Room.”
- Dr. Willem Kolff begins work on developing an artificial heart. Dr. Kolff was a pioneer inventor of artificial organs. He invented a dialysis and a heart-lung bypass machine.
- The Albert Lasker Basic Medical Research Award is given to Cleveland Clinic chemist and clinician Dr. Irvine Page for his pioneering research in describing the renin-angiotensin system, the major mechanism the body uses to control blood pressure. The Albert Lasker Medical Research Awards recognize scientists, physicians and public servants who help make major advances in the understanding, diagnosis, prevention, treatment and cure of disease. The award has come to be known as “America's Nobel Prize.”
- Researcher Helen Brown, PhD, is a key investigator in the National Diet Heart Study that helps establish the role of dietary cholesterol in cardiovascular disease. She creates one of the first diets to reduce blood cholesterol levels.
- Dr. Carl E. Wasmuth and colleagues in the Department of Anesthesia are able to control blood pressure during and after cardiac surgery using sodium nitroprusside. This development reduces post-operative complications and mortality.
- Cleveland Clinic heart surgeon Dr. René Favaloro pioneers coronary bypass surgery, a new method for ensuring adequate blood flow to the hearts of patients with severe coronary artery disease. The Favaloro procedure involves removing a blood vessel from the leg (saphenous vein), and re-attaching one end of it to the aorta and the other end strategically to the diseased coronary artery. This creates a new blood vessel that “bypasses” the clogged portion of the coronary artery. The procedure saves tens of thousands of lives every year and is one of the most successful means of treating coronary heart disease. Today, some 800,000 bypass procedures are performed each year, all over the world.
- Cleveland Clinic's first Cardiovascular Unit opens in the hospital, with its own operating suite, intensive care unit and step-down unit.
- Cleveland Clinic's first heart transplant takes place, performed by Dr. Laurence Groves along with Dr. Donald Effler and Dr. René Favaloro.
- Dr. Bumpus is awarded the Stouffer Prize for the synthesis of angiotensin. Later in 1970, Dr. Irvine H. Page is awarded the Stouffer Prize for his discoveries and research. In the photo to the right, Dr. is with President Dwight D. Eisenhower, Dr. Harry Goldblatt (a renowned pathologist), and Vernon Stouffer.
- Bypass surgery undergoes one of its most important early refinements. Cleveland Clinic cardiothoracic surgeon Dr. Floyd D. Loop and colleagues confirm the clinical application of an alternative bypass technique that produces better results than the original procedure, which involves using a vein taken from the leg. The new technique makes use of a blood vessel (internal mammary artery) located near the heart, eliminating the need for “harvesting” a blood vessel from another location. Dr. Loop also refines other cardiac surgical techniques, performs long-term follow-up on bypass patients, and devises measures to help lower the cost of hospitalization following cardiac surgery.
- Cardiovascular specialists Dr. William L. Proudfit, Dr. William C. Sheldon and Dr. Loop establish a cardiovascular information registry, the world's first computerized registry of data on cardiac diagnosis and treatment. Created with the assistance of Emily Wagstaff, RN, the registry is a powerful tool for studying heart disease.
- Drs. Heupler and Proudfit introduced the Ergonovine Test for detection of coronary spasm in patients with normal coronary arteries.
- Led by Dr. Lon Castle, the Heart & Vascular Institute establishes the Pacemaker Section (now called the Section of Electrophysiology and Pacing), which is dedicated to the diagnosis and treatment of cardiac arrhythmias. Dr. Victor Morant joins Dr. Castle one year later.
- America's first department of Cardiothoracic Anesthesiology is founded at the Cleveland Clinic, under the chairmanship of Dr. F. George Estafanous. Dr. Estafanous makes significant contributions in the areas of post-myocardial revascularization hypertension, the hemodynamic effects and clinical effects of opioids and muscle relaxants, blood conservation, and the limitations of hemodilution.
- The artificial heart program continues. Dr. Leonard Golding installs a LVAD (Left Ventricular Assist Device) with first centrifugal pump in a patient who survived.
