15 Years of Heart

LOS ANGELES (Oct. 3, 2022) — Pioneering heart care is a tradition at Cedars-Sinai. It’s a tradition that took root in 1924, when Cedars-Sinai became home to the first electrocardiogram machine in Los Angeles. 

The roots grew stronger in the 1970s, when two Cedars-Sinai cardiologists invented the game-changing Swan-Ganz catheter. And stronger still in 2007, when Cedars-Sinai founded what is today the Smidt Heart Institute.

On the occasion of the institute’s 15th anniversary, the Cedars-Sinai Newsroom sat down with Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark Siegel Family Foundation Distinguished Professor, to get his views on the state of cardiac medicine.

Newsroom: What are the advances you’ve seen in heart medicine over the past 15 years?   
Marbán: We’ve been able to really address programs from the point of view of the need of the patient. One thing we’ve excelled at, for example, is helping our patients with advanced heart disease—heart failure so severe that they’re facing either highly experimental stem cell treatments or heart transplantation. And these are two areas in which we’ve excelled, become the world leader in the number and also in the outcomes of heart transplants for those patients who need them. And we’ve also made quite a lot of progress in the area of regenerative medicine.

When the Heart Institute was established 15 years ago, almost all valvular problems in the heart or major structural problems required opening the chest surgically. Putting a patient on cardiopulmonary bypass. Fixing the problem in an operating room. And then keeping the patient in the hospital for about a week. In the past 15 years, the management of valvular heart disease has been completely transformed so that things that used to take that long and were that complicated can now be done as overnight therapy, using just a catheter inside the heart, and no opening of the chest.

We’ve led the way in the development of these technologies. We’ve done more such procedures than any other center in the United States.

Newsroom: How much has the Smidt Heart Institute grown?
Marbán: Over the last 15 years, the Heart Institute has seen an incredible increase in volume. We have gone from doing 25 thoracic transplants a year, meaning either lung or heart or both, to doing over 200 now, with outstanding outcomes. We have gone from doing about 3,000 catheter-based procedures a year, to 13,000 a year.

We have gone up in our U.S. News and World Report (Best Hospitals) ranking nationally, from #17 Heart Program and #5 in the western U.S. to now being #1 in the western U.S. for the past 10 years and to being the third-ranked program nationally for the last four years.

Newsroom: Also during that time, the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute has pioneered a lot of work on sex differences in heart disease.
Marbán: The Smidt Heart Institute has come to be known as the world leader in a number of areas. One of those is in women’s heart disease. In the last 15 years, we’ve really become recognized as a go-to destination for teaching, research and training. We’ve trained generations of researchers and physicians who are going into this field, and we’ve discovered that women are not the same as men and the way they manifest their heart disease. Nor are the treatments necessarily likely to work equally in men and in women.

Newsroom: What lessons were learned from the COVID-19 pandemic?  
Marbán: When the pandemic of COVID-19 started early in 2020, we were among the first to codify the cardiac complications that are associated with the disease. For example, myocarditis and other forms of acute manifestations and the long-running complications that have to do with long COVID. We were among the first to describe these situations. And since then, we’ve been at the forefront of studying the cardiac complications of COVID-19 in communities.

For example, we have a large ongoing study looking at a large number of community-based participants that then develop COVID-19 and some of whom go on to develop heart disease. We’re asking questions like, how does the heart disease manifest itself? Who’s at highest risk? What can we do about it? And of course, we’re in the data collection stage more than in the answer formulation stage, but we’ve really tried to get ahead of it rather than just being observers.

Newsroom: What kind of progress do you expect in the next 15 years?
Marbán: It’s mind boggling to imagine what might happen over the next 15. But for sure, among the trends that we’ve seen there will continue miniaturization. We believe that it’s very likely that major equipment that is now required, for example, to sustain the heart artificially—luggage sized pumps that need to be plugged in periodically to batteries—for example, as an external pump for the heart. These things will be miniaturized and implanted.

We’re going to see an enormous rise in the maturation and ability of biological therapies, gene-based and cell-based therapies, to address heart disease in a very fundamental way that actually changes the disease rather than just reacts to it. And of course, we’re getting better at prevention and also the understanding of how disease is manifested differently in men and in women, as well as in various socioeconomic groups.

Newsroom: Is there a single achievement of which you are most proud?
Marbán: The signature accomplishment of the Smidt Heart Institute has been proof of principle that by bringing together diverse specialists from different backgrounds into one setting, that we can improve patient care and our understanding of disease. What we’ve done here is created a model for how cardiology and cardiac surgery should work together to transform the care and the knowledge about illness as we move forward.

Read more on the Cedars-Sinai Blog: Matters of the Heart: C. Noel Bairey Merz, MD