40 Years of Advances in Cardiovascular Medicine

Life expectancy has increased approximately seven years since 1960, and 50 percent of this increase was attributed to improved health care, according to a study published in 2006 in the New England Journal of Medicine.

Some 70 percent of the longevity gain from improved health care was due to advances in the fight against cardiovascular disease. The University of Arizona College of Medicine has been at the forefront of this revolution.

At the same time, however, heart and vascular disease is still the leading cause of death in the United States, accounting for 38 percent of all deaths and underscoring the need for new therapies and diagnostics.

What started in 1969 as the College's Section of Cardiology since has expanded into the UA Sarver Heart Center, an interdisciplinary Center of Excellence providing cardiovascular research, education and patient care. Founded in 1986, the Sarver Heart Center is home to more than 150 physician and scientist members with national and international reputations. The center brings together experts from a variety of disciplines cardiology, surgery, molecular biology, physiology, neurology, and emergency medicine, to name a few. Their goal is to work together toward a future free of heart disease and stroke through research, education and patient care.

Similarly, the University Hospital, which opened in 1971, has evolved into University Medical Center (UMC), a facility consistently ranked among America's Best Hospitals by U.S.News & World Report. For cardiovascular care, UMC is one of the top-ranked heart centers in the western United States.

Hope made in Arizona: The Total Artificial Heart

Sarver Heart Center Co-Director Jack G. Copeland, MD, made Arizona history on March 25, 1979, when he performed the first heart transplant in the state. Since then, The University of Arizona has joined the ranks of a select few heart centers in the world that consistently have pioneered innovative therapies and advanced life-saving technology.

Started in 1985 under the umbrella of UMC's cardiothoracic surgery program, the Cardiothoracic Transplant Program celebrated its 800th heart transplant in June, saving the life of a 6-month-old baby girl.

Nearly 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. Although the risk for heart failure increases with age, some hereditary heart ailments, such as cardiomyopathies, can lead to heart failure at a very young age. "Each group of patients requires a different set of medications, surgical techniques and devices," says Dr. Copeland. "Our ambitious program enables us to address all these things at once and help people of all ages."

Under the leadership of Dr. Copeland and Richard Smith, technical director of the Marshall Foundation Artificial Heart Program, a technology was developed at UMC that would impact the lives of heart failure patients all over the world: the CardioWest temporary Total Artificial Heart (TAH-t).

On Aug. 29, 1985, Dr. Jack G. Copeland became the first surgeon in the world to perform a successful bridge-to-transplant procedure using an artificial heart, the CardioWest predecessor Jarvik-7-100. The TAH-t is the only artificial heart device in the world approved in the United States and Europe as a bridge to transplant. It replaces the diseased hearts of end-stage heart failure patients and keeps them alive while they wait for a donor organ. The American Heart Association named the TAH-t the greatest medical advance in 2004.

To date, the cardiothoracic surgery team at University Medical Center has implanted 99 Total Artificial Hearts. Tucson has become "Artificial Heart Central" in regard to the unique constellation comprising the UA Sarver Heart Center, the Cardiothoracic Transplant Program at University Medical Center and TAH manufacturer SynCardia. "We are in the process of becoming a global hub in heart-failure management and care," Smith says. "We cover all aspects – medications, pacemakers, assist devices, transplants, rehabilitation and diet." Transplant teams from all over the globe flock to Tucson to learn how to use the technology. Before a transplant center can use the technology, it completes a training and certification process in Tucson, which has acquired the status of a worldwide hub in research, development and training for artificial heart technology. So far, 30 transplant centers have completed the program, including internationally renowned cardiovascular centers such as Cleveland Clinic and Mayo Clinic.

A ‘Bridge to Recovery’

The artificial heart is not the only device technology pioneered at the UA and UMC. In 2000, then 7-year-old Carlos Ochoa was the first patient in North America to be implanted with a "Berlin Heart," a ventricular-assist device attached to (but not replacing) the heart. Relieved from its strenuous work load, Ochoa's heart had a chance to recover from a congenital cardiomyopathy. In 2006, Dr. Copeland and Smith initiated a "paradigm shift" in the treatment of cardiomyopathy, after two baby girls miraculously recovered from end-stage heart failure while they were on the Berlin Heart – no longer needing a transplant.

"It really changed our way of thinking," says Smith. Adds Dr. Copeland, "It caused us to revisit our strategy for dealing with heart failure in kids. If the device were available on a routine basis, possibly many more children could have this outcome. We no longer see this device only as a bridge to transplant, but as a possible new route, a bridge to recovery."

A New CPR for Arizona and the World

Cardiac arrest takes the lives of 490,000 Americans every year, more than all cancers combined. "It's not what you see on E.R.," says Sarver Heart Center Director Gordon A. Ewy, MD, a founding father of the College of Medicine’s Section of Cardiology. "For the most part, no more than 3 percent survive when their heart suddenly stops and they’re not in a hospital setting." In spite of periodic updates of standardized international guidelines, those rates have remained more or less unchanged over the past two decades." Many lives could be saved if bystanders at the scene performed chest compressions until professional help arrives. However, four out of five individuals will not initiate bystander CPR, mostly because of the aversion to mouth-to-mouth contact or fear of doing something wrong. To encourage bystander rescue efforts, the UA Sarver Heart Center Resuscitation Research Group set out to develop a new CPR concept that would be easier to learn, easier to remember and easier to perform than guideline CPR: Continuous-Chest-Compression CPR. Because it does not involve mouth-to-mouth breathing, bystanders are more likely to perform the life-saving technique on a stranger. In addition, studies performed by the Sarver Heart Center researchers and elsewhere have discovered that their method increases the chances of survival compared to standard CPR. The group also has developed a modified protocol for professional emergency first responders, called Cardiocerebral Resucitation. Emergency medical services in Arizona and other states have reported a dramatic increase in the number of "saves" after they adopted the new protocol.

There is a difference: Heart Disease in Men and Women

Women are 10 times more likely to die from cardiovascular disease than from all cancers combined. Women are less likely to receive adequate treatment for a heart attack than men, and may experience symptoms of heart disease that are very different from those experienced by men.

To heighten awareness of heart disease in women, and to help bring about necessary changes in diagnosis and treatment, the Sarver Heart Center has joined the ranks of only a few institutions in the world with a research program dedicated to research on heart disease in women. At the core of this program is the Allan & Alfie Norville Endowed Chair for Heart Disease in Women Research, which focuses on unravelling the molecular mechanisms underlying heart disease in men vs. women. The endowed chair is part of the UA College of Medicine's Molecular Cardiovascular Research Program, which will emphasize translational research "from bench to bedside": Basic and clinical researchers will work hand in hand to bring more new discoveries from the laboratory to clinical application.