Stanford Medicine Newsletter Updates For the Local Community

 

The heart of the matter

Innovations ahead for cardiovascular care

Robert Robbins, MD, chair of the Department of Cardiothoracic Surgery at Stanford, sees promising changes ahead in the prevention, diagnosis and treatment of heart disease.

   

To mark American Heart Month, Stanford Medicine News sat down with Robert Robbins, MD, chair of the Department of Cardiothoracic Surgery at Stanford, 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 the patient to recover.

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.

You’re director of the Stanford Cardiovascular Institute, one of the nation’s top heart-research centers. What are some areas of research you find compelling?

The ability to map the human genome has opened up a whole new realm of possibilities. Much work in this area is being done at Stanford, where we have a lot of strength not only in mapping DNA but in interpreting the massive amount of data it produces. Our researchers will be able to create algorithms and ways to manage and interpret this data. You may one day 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 be able to look at a genetic profile and try to customize drug therapy to specific cardiovascular diseases, such as hypertension. If your genes make certain proteins or enzymes that metabolize a certain class of drugs better than another class, then doctors could use a 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 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 apply wireless technology to help us manage their heart health. This might include biometrics, such as checking blood pressure and pulse, which could be transmitted 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.

Learn more about the Stanford Cardiovascular Institute at cvi.stanford.edu.

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