Heart & Lung - St. Paul's Hospital Foundation


Heart & Lung - St. Paul's Hospital Foundation

Pulmonary pioneer Dr. Peter Paréwith St. Paul’s iCAPTURE scientistDr. Denise Daley.12 Promise • Spring/Summer 2009 Photograph: Brian Smith

y vicki o’brienHeart+LungInnovationA new generation of gifted physicians and stellar scientists explore the frontiers of heartand lung medicine, building on the tradition of innovation of St. Paul’s medical pioneersJust as heart and lung interactions occur with ourevery breath, the history of heart medicine isinextricably linked to the history of lung medicine.At St. Paul’s Hospital, the war against heart and lung disease has acolourful 60-year history. Its roots lie with a succession of talented youngphysicians invited to head west from teaching hospitals in Central andEastern Canada, lured here by the opportunity to create brand new diagnosticand treatment services in the early days of cardiopulmonary care.Attracted to St. Paul’s by progressive administrators and the visionarySisters of Providence, they were sold on the hospital’s communityspirit and family atmosphere. Over the next six decades they proved thata small centre could deliver the same excellence in research and patientcare as larger institutions, often at a lower cost.In the 1950s and ’60s, finding space to expand, learn and teach withinSt. Paul’s was just as challenging as it is today. It often meant spendinglong hours toiling in tight quarters, working on world-class projectsand programs with little or no staff or equipment. These early pioneerspaved the way for then unimaginable innovation. What’s more, they didso in an environment where competition for funding was fierce, wherecollaboration between institutions was almost non-existent, and whereminimal research was being done at the bench or bedside.Stories abound about the many advances in heart and lung care andresearch at St. Paul’s over the last half-century. Here are a few that illustratehow early advances in cardiac care at St. Paul’s set the stage for thehospital’s current specialists, and how groundbreaking lung researchconducted decades ago has influenced the next generation of St. Paul’sscientists studying respiratory health.Breaking New GroundAmong the early young stars recruited to develop heart medicine atSt. Paul’s was Dr. Doris Kavanagh-Gray, the hospital’s first cardiologist.Her primary role was to develop electrocardiogram (ECG) services (atest that reads the electrical activity of the heart) and establish a newcatheterization laboratory. Her contribution was vital for a hospitalbent on performing complex heart surgeries. (During a catheterizationprocedure, a thin, flexible tube is inserted into a patient’s artery or vein,usually through an artery in the leg, and threaded up into the heart. Inaddition to being a vital diagnostic tool for cardiologists, it would laterbecome a procedure to clear blocked arteries.)One of Kavanagh-Gray’s contemporaries was the brilliantDr. Harold Rice, who when he arrived in B.C. had already developedan electroencephalogram (EEG) machine to study electrical activityof the brain. Joining St. Paul’s in 1958, he invented and built Canada’sfirst heart bypass machine, which takes over the role of the heartand lungs while a surgeon makes repairs. He went on to producemuch of the equipment needed for the hospital’s emerging heart andlung services.The first open-heart surgery at St. Paul’s in 1960, made possible bythe commitment of physicians like Rice and Kavanagh-Gray, allowedthe hospital to attract talented young cardiologists and cardiac surgeons.These medical leaders built on the work of the early pioneers and helpedestablish St. Paul’s as B.C.’s premier centre of cardiac care. In 1994, on its100th birthday, St. Paul’s launched the flagship Heart Centre, which consolidatedmany of the province’s highly specialized cardiac programs.Kavanagh-Gray, 78, who retired in 1997 as head of cardiology after a46-year career at St. Paul’s, says she is proud to have played a significantrole in developing a world-class Heart Centre in Vancouver.“Looking back, I think my greatest achievement was launching thecath lab,” says Kavanagh-Gray. “When we first opened, we were onlyallowed to do two procedures a week; when I left, we were doing four a day.”