- Cardiothoracic surgeon Dr. Delos (Tony) M. Cosgrove develops a computerized device that monitors a patient's condition during recovery from heart surgery and automatically administers drugs as they are needed. Designed to treat the drastic changes in blood pressure that often occur after cardiac surgery, this new device reduces post-surgical complications.
- Dr. Cosgrove also develops a mitral valve retractor and annuloplasty ring that improves surgical repair of the valve.
- The Cardiac Health Improvement and Rehabilitation Program (CHIRP) is founded to promote health recovery and wellness of cardiac patients in the Heart & Vascular Institute.
- Dr. Cosgrove develops the cardiotomy autotransfusion system, a device that conserves a patient's blood during open heart surgery. The system significantly reduces the need for donor transfusion, decreases the risk of disease transmission from donated blood and reduces the risk of transfusion reaction.
- 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, MD introduces and refines a technique that extends the safe interval of total circulatory arrest necessary to perform these complex surgeries without neurological complications.
- Dr. Delos (Tony) M. Cosgrove 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.
- 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. Cleveland Clinic is a world leader in the development and use of mechanical heart assist devices.
- 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 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.
- The National Institutes of Health names 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 Dr. Cosgrove, 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.
- 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 Dr. Eric Topol, 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.
- 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.
- 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.
- Dr. Delos M. Cosgrove 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.
- 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.
- 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 Dr. Delos Cosgrove receives his second Innovation Award, this time for inventing a ring that aids the repair of mitral valves.
- The Miller 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.
- Dr. Eric Topol 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, including Dr. Thomas Marwick, 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.
- Results from two important studies led by Dr. Eric J. Topol 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 Dr. Delos M. Cosgrove 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.
- Dr. Patrick McCarthy 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.
- 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.
- Cleveland 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Perimount bovine pericardial valve:
The first biomechanically engineered valve developed specifically for replacement of the human mitral valve was implanted for the first time in America at Cleveland Clinic.
- Refinements of Maze Procedure:
Clinic heart surgeons continue to make refinements to the Maze procedure, a technique used to treat atrial fibrillation (an abnormal heart rhythm). The randomly traveling electrical impulses are redirected down a new path or “maze” created by surgical incisions in the heart's right and left atrium. Maze procedures are often performed in combination with mitral valve repairs. The Maze technique is an open heart procedure, requiring a traditional incision and the use of a heart-lung machine. Clinic surgeons are developing approaches that would allow the Maze to be performed in a minimally invasive manner.
- Discovery of Gender Differences in Lp(a) Levels and Coronary Artery Disease Risk:
Heart & Vascular Institute researchers show that elevated lipoprotein(a) [lp(a)] may significantly increase the risk of coronary artery disease in women, as well as in men (as had been previously known). In addition, they discovered that while elevated lp(a) levels predicted coronary artery disease in men under age 55, elevated levels increase the disease risk significantly in women of all ages.
- New diagnostic tools: Color M-Mode and Tissue Doppler Echocardiography:
Heart & Vascular Institute clinicians demonstrate the utility of Color M-Mode and Tissue Doppler Echocardiography, diagnostic tools that can aid the diagnosis of diastolic dysfunction. Diastolic dysfunction indicates the presence of conditions such as coronary artery disease, hypertension, cardiomyopathy (abnormal enlargement of the heart) and constrictive pericarditis, inflammation of the protective sac that surrounds the heart. Compared with conventional echocardiography, the new technology offers much more detailed information about diastolic function.
- Link Between Homocysteine and Atherosclerosis:
New Miller Family Heart & Vascular Institute research findings show that coronary artery disease risk is related to increased levels of plasma homocysteine in the elderly and women, as well as in young men. The findings also show that a low level of serum B6 is an independent risk factor for heart disease.
- Homograft Mitral Valve Replacement:
Miller Family Heart & Vascular Institute cardiothoracic surgeons show that replacement of diseased heart valves can be improved in younger patients and women of childbearing age with the use of valves taken from donor hearts unsuitable for transplantation.
