Francisco Fernández-Avilés, MD, PhD, FESC, FACC - Circulation

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Circulation June 9, 2009 Centre of Excellence: Department of Cardiology, University Hospital Gregorio Marañón, Madrid, Spain An Ambitious Research Programme with a Budget of $6 Million and Major Research Projects on Heart Failure, Coronary Syndromes, Cardiac Valve Disease, Cardiovascular Imaging, Arrhythmias, and Stem Cell Therapy Francisco Fernández-Avilés, MD, PhD, FESC, FACC, chair of the Department of Cardiology, University Hospital Gregorio Marañón, Madrid, Spain, describes the Department and its work to Barry Shurlock, MA, PhD. Team photo May 2007. Department of Cardiology. University Hospital Gregorio Marañón, Madrid, Spain. The Department of Cardiology has 4 divisions—clinical, noninvasive, invasive, and research, innovation, and education—with a medical staff of 30, about 25 fellows and newly qualified specialists, and an ever-changing contingent of about 20 visiting researchers. Photograph courtesy of Professor Fernández-Avilés. In Madrid, Francisco Fernández-Avilés, MD, PhD, FESC, FACC, runs a large Department of Cardiology at the University Hospital Gregorio Marañón, Madrid, Spain. With origins in 1567, when King Phillip II founded the hospital, it now belongs to the Public Heath Service of Madrid and receives more than 65000 admissions a year in all departments. Every year, more than 35000 cardiac patients pass through the 7 outpatient clinics, and more than 5000 are admitted to the 51-bed cardiology ward and/or the 11-bed coronary care unit. They are served by 4 catheterisation laboratories, 2 focused on intervention plus another for electrophysiology and a multifunction laboratory. A large imaging centre with 11 echocardiographs produces more than 20000 scans (echos) each year. The department performs nearly 1000 electrophysiology studies a year, of which about 75% are therapeutic. Despite a considerable administrative load, Professor Fernández-Avilés manages to spend about half his time with patients or doing research. He explains, “I love my department! I am an interventional cardiologist and I love it! But I also love to be close to the patient and receive input from the patient. I believe that everything should be based on the patient. I am not fond of administration—but it’s very important: If you want to improve the situation of patients, staff, Downloaded from http://circ.ahajournals.org/ by guest on December 2, 2012 f131 Circulation: European Perspectives
f132 Circulation June 9, 2009 Circulation: European Perspectives An endovascular percutaneous implantation of a prosthetic aortic valve perfomed by Professor Fernández-Avilés at the Department of Cardiology at the University Hospital Gregorio Marañón, Madrid, January 31, 2009. This type of procedure, which is performed using a simple groin puncture and local anaesthesia, avoids the need for open heart surgery and has revolutionised the field of cardiac valve replacement. Photograph courtesy of Professor Fernández-Avilés. fellows, and students, you must fight for it, and that means lots of administration! To achieve goals, you need to spend time—you have to have a meeting, then another meeting, and another. So, although one very important focus is the patient, the other is the team. As ‘the boss,’ you need to create a framework and have goals, and you need to be firm. But you also need to allow people to ‘roam’ with freedom, to be free and autonomous, otherwise the team will fragment.” “Working in Another Country Is Essential” Professor Fernández-Avilés clearly values working abroad, although he never managed to do so himself. In 1982, after completing his PhD, he planned to work at the Montreal Heart Institute, Quebec, Canada, but his plans were thwarted when his mother fell ill and he decided to stay home. He comments, “For young cardiologists, working in another country is essential. It’s almost obligatory for my young fellows to go abroad. They normally come back and then try to incorporate the knowledge they have gained into their clinical practice. But it’s not only for clinical and scientific knowledge that they go─they also get new ideas on life and culture.” In line with this philosophy, the Department of Cardiology has close relations with a number of major institutions, including the Mayo Clinic, Rochester, Minn, the Mount Sinai Heart Centre, New York, NY, and the Texas Editor: Helmut Drexler, MD, FESC Managing Editor: Lindy van den Berghe, BMedSci, BM, BS We welcome comments. E-mail lindy@circulationjournal.org Heart Institute, Houston, Tex. It also runs a “Meet With the Cardiovascular Experts” programme, where senior specialists from top cardiac centres in the world spend 2 days every month in the University Hospital Gregorio Marañón giving lectures and sharing their experiences with staff members. “We Are Focusing on Translational Research” The Department of Cardiology has an ambitious research programme with a budget of $6 million and major research projects on heart failure, coronary syndromes, cardiac valve disease, cardiovascular imaging, arrhythmias, and stem cell therapy. 1–3 All cardiovascular interventions are performed, including heart transplantations, left-ventricular support procedures, and stem cell therapy. Emphasising that the Department of Cardiology has one of the largest cardiovascular caseloads in the whole of Spain, Professor Fernández-Avilés says, “We want to cure, so we need to know more. In other words, in our research the idea is to put the patient at the centre of the work, both in clinical and basic studies. We are focusing on translational research, trying to reduce the impact of the main cardiovascular pathologies through biomedical innovation.WearepartofanorganisationofwhichIamthe national chair, namely, the Spanish Cooperative Cardiovascular Disease Research Network [Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares], which is run by the Spanish Ministry for Science and Innovation and integrates about 700 researchers and 50 basic and clinical research groups from around the country. We are mainly concerned with heart failure, ischaemic heart disease, and arrhythmias—trying to improve knowledge and therapy. Our main research areas include molecular biology, imaging, stem cell therapy, and electrophysiology. A major priority is to reduce the detrimental impact of myocardial infarction on left-ventricular function by reperfusion, myocardial protection, and stem cell therapy.” References 1. Cortina C, Bermejo J, Yotti R, Desco MM, Rodríguez-Pérez D, Antoranz JC, Rojo-Alvarez JL, Garcia D, García-Fernández MA, Fernández-Avilés F. Noninvasive assessment of the right ventricular filling pressure gradient. Circulation. 2007;116:1015–1023. 2. Bratos-Pérez MA, Sánchez PL, García de Cruz S, Villacorta E, Palacios IF, Fernández-Fernández JM, Di Stefano S, Orduña-Domingo A, Carrascal Y, Mota P, Martín-Luengo C, Bermejo J, San Roman JA, Rodríguez-Torres A, Fernández-Avilés F; Grupo AORTICA (Grupo de Estudio de la Estenosis Aórtica). Association between self-replicating calcifying nanoparticles and aortic stenosis: a possible link to valve calcification. Eur Heart J. 2008;29:371–376. 3. Datino T, Almendral J, González-Torrecilla E, Atienza F, García-Fernández FJ, Arenal A, Atea L, Fernández-Avilés F.Rate-related changes in QRS morphology in patients with fixed bundle branch block: implications for differential diagnosis of wide QRS complex tachycardia. Eur Heart J. 2008;29:2351–2358. Barry Shurlock is a freelance medical journalist. The opinions expressed in Circulation: European Perspectives in Cardiology are not necessarily those of the editors or of the American Heart Association. Downloaded from http://circ.ahajournals.org/ by guest on December 2, 2012
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Francisco Fernández-Avilés, MD, PhD, FESC, FACC - Circulation

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