(Today the hospital performs between 16 and 20 such procedures daily.)During her tenure Kavanagh-Gray implemented many other innovativechanges, which considerably enhanced St. Paul’s cardiac expertise:she recruited the first specialist at St. Paul’s with a knowledge ofboth heart and lung disease (Dr. John Boone) and the hospital’s secondcardiologist, Dr. Dwight Peretz, to set up and run St. Paul’s first IntensiveCare Unit (ICU). Kavanagh-Gray also developed a sabbatical programfor St. Paul’s Department of Cardiology, enabling cardiologists to takeleaves of absence in order to learn new techniques and procedures fromspecialists at other hospitals.Advancing heart careIf the valuable contributions of pioneers like Kavanagh-Gray representthe historic development of world-class heart care at St. Paul’s, thenheart surgeon Dr. Jamil Bashir, 40, the youngest of St. Paul’s Hospital’ssix cardiac surgeons, exemplifies its extremely bright future.A University of Alberta Medical School gold medal winner, BashirSpring/Summer 2009 • Promise 13

Sikander Sahotaand his gratefulparents withDr. Anson Cheung.SikandeR’S StoRYThough less than a centimetre wide, a tiny device created to give a boostto hearts weakened by disease had a big impact on the life of one Burnabyteenager last fall – it ensured he would see his 14th birthday.Seemingly healthy, Sikander Sahota suddenly fell ill last October. Afterhis mother took him to BC Children’s Hospital, doctors discovered he wassuffering from viral myocarditis, a life-threatening condition in which hisbody was attacking his heart muscles, causing his heart to function at just20 per cent of its normal capacity.Sahota was rushed to St. Paul’s Hospital where Dr. Anson Cheung, headof the B.C. Acute Heart Failure Program, immediately implanted a temporaryImpella heart pump – also known as a ventricular assist device (VAD) – whichdraws blood away from the heart, giving it a chance to recover.In doing so, Sahota became the youngest person in the world to be fitted withAbiomed’s Impella LP 5.0 heart pump, a device Cheung says is crucial to therecovery of patients like Sahota.“Because it is tiny in size and can be implanted minimally invasively, it’s lessrisky for the patient, buys time for heart recovery and avoids further damage to theheart muscles,” explains Cheung.The pump bought Sahota invaluable time – and a future. Just days after hearrived at St. Paul’s Hospital in critical condition, Sahota was able to resumetypical activities of a teenager, including soccer.Not bad for a piece of equipment smaller than your baby finger.Since its inception at St. Paul’s Hospital in 2002, the B.C. Acute Heart FailureProgram (with the help of startup money provided by donors to St. Paul’s HospitalFoundation) has implanted more than 110 long- and short-term VADs in heartpatients, saving dozens of lives. The program, part of the Providence Heart + LungInstitute at St. Paul’s Hospital, is now funded by the Provincial Health ServicesAuthority and is a national leader in ventricular assist device implantation. lAbove left: Dr. Doris Kavanagh-Gray pioneered electrocardiogram services andheart catheterizations at St. Paul’s Hospital; Cardiac surgeon Dr. Jamil Bashir(above right) says the use of devices for the treatment of heart failure is thefastest growing of all the cardiovascular disciplines.initially joined the St. Paul’s team in 1993 at age 28, as a general practitioner(GP) assisting with open-heart surgery. After leaving to study aorticsurgery and excimer lead extraction in the U.S. and Sweden, he returnedto St. Paul’s as a resident and joined the surgical team in 2005.Bashir’s expertise is important; in addition to performing standardheart surgeries, he is an expert at repairing the heart’s electrical systemin complex, severely compromised patients. With our rapidly agingpopulation, and what Bashir describes as “an epidemic of heart failurein North America,” the treatment of heart failure using devices is thefastest growing of all the cardiovascular disciplines.Bashir notes that we have come a long way since the 1950s whenthe early cardiac pioneers began performing surgery – 60 per cent oftheir patients died.