In one of the largest genetic studies of its kind, “GeneQuest” investigators and collaborators at 15 institutions used a technology called “high throughput” microarray genotyping to sift through 62 genes of 352 families with coronary artery disease and 418 families without. Three previously unidentified genetic variants were discovered that may explain why some families are prone to premature heart disease. The culprit genes belong to a family of genes that regulate thrombospondin, a protein that fosters blood clotting.
- Jarvik Heart Pump:
Surgeons at Cleveland Clinic successfully implanted a Jarvik 2000 ventricular assist device into a 60-year-old Cleveland man. The Jarvik 2000 is a valveless, axial flow pump about the size of a “C” battery. Pumps such as these are used to keep failing hearts functioning as a bridge to recovery or until transplant surgery can be performed.
- Vascular Intervention Program:
A team of physicians, specifically trained in vascular intervention, including peripheral and carotid interventions, join together to form the Vascular Intervention Program. These physicians employ angioplasty and stenting techniques to prevent stroke in cardiac surgery patients with peripheral or carotid occlusions, and to treat intracranial occlusions in patients with acute stroke or who fail antiplatelet and anticoagulation therapy. Outcomes of percutaneous interventions are monitored through patient registries.
- Embolx arterial filter:
Begun mid-2000, CCF was selected as a center for the evaluation of Embolx, an intraaortic filtration system. This system is a filter device deployed via the arterial cannula to capture debris that may occur from the aortic cross clamp or manipulation of the heart during surgery. This technology should help to eliminate or reduce neurologic injury that may occur during heart surgery.
- New Risk Factor for CAD:
Researchers from Cleveland Clinic Center for Cardiovascular Diagnostics and Prevention and The Cleveland Clinic Lerner Research Institute demonstrated that people with increased levels of the enzyme myeloperoxidase (MPO) in white blood cells have increased prevalence of coronary artery disease. Significantly, the research showed that increased levels of MPO were observed in people with coronary artery disease even if they did not have traditional risk factors.
- New Technology for Wounds:
The Arglaes Dressing study was begun at Cleveland Clinic late 1999 and completed in December, 2000. Over 900 patients were randomized to receive Arglaes dressing or conventional dressing therapy. Results are being analyzed and will be reported at the national meetings during the next several months. The Arglaes dressing contains a polymer which releases ionic silver to create an environment hostile to bacteria; the controlled release is achieved by use of special slow-release polymers. The dressing remains intact for up to five days and creates a barrier for wound infection.
- Space-based Digital Echocardiography:
Working with NASA, the Miller Family Heart & Vascular Institute developed a digital echocardiography laboratory for use in the International Space Station. The project calls for improving methods of compressing digital data for satellite downlinks and new real-time 3-D echocardiogram technology.
- Raising a Cautionary Flag About COX-2 Use in High-Risk Heart Patients:
Eric J. Topol, MD, and Steven Nissen, MD, Chairman and Vice-Chairman of cardiovascular medicine at the Cleveland Clinic, performed a retrospective review of the original data submitted to the FDA in the randomized multicenter safety trials of rofecoxib (Vioxx) and Celecoxib (Celebrex). They found physicians should use caution when prescribing COX-2 inhibitors to patients with known coronary disease since these anti-inflammatory agents may lead to an increase in risk of heart attack and stroke.
- Myeloperoxidase (MPO), a marker for cardiovascular risk:
The molecule myeloperoxidase, or MPO, has a clear and well-known role in immune-system defense, and is associated with inflammation, a key suspect in atherosclerosis, myocardial infarction (heart attack), stroke and need for bypass surgery. “MPO is one of the most potent chemical weapons used by monocytes, neutrophils and other cells against microbial invasion,” says Stanley L. Hazen, MD, PhD, a cardiovascular researcher and coordinator of the Clinic’s latest study of MPO. “When released, it creates a variety of free radicals and chlorine-based oxidants.” For patients with chest pain, MPO testing increases the ability to predict future (60month) cardiac risks from 50 to 95 percent. Before MPO can be used as a screening tool, a commercially available test needs to be developed.
