LIFETIME ACHIEVEMENT: “IT TAKES A VILLAGE”

LIFETIME ACHIEVEMENT:
“IT TAKES A VILLAGE”
…AND WHAT VILLAGES
I’VE LIVED IN!!
It is especially gratifying and humbling
to be included in the small group that
includes two of my main mentors
NORMAN SHUMWAY
MARGARET BILLINGHAM
Early 1960’s…
“Crazy stuff”
happening in the
lab at Stanford –
The first dog to
live with a
transplanted heart
I AM IN HIGH SCHOOL
The Stanford group described…
…the physiology of the denervated heart
in the orthotopic position in the dog,
demonstrating nearly normal cardiac
function at rest and during exercise*.
*Lower RR, Shumway NE. Studies of orthotopic
homotransplantation in the canine heart. Surg Forum
1960;11:18-19
MEANWHILE…
I am working summers during
undergraduate school in a
Cleveland Clinic research lab
under the guidance of a fatherly
old guy
There were a number of interesting
people there doing exciting things…
Willem Kolff
James McCubbin
Rene Favaloro
Mason Sones
Harriet Dustan
,
Dr. Willlem Kolff
Kolff actually implanted the first artificial heart in
1957. The animal lived for 90 minutes.
Dr. Rene Favaloro
.
THE FATHERLY OLD GUY
.
1968 - The first year that the N of women
in a Stanford medical school class was >1
.
1968 - The first year that the N of women
in a Stanford medical school class was >1
Lead article from same journal
December 3, 1967…
The first clinical heart
transplant..
…in South Africa,
not Palo Alto…by Dr.
Christian Barnard
January 6, 1968
First Stanford clinical
transplant by Shumway et al.
Our Fearless Leader…
Norman E. Shumway
Ed Stinson
Norman Shumway
Philip Oyer
1968-1969
Unbridled enthusiasm for heart
transplantation…
101 procedures in first calendar
year…with abysmal results (<30%
survival)
After 1969…
The “birth” of heart
transplantation…
Almost “aborted” with an unofficial
moratorium on clinical transplants
.
Decade of the 1970’s…
Slow, steady progress, many incremental
“milestones”…
Introduction of biopsy to diagnose rejection
and assess efficacy of therapy
Introduction of distant heart procurement
Many improvements in infection diagnosis
and therapy
1982 – A “milestone” year
Cyclosporine immunosuppression
introduced
Survival rates increase markedly, now
>80%
.
EVOLUTION OF PUBLIC PERCEPTION
Many Milestones:
INTRODUCTION OF HEART BIOPSY FOR
REJECTION SURVEILLANCE
1972
Philip Caves
Scottish surgical resident at Stanford
Other Milestones:
INTRODUCTION OF
STANDARDIZED BIOPSY
GRADING SCALES
First one at Stanford by
Margaret Billingham
1974
Other Milestones:
CLINICAL INTRODUCTION OF DISTANT
HEART PROCUREMENT
1977
Distant heart procurement…
 Current organ distribution relies almost
totally on this system
 Previously, the brain dead donor needed to
be transported to the transplant center and
the heart “harvested” in an adjoining
operating room
 This was not an agreeable arrangement for
donor families and did not promote multiorgan donations
Other Milestones:
FOUNDING OF OUR :
INTERNATIONAL SOCIETY
FOR HEART
TRANSPLANTATION
1980
Other Milestones:
And later…
ESHLT, and others
Other Milestones:
CLINICAL INTRODUCTION OF MAJOR
CHANGE IN IMMUNOSUPPRESSION:
(at Stanford)
1982
Cyclosporine
Increase in survival rates from 60% to 80%
range at 1 year
Other Milestones:
Our own journal
and Registry
1982
Other Milestones:
INTERNATIONALLY STANDARDIZED HEART
BIOPSY GRADING SYSTEM*
1990
Internationally accepted
Reproducible
*Billingham ME et al. J Heart Transplant 1990;9:587.
Other Milestones:
Recognition by the larger
cardiovascular
communityACC Bethesda Conference
1992
ACC Bethesda Conference - 1992
Other Milestones:
Recognition by the larger cardiovascular
communityACC Core Cardiology Training Symposium
1994
First outlined training for transplant
cardiology specialists
Updated in 2002 and 2009
Most recent milestone:
Recognition by ABIM of the field
(Advanced Heart Failure/Transplant
Cardiology) as a discrete subspecialty
First board exam was given November
2010, will be given every two years
All in all…an incredibly
rewarding career!
Working with incredibly bright
and dedicated colleagues and
trainees.
I’M A VERY LUCKY LADY!!
THANK YOU!!!!