“Today, when it comes to most routine major heart surgeries, wehave an almost zero per cent mortality. It isn’t just our surgical skillsthat have improved: we’ve also seen enormous improvements inpre-op care, anesthesia and post-op care, especially when it comes tonursing. Over the years, St. Paul’s has developed a culture of excellence,which has contributed enormously to our current reputation asone of the best heart centres in the world.”Breath oF LiFeThat St. Paul’s is also recognized worldwide for its lung research isthanks in large part to the leadership of two lung specialists recruited toSt. Paul’s more than three decades ago.EThe Providence Heart + Lung Institute at St. Paul’s Hospital is built upon a legacy of innovation and commitment to excellence. From the creation ofthe only Canadian-made heart-lung machine to the world’s first minimally invasive aortic valve replacement surgery, our history is one of pioneeringmedical advances and new care solutions. Below are some key milestones in cardiopulmonary care and research:1959Dr. Harold Rice, (right)the director of the ClinicalInvestigation Unit at St. Paul’sHospital, designs and builds theonly Canadian heart-lungbypass machine ever made.The machine is used for thefirst 1,000 open-heartsurgeries performed atSt. Paul’s.1960In the first open-heart surgery atSt. Paul’s, an atrial septal defect (holein the heart) is successfully closed.1963 – 1964Dr. Al Gerein performs the firstsuccessful valve replacement surgeryin B.C. One year later he performs thefirst double valve replacement reportedin Canadian medical literature and whatis likely the first triple valve replacement in Canada.Mid-1960sSt. Paul’s Hospital opens its first Pulmonary FunctionLaboratory to test patients’ lung function.1973St. Paul’s Hospital’s chapel is transformed into a new15-bed Cardiac and Pulmonary Unit. The number ofopen-heart operations increases to five per week withthe new facility.14 Promise • Spring/Summer 2009Photographs: courtesy PHc archives (dr. kavanagh-Gray and dr. Rice); Brian Smith (Sahota family, drs. cheung and Bashir)

lung function and lung pathology. Now we are more concerned withmolecular studies, right down to the DNA. It holds a lot of promisefor our patients.”Above left: Dr. Denise Daley is studying the genetics of asthma; Dr. Peter Paré(above right) continues to research chronic obstructive pulmonary disease.In 1977, Drs. James Hogg and Peter Paré from McGill Universityarrived at St. Paul’s to establish its first Pulmonary Research Laboratory;it marked the hospital’s first step into significant laboratory research.Twenty years after Rice and his colleagues had struggled for space, Hoggand Paré’s first challenge was finding a home for the lab’s new electronmicroscope. They finally settled on an underused nurses’ locker room inthe hospital. With a rare combination of research and clinical skills, Hoggand Paré were charged with establishing a culture of scientific researchwithin a busy hospital environment, something Paré believes is still a workin-progressat St. Paul’s – from hospital administrators affirming how policiesand procedures affect patient care, and caregivers conducting clinicaltrials, to researchers discovering new tests for health problems.Thanks to Hogg’s, and later Paré’s, leadership, combined with recentexciting breakthroughs in genetics and molecular biology, St. Paul’s haswitnessed an explosion of lung research through the years, especially inthe areas of asthma and emphysema. Along the way, the team developedone of the world’s largest lung tissue banks, providing an invaluable toolfor researchers around the world studying lung diseases at the cellular andmolecular levels. Having outgrown two facilities, the Pulmonary ResearchLab is now a vital component of the interdisciplinary James Hogg iCAP-TURE Centre for Cardiovascular and Pulmonary Research.“So far it has been a very exciting and challenging journey,” observesParé, who after 32 years at St. Paul’s is still conducting research intochronic obstructive pulmonary disease (COPD), particularly emphysemaand asthma.