- Robotic Heart Surgery:
Coronary artery bypass surgery, or CABG, involves using healthy blood vessels (“harvested” from key locations in the body) to reroute blood flow around blocked coronary arteries. This is a significant, complex surgical intervention that involves opening the chest with a large incision to expose the heart and that requires several days of hospitalization. But Cleveland Clinic cardiothoracic surgeon Jose Navia, MD, demonstrates a less invasive option with a robotic device—the da Vinci Surgical System. Robot-assisted surgery is used to assist the surgeon to harvest the mammary artery (in the chest wall) through a very small incision. The mammary artery is then used to bypass a blocked LAD (left anterior descending) artery through a small incision. The da Vinci surgery reduces surgical trauma, causes less pain, and requires lower amounts of pain medication. The da Vinci system also results in less bleeding, a lower risk of infection, shorter hospital stays, and faster return to normal activities. Learn more.
- First Gene Linked to Heart Attack, Coronary Artery Disease:
Scientists at Cleveland Clinic have identified the first gene confirmed as a cause of coronary heart disease in humans. Results of this groundbreaking research appears in the Nov. 28 issue of Science*. The gene, MEF2A, was discovered by methodically studying the genetic makeup of 21 members of an Iowa family plagued for generations by incidents of coronary artery disease and heart attack. Every patient in the Iowa family who experienced a heart attack had at least one coronary risk factor. As Cleveland Clinic scientists looked for the genetic link, researchers in the laboratory of Qing Wang, Ph.D., scanned the complete genomes of all participating members of the family. The area of interest proved to be located on chromosome 15, long arm 26. This region contains about 93 genes. Dr. Wang and his colleagues noticed a big difference in the MEF2A gene between family members who had developed coronary heart disease and those who had not. The MEF2A gene makes a regulatory protein that controls the expression of hundreds or even thousands of other genes in the endothelium, the barrier between blood vessels and blood elements.
- Coated Stents to Decrease Restenosis:
Stents are slender mesh cylinders, used to keep open arteries narrowed because of atherosclerosis. Although stents are effective in reducing restenosis (re-narrowing), 20 percent of stented patients still have this problem. In April 2003, the FDA approved the use of drug-eluting stents, designed specifically to counteract restenosis. It was clinical trail research conducted by Miller Family Heart & Vascular Institute interventional cardiologists that helped demonstrate the effectiveness of the new drug-coated, or drug-eluting stents. The development is important, not only because of restenosis, but because use of drug eluting stents could significantly reduce the need for bypass surgery, a costly involved intervention.
- New Tricuspid Annuloplasty Ring:
Cleveland Clinic heart researchers, working with Edwards Lifesciences Corp., developed a special ring called the Edwards MC3 Tricuspid Annuloplasty System. The ring fits precisely on the contours of the tricuspid opening and reduces amount of regurgitation in persons with valve disease. Learn more.
- New Mitral Valve Ring:
A Cleveland Clinic research collaboration, however, results in the development of a special ring (Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring) that can be fitted strategically to the mitral valve to improve function and reduce the amount of regurgitation in persons with valve disease.
- 1,000th Transplant:
The Miller Family Heart & Vascular Institute at Cleveland Clinic Transplant Program completes its 1,000th heart transplant. Only two other hospitals across the nation achieve this milestone, according to the United Network for Organ Sharing. Although the Clinic performed its first heart transplant in 1968, it officially began a heart transplantation program in 1984. In 1998, the Miller Family Heart & Vascular Institute at Cleveland Clinic performed 113 heart transplants, marking a new world record for the number of heart transplants performed in a single year. The one-year survival rate for these patients was 95 percent, well above the national one-year survival rate average of 83 percent. In 2002, Cleveland Clinic was only one of 168 U.S. heart transplant programs to achieve better-than-expected patient survival rates at three different time periods after transplant, according to data released by the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. Cleveland Clinic's actual survival rate was 96.2 percent vs. an expected rate of 91.7 percent.
- Ascending and descending aortic aneurysm repair:
For patients with aneurysms, the aorta can be replaced from the aortic valve down to the aortic bifurcation in a single operation at Cleveland Clinic. This is done through combined incisions in the chest and mid abdomen. The axillary artery is used to provide ongoing blood perfusion to organs during aortic aneurysm repair and when atherosclerosis (plaque) is present in the ascending aorta. Learn more.
