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  • 1. Inside This Issue The Young Low LDL & Normal Indications Remote Moni- Genetic Cause of Helping Blood Pressure for Ventricular toring in Heart Deadly Irregular Heart the Old? p3 Slows Arterial Plaque Assist Devices Failure p16 Beat Discovered p17 Growth p4 Expanded p6 Cardiac Consult Heart and Vascular News from Cleveland Clinic | Summer 2009 | Vol. XVIV No. 2 Featured Article Minimally Invasive Cardiac Surgery Comes of Age - p8Flashback:
  • 2. Dear Colleagues, Cardiac Consult offers updates on state- of-the-art diagnostic and management techniques from Cleveland Clinic heartMinimally invasive surgery is no longer exotic. Thirteen years ago, Delos M. and vascular specialists. Please directCosgrove, MD, performed the rst minimally invasive aortic valve surgery. correspondence to: Medical EditorsIn 2008, we performed 462 minimally invasive aortic and mitral valve Christopher Bajzer, MDprocedures, with 0 percent hospital mortality. Cleveland Clinic surgeons A. Marc Gillinov, MD Sean Lyden, MDnow consider a minimally invasive option rst for nearly every patient. 216.448.1026 gillinm@ccf.orgThis issue of Cardiac Consult offers a brisk review of Cleveland Clinics minimally Managing Editorinvasive thoracic and cardiovascular surgery program. Youll nd mention of the Ann Bungohighly successful valve procedures, along with our robotic surgery program, Marketing Manager Megan Frankelvideo-assisted lobectomies, and new percutaneous techniques. Art Director Michael ViarsMedical technology is racing to keep ahead of demand for minimally invasive Photographers Tom Mercealternatives. The appeal is obvious: less pain, fewer complications, shorter hospital Steve Travarca Don Gerdastays. Minimally invasive cardiac surgery is bound to be a hot topic at the big Russell LeeThe Treatment of Cardiovascular Disease: Legacy & Innovation symposium, beingheld here in June. We invite you to join us for this one-time state of the heart offers informa- tion on new procedures and services, clini-global overview of the very latest in cardiac surgery, vascular surgery, cardio- cal trials, and upcoming CME symposia, as well as recent issues of Cardiac Consult.vascular medicine, and their related disciplines. The Sydell and Arnold Miller Family Heart & Vascular Institute, ranked No. 1 in the nation for cardiac care by U.S.NewsThe other articles in this issue of Cardiac Consult reect the breadth and variety & World Report every year since 1995, accommodates nearly 300,000 patientof our eld: new views on ventricular assist devices, lung transplant donation, visits each year in world-class facilities.remote monitoring in heart failure and more. Staff are committed to researching and applying state-of-the-art diagnostic and management techniques. Cleveland Clinic is a not-for-prot, multispecialty academicWe continue to be inspired by the way new technologies advance medicine medical center.and transform lives. As minimally invasive techniques become commonplace, Cardiac Consult is written for physicians and should be relied upon for medicalyoull nd us at the frontier of the next big advance, whatever it may be. education purposes only. It does not provide a complete overview of the topics covered, and should not replace the inde- pendent judgment of a physician about the appropriateness or risks of a procedureSincerely, for a given patient.Christopher Bajzer, MD Sean Lyden, MD The Cleveland Clinic Foundation 2009Associate Director, Peripheral Intervention Staff Surgeon,Interventional Cardiology Vascular SurgeryA. Marc Gillinov, MDThe Judith Dion Pyle Chair in Heart Valve ResearchThoracic and Cardiovascular SurgeryPage 2 | Cardiac Consult | Summer 09 | Cleveland Clinics toll-free physician referral number is 800.553.5056
  • 3. The Young Helping the Old? Can younger or newer stem cells give a regenerative boost to donors could help older patients who are recovering from heart Marc Penn, MD, PhD attacks or aortic stenosis. Marc Penn, MD, PhD, Cleveland Clinic Stem Cell Biology and Regenera- tive Medicine and Department of Cardiovascular Medicine, investigates how hearts damaged by heart attacks attract adult stem cells by sending out homing signals. Stem cells found in the bone marrow respond to this signal and migrate to the damaged area to become new heart tissue cells. Dr. Penns research has expanded to also focus on how aging might affect the homing process and the stem cells ability to specialize, or differenti- Dr. Penn induced aortic stenosis in mice. Stem cells from the bone marrow of an older generation of the mice were transplanted into younger mice with the condition. The younger mice didnt respond well and the condition worsened. However, stem cells from the younger mices bone marrow were trans- planted into the older generation with noticeable improvement to the older mices cardiac health. It would appear that stem cells may tire out over time. Theres evidence that aging does play a role on stem cell function. Now were trying to determine if its the heart not sending out the message to stem cells, or the stem cells not responding to the signal, Dr. Penn says. The heart needs to grow new vessels to nourish the new cells. But if the stem cells arent getting to the heart, the heart dilates and the patient develops heart failure in response to aortic stenosis. We hope that by deciphering the signaling process we will be able to develop new therapies for patients with aortic stenosis and weak hearts. To coordinate the range of stem cell and regenerative medicine research projects focused on cardiovascular diseases, Dr