“We have witnessed some incredible, almost unimaginable advancesin recent years,” he says. “Back when we started we only looked atinvestigating asthmaHelping to unlock the key to asthma to improve the outcomes forthe more than three million Canadians with the disease is St. Paul’siCAPTURE scientist Dr. Denise Daley. Daley, 40, is one of the onlyresearchers in Canada with a background in genetic epidemiology, afield which draws upon epidemiology (the study of how diseases oftenoccur in different groups of people and why) and genetics (the study ofhow traits such as eye and hair colour or asthma can be passed fromparent to child), and biostatistics (the interpretation of statistical datacollected in studies related to human health). She is one of the world’spremier young investigators of the genetics of asthma. She is also aMichael Smith Foundation Scholar and holds a Canada Research Chairin Genetic Epidemiology. Combining the skills of a classically trainedepidemiologist and a geneticist, Daley brings unique expertise andperspective to the study of the genetic risk of heart and lung diseases.Researchers have long known that asthma has both a genetic andenvironmental component. Taking this one step further, Daley is interestedin how genetic predisposition and environmental factors interact:whether they cause asthma or protect against it. Her work is partof an important worldwide collaborative effort to isolate the causes ofasthma, which is on the rise.Like Bashir, Daley typifies the youth, enthusiasm and energyfound in all corners of the Providence Heart + Lung Institute atSt. Paul’s Hospital. While she describes asthma as “a complex puzzle”(and one she does not expect to be solved in her lifetime), Daley isnot discouraged. She simply works harder: “It gives me a great sense+St. Paul’s Hospital Foundation is proud to facilitate support fromgenerous donors for many initiatives in the Providence Heart + LungInstitute at St. Paul’s Hospital. Current needs in the institute includefunding for Western Canada’s first high-definition CT scanner to diagnoseheart and lung problems, research fellowships for physician fellows andnurses, a Chair in Women’s Cardiovascular Health and a Professorship inAdult Congenital Heart Disease.For more information about these and other needs to furtherSt. Paul’s excellence in heart and lung care, education and researchor to donate, call 604-682-8206 or visit www.helpstpauls.com. l1977The addition of the Pulmonary Research Laboratoryin 1977 brings Dr. James Hogg, a lung pathologist,Dr. Peter Paré, a respiratory physician (respirologist),and Lisa Baile, a respiratory research scientist, toSt. Paul’s and launches a new era of research and afurther expansion of St. Paul’s capabilities.1980Drs. Doris Kavanagh-Gray and Art Dodek performthe first angioplasty at St. Paul’s.St. Paul’s is the first hospital in B.C. to treat AIDSpatients. Often involving respiratory complicationssuch as resistant pneumonias, AIDS quickly becomesa major part of respiratory care. >>St. Paul’s lung research pioneers Drs. James Hogg (top left) and Peter Paré (top middle) proudly pose with a pulmonary plethysmograph (used to measure lung capacity)in the late 1970s with then-chairman of St. Paul’s Hospital’s board Dr. Ron Longstaff (top right) and Dr. Pat McGeer, a UBC professor and then B.C.’s Minister of AdvancedEducation (bottom).Photograph: courtesy PHc archivesSpring/Summer 2009 • Promise 15

»PRoVidence HeaRt +lunG inStitute atSt. Paul’S HoSPitalToday all Providence Health Care’s heartand lung research, teaching and patientcare programs operate under a singleumbrella at St. Paul’s – the Providence Heart+ Lung Institute. Since its creation in 2007,the institute has improved collaborationbetween hundreds of researchers, educators,physicians and other health-care professionalsworking in laboratories, classrooms, operatingrooms and at patients’ bedsides to developbetter care for British Columbians.The institute continues to attract someof Canada’s brightest medical and investigativeminds. It is home to an unmatchedcross-section of clinical and investigativeefforts across four distinct but linkedhospital enterprises: the St. Paul’s HeartCentre; the Pacific Lung Health Centre;the James Hogg iCAPTURE Centre forCardiovascular and Pulmonary Research;and the Centre for Health Evaluation andOutcome Sciences (CHÉOS). lof satisfaction to know that I am working onproblems that will help people now and in thefuture – that what I am doing matters.”Daley is very much aware that she, Bashirand their contemporaries are fulfilling thedreams of hundreds of heart and lungresearchers at St. Paul’s who paved the way forcurrent and future advances.