The ACORN CorCap® is a mesh-like polyester “jacket” that is surgically wrapped around a dilated left ventricle to help restore an enlarged heart to a more normal size and shape. The Cleveland Clinic was integrally involved in a worldwide randomized trial utilizing this device. Nicholas Smedira, MD, and Randall Starling, MD, MPH, were the Cleveland Clinic co-principal investigators. In Fall 2004, clinical trial results presented at the American Heart Association Scientific Sessions indicated that patients treated with this device demonstrated sustained improvements in heart size and shape; showed significant improvements in quality of life using standardized evaluation methods; and were 50 percent less likely to require additional cardiac procedures for worsening heart failure, such as transplants and implants of ventricular assist or electrical stimulation devices.
- Stentless bioprosthetic mitral valves:
The ultimate goal of valve replacement is to mimic the structure and performance of a normal native valve.
- Stentless Mitral Bileaflet Valve with Chordae
- Jose Navia, MD, Department of Thoracic and Cardiovascular Surgery, has developed a stentless mitral valve, made of one piece of bovine pericardium. This design preserves the structural integrity of the mitral annulus and provides papillary muscle continuity. This is essential for normal left ventricular function and hemodynamic efficiency. Two valve concepts have been created: the Classic Bileaflet Valve and the Classic Bileaflet Valve with Chordae.
- The SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) study was the first study to compare carotid stenting with embolic protection to traditional open surgery to clear clogged neck arteries and restore blood flow to the brain in high-risk surgical patients. According to the study led by Jay Yadav, MD, Director of Vascular Intervention at the Cleveland Clinic, a minimally invasive procedure to clear plaque-filled neck arteries is as effective as traditional surgery in patients at high risk for open heart surgery. The minimally invasive treatment uses a stent in combination with a special filter to catch any emboli, or bits of plaque, that break free during the procedure.
- CRUSADE quality improvement initiative:
Cleveland Clinic cardiologist Deepak L. Bhatt, led research that shows earlier and more aggressive treatment for patients at high risk of heart attack can reduce their chances of dying during hospitalization, but such treatment often is underutilized. According to the research, performing cardiac catheterizations on high-risk patients seeking treatment for acute coronary syndromes — conditions ranging from heart-disease-related chest pain to heart attack — within 48 hours of their seeking help can significantly reduce their risk of in-hospital mortality. Cardiac catheterization is a minimally invasive procedure used to diagnose or treat heart problems, and often serves as a prelude to angioplasty/stenting or bypass surgery. Exercise stress test combined with health risk assessment helps predict mortality in patients without cardiovascular disease: Research conducted by Cleveland Clinic showed that combining a simple treadmill test with a global health risk assessment can help to determine a person’s mortality risk even when that person does not have signs or symptoms of cardiovascular disease. Complete results of the 12-year study appear in the Sept. 22 issue of the Journal of the American Medical Association. “Previous Cleveland Clinic research has found exercise stress tests to be valuable in monitoring the health of people with known or strongly suspected cardiovascular disease,” said Michael S. Lauer, MD, study investigator and staff cardiologist at the Cleveland Clinic. “This study shows how to make the tests relevant for people without obvious cardiovascular disease or symptoms. The way we’ve found to do this is to combine a global risk score with the exercise stress test.
- REVERSAL trial shows intensive cholesterol lowering with atorvastatin halts progression of heart disease:
The REVERSAL trial, directed by Cleveland Clinic cardiologist Steven Nissen, MD, compared the highest doses available at the time of two popular statin drugs, pravastatin and atorvastatin. Both medications work to block the liver’s ability to produce harmful cholesterol, which can clog coronary arteries. Complete trial results were published March 3 in the Journal of the American Medical Association. The more intensively-treated atorvastatin patients reached an LDL-C level (the bad cholesterol) of 79 milligrams per deciliter (mg/dL), while the more moderately treated pravastatin patients achieved an LDL-C of 110 mg/dL. Current guidelines set by the National Cholesterol Education Program* suggest treating patients to an LDL-C target level of 100 mg/dL. “The REVERSAL trial demonstrates that if we want to prevent the progression of coronary disease, we need to treat patients to much lower levels,” Dr. Nissen said.
