Pulse: A Message from Chancellor Joel A. Kaplan

The year 2003 has been especially significant for me, as a cardiovascular specialist (cardiac anesthesiologist), and for the University of Louisville, with its growing translational research and clinical programs in cardiovascular care.

This issue of Medicine features articles on the Research, Development and Delivery -- R & D & D -- of future aspects of innovative care by our world-class cardiac surgeons and cardiologists.

Fifty years ago, the modern era of cardiac surgery began when John H. Gibbon, M.D., repaired an atrial septal defect in an 18-year-old woman during 45 minutes of total cardiopulmonary bypass.

This first successful cardiac surgical procedure using bypass was done at Jefferson Medical College in Philadelphia. Jefferson is my medical school alma mater, and I was very fortunate to have Dr. Gibbon as my professor of surgery (from 1964-1968) because he stimulated my interest in the perioperative management of patients during and after cardiac surgery.

It had taken Dr. Gibbon and his wife, Mary, who was his research assistant, 20 years to develop the piano-size heart-lung machine that took over the patient's circulatory and respiratory functions during surgery.

This great surgeon died in 1973, and he would be amazed by the subsequent developments in cardiac surgery and circulation support.

In approximately 30 years of active clinical practice, I have seen the Gibbon heart-lung machine replaced by much smaller, modern membrane oxygenators, heparin-coated circuits and centrifugal pumps.

I also have seen new cardiovascular operations developed by surgeons working with engineers to introduce mechanical heart valves, vascular conduits, implantable pacemakers and defibrillators, and cardiac support devices such as the intra-aortic balloon pump and ventricular assist devices.

With all this experience, I was still amazed to watch Laman Gray Jr., M.D., and Rob Dowling, M.D., implant the first AbioCor total artificial heart in a calf in the School of Medicine's research center shortly after my arrival in Louisville.

Since then, the entire world has watched as the University of Louisville/Jewish Hospital team has successfully implanted the AbioCor heart first in Robert Tools and then, most successfully, in Tom Christerson, who survived for 16 months.

In this issue, you will read of the new Cardiovascular Innovation Institute, designed to further expand and advance work in cardiac diseases.

The institute's initial emphasis will be on developing miniature biosensors to measure cardiovascular dynamics, and on working with industry to test new cardiovascular devices, first in animals and then in clinical trials.

Later, the institute also will incorporate newer aspects of molecular and genetic medicine, such as the use of cardiac stem cells for myocardial regeneration.

The cover story of this issue features Roberto Bolli, M.D., chief of the Division of Cardiology in the Department of Medicine and director of the Institute of Molecular Cardiology, which will be housed in the recently opened Baxter II research building.

Dr. Bolli won the American Heart Association's 2001 Basic Research Prize and is recognized as one of the world's leading researchers in the field of ischemic heart disease.

His clarification of the mechanisms of ischemic preconditioning has profound implications for how the heart protects itself and how we can intervene to prevent and/or treat myocardial ischemia.

In 1976, I developed and introduced the use of intravenous nitroglycerin (NTG) in the operating room to treat myocardial ischemia during coronary artery surgery.

Dr. Bolli's work with nitric oxide and inducible nitric oxide synthase explains some of the success we have seen with intravenous NTG in the operating room, catheterization laboratories during angioplasty and intensive care units.

In the near future, members of Dr. Bolli's group will be studying new molecular techniques for treating the ischemic or failing heart with stem cell transplants and/or cardiac gene therapy.

It is anticipated that these molecular biology techniques may replace some present-day surgical procedures.

The development of these new treatments is already leading to the formation of new companies in our Biopark. In the future, many more businesses will be created from both the Cardiovascular Innovation Institute and the Institute for Molecular Cardiology, as part of the "Next Economy" developing in Louisville today.

Joel A. Kaplan, M.D.
Executive Vice President for Health Affairs
and Chancellor for the Health Sciences Center