“While every era has its breakthroughs,this is an especially exciting time because thefield of genetics is moving at such an amazingpace,” says Daley. “What I learned in gradschool is now obsolete. Today we’re mappingsusceptibility genes and doing studies that 10years ago were only theoretically plausible.”As St. Paul’s looks forward to futuregrowth and expansion, the history of thesepioneering efforts in heart and lung careremind everyone involved of the commitmentrequired to leave a legacy of excellenceand to improve the care for hundreds of thousandsof patients in B.C., Canada and beyond.From the world-renowned research intorespiratory illnesses like COPD that is beingadvanced by younger generations of cliniciansand scientists, to early innovations incardiac procedures and surgeries that haveinspired internationally recognized innovationsin heart repair and treatment, the healthcareadvances of yesterday are influencing thesolutions of tomorrow at St. Paul’s.This commitment continues at the ProvidenceHeart + Lung Institute, evident in the1987The McDonald Research Laboratory opens, spurred byadvancing lung research programs as well as deepeningefforts in critical-care research and heart failure studies.1993Dr. Bruce McManus and his cardiovascular researchteam are recruited to Vancouver and join theMcDonald Research Laboratory, leading investigationsof heart- transplant rejection and virus infection ofheart muscle.1994St. Paul’s celebrates its 100th birthday and launches theflagship Heart Centre. Over the next few years many ofthe province’s highly specialized cardiac programs andservices are transferred to St. Paul’s from ShaughnessyHospital and Vancouver General Hospital.1999B.C.’s first percutaneous atrial septal defect (holein-heart) and ventricular septal defect closures areperformed at St. Paul’s Hospital.St. Paul’s Hospital becomes one of the first in the worldto perform chemical (alcohol) ablation for hypertrophicobstructive cardiomyopathy. This technique is thenshared with interventional cardiologists from Calgary,Edmonton, Winnipeg and Toronto.2000 – 2001Investigators of the iCAPTURE Centre laboratories(formerly the McDonald Research Laboratory) twiceattract major national infrastructure funding, andreopen with leading-edge technologies, establishingSt. Paul’s as one of the leading centres for cardiovascularand pulmonary research in North America.2002The B.C. Acute Heart Failure Program opensat St. Paul’s Hospital and the first successfulventricular assist device (mechanical heartpump) implant in Western Canada is performed.2004The Pacific Lung Health Centre opens at St. Paul’sHospital to provide excellent care and patienteducation programs for common lung diseaseslike asthma for people throughout B.C.high level of co-operation and collaborationthat exists between physicians, nurses andresearchers, between the hospital and theUniversity of British Columbia and betweeneveryone involved with the institute and theirmany grateful patients. ■2005A team of specialists at St. Paul’s Hospital performthe world’s first minimally invasive “beating heart”apical aortic valve replacement surgery.2006St. Paul’s Hospital performs Canada’s first implant ofa wireless defibrillator cardiac device.St. Paul’s Hospital launches Canada’s first MetabolicSyndrome Program, a prevention program for peopleat risk of cardiovascular disease, stroke, and Type 2diabetes.2007The Providence Heart + Lung Institute at St. Paul’sHospital is established to integrate all areas in thehospital devoted to heart and lung care and researchfor greater value and impact.The Heart Centre’s interventional cardiology programperforms St. Paul’s 100th percutaneous heart valvereplacement.A Pacific Lung Health Centre team wins an internationalaward for PRIISME, an integrated chronic diseasemanagement program for patients with chronicobstructive lung disease (COPD) for use in bothhospital and community settings.2008Cardiac surgeons perform British Columbia’s 300thheart transplant.British Columbia’s first-ever Advanced Cardiac ImagingOperating Room opens at St. Paul’s Hospital.Four Providence Heart + Lung Institute scientiststake the lead on the genetics component of thelandmark, six-year, multi-site Canadian HealthyInfant Longitudinal Development (CHILD) Study todetermine how genetic and environmental factorsinfluence the development of asthma and allergiesin children.To learn more about the history of pulmonary and cardiaccare and research, or for more information about theProvidence Heart + Lung Institute at St. Paul’s Hospital,visit www.heartandlung.ca16 Promise • Spring/Summer 2009

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