- Valve Hemodynamics:
Cleveland Clinic was one of the earliest adopters of this new tissue based aortic valve. The Magna valve by Edwards Lifesciences represents new valve technology that has helped improve the hemodynamics and durability of bioprosthesis. Cleveland Clinic research and experience have demonstrated that for most patients, tissue valves provide the best option when valve replacement is required.
- Virtual Histology:
D. Geoffrey Vince, PhD, Department of Biomedical Engineering, D. Geoffrey Vince, PhD, Department of Biomedical Engineering, has developed virtual histology with intravascular ultrasound, which provides an accurate picture of the concentration and composition of vascular plaque in a format that is fast, inexpensive and portable.
- Retrograde Perfusion System:
Developed by Cleveland Clinic surgeon Jose Navia, MD, this system facilitates auto-retroperfusion of the patient's oxygenated blood through the coronary sinus without total occlusion of the sinus and without a complex gating mechanism for the obstructive balloon. The cannula also allows for percutaneous drug delivery.
- New gene linked to blood vessel formation:
Cleveland Clinic-led researchers identified a new gene that regulates blood vessel formation, or angiogenesis, within the human body. Their discovery may have potential in devising new treatments for cancer, ischemic heart disease, stroke and other conditions. The research, led by Qing Wang, Ph.D., director of The Cleveland Clinic’s Center for Cardiovascular Genetics and associate staff member in the Department of Molecular Cardiology within the Clinic’s Lerner Research Institute, provides additional insight into the rare illness we studied to help isolate the angiogenesis gene. It also has shown how certain processes work within the body to increase or decrease blood vessel growth — either by starting or stopping it — to help control disease.
The Miller Family Heart & Vascular Institute at Cleveland Clinic was one of eight leading transplant centers involved in the Cardiac Allograft Rejection Gene Expression Observational (CARGO) study to evaluate peripheral blood gene expression for cardiac transplantation acute rejection management. AlloMap is a new blood sample based diagnostic test developed to manage the complex immunologic questions posed by cardiac transplant patients. Traditionally, a heart transplant patient has multiple biopsies on his/her transplanted heart (called an allograft), to detect evidence of rejection. The AlloMap molecular expression test offers a technologically advanced, less invasive alternative and is designed to reduce the need for endomyocardial biopsy.
A Look Into The Future
Innovations being worked on by our surgeons, physicians and cardiologists:
Gut Flora Metabolism
In a study by Cleveland Clinic researchers published in the journal Nature, it was discovered that as gut flora metabolize lecithin, an abundant dietary phospholipid found in animal products, byproducts (metabolites) are formed that directly contribute to the development of atherosclerosis and cardiovascular disease (CVD).
Transcatheter Mitral Valve Implant
Transcatheter procedures to replace mitral valves will benefit patients with heart failure who are not eligible for surgery. Cleveland Clinic researchers are developing a novel valve stent framework, tissue valve and delivery system that safely and securely attaches the valve to the valve annulus without the use of sutures. The stent has “wings” that attach firmly to both sides of the valve annulus when the stent is expanded and hold the new valve in place. Results from studies to-date are encouraging, and additional studies are ongoing.
Bifurcated Bifurcated Branched Implant
The design concept for the bifurcated bifurcated iliac branched implant is to allow for treatment of patients with relatively short common iliac arteries, primarily women and those of Asian decent. This device is combined with several other endograft components and is used in conjunction with infrarenal aneurysm repair and other proximal aortic repairs requiring fenestrated or branched components. The delivery system has been modified from that of a standardized helical branch device to combine that of a standard bifurcated component currently used in a fenestrated procedure and the helical hypogastric branch device. This combines three components into one, eliminating several overlap joints while stabilizing the repair. At the same time, the self-sealing fenestration allows for cannulation of the helical branch by using a method that adapts well to difficult angles and anatomies.