Research at Sutter Health Brings New Hope to People with Cardiovascular Diseases
SAN FRANCISCO – New discoveries in cardiovascular diseases can arise in a heartbeat, and few researchers across Sutter Health know this better than David Roberts, MD, FACC, FSCAI, Medical Director of Cardiovascular Services (Valley Region) at Sutter Health. Dr. Roberts’ 25-year career at Sutter parallels the leading-edge advances in cardiovascular diseases care and research aimed at treating patients with illnesses such as hypertension (high blood pressure), heart valve diseases, heart failure, myocardial infarction (heart attack), and coronary artery disease.
“It’s been an incredibly exciting time to conduct cardiovascular research. Over the last two decades, advances driven by research have been breathtaking and revolutionary. We are now applying lessons from research every day to dramatically impact and improve the lives of our cardiovascular patients,” says Dr. Roberts, who has led over 30 clinical trials at Sutter Medical Center in Sacramento.
Board certified in internal medicine with sub-specialties in interventional cardiology and cardiovascular diseases, Dr. Roberts’ pioneering research at the Sutter Institute of Medical Research and his clinical expertise helped propel the cardiovascular diseases services offered at Sutter Medical Center and the Sutter Heart and Vascular Institute, setting them on track to become quaternary cardiovascular programs in Northern California.
Sutter offers a wide array of heart-related services in Northern California, including expert diagnoses and treatment for heart attacks, congenital cardiac defects, congestive heart failure, valve conditions, heart arrhythmias, and circulation problems. From its beginning in 1957, the Sutter Heart & Vascular Institute has been a pioneer in providing the latest advances in care to patients of all ages.
We interviewed Dr. Roberts about his perspectives on the latest cardiovascular diseases research and clinical trials at Sutter Health.
- Despite advances in minimally invasive interventional approaches, what are the most pressing challenges in treating patients with diseased or damaged heart valves?
We still do not have good options for treating high-risk patients with mitral stenosis, which is a narrowing of the mitral valve opening that obstructs blood flow from the left atrium to the left ventricle. Left untreated, mitral valve stenosis can lead to serious heart complications. However, there is significant research underway that is trying to address this need. I am optimistic we will have some excellent solutions over the next few years.
- How has your research and pioneering work in valve replacements and interventional clinical trials set the stage for recent advances at Sutter?
At the Sutter Heart and Vascular Institute, we have conducted almost 1,000 transcatheter aortic valve replacement (TAVR) procedures since 2012. This expertise in treating aortic valve stenosis puts us in the top tier of programs in the nation, with the research base and skills to treat patients requiring this procedure. This experience has allowed us to study TAVR in patients at low or standard risk for surgical aortic valve replacement, with our participation in both the PARTNER 3 randomized study, as well as the MedStar registry. The PARTNER 3 trial recently led to the U.S. Food and Drug Administration (FDA) approval of TAVR for standard risk patients. We have also studied the Portico™ TAVR valve, a self-expanding valve we are still studying for use in failed surgical valves.
Most exciting, our experience has given us the knowledge to successfully treat the other three valves in the heart, and to participate in other clinical trials treating the other three valves. As such, with our leading-edge research in heart valve diseases at Sutter, we are able to test new devices under review by the FDA for the treatment of other heart valve diseases. The result is a high-volume, high-performing, renowned program that receives referrals from leading centers across the state.
Research is an integral component of that success, helping explore new methods that may improve patients’ quality of life, with shortened recovery times, less need for lifelong medications, less re-hospitalizations after surgery, and freedom for patients to engage in their normal activities.
- What are you most excited about when we look to new advances in treatment on the horizon? (This might include new clinical trials offered at Sutter.)
With recent refinements in TAVR and an improved understanding of the best approach to treat aortic valve stenosis, we now seek to improve interventional strategies for treating patients with diseased or damaged tricuspid or mitral valves, and adult congenital heart disease of the pulmonary valve. (The tricuspid valve forms the boundary between the right ventricle and the right atrium.)
For example, we are one of the few centers in Northern California offering Melody™ TPV Therapy, which treats minimally, invasively narrowed or leaking pulmonary valve conduits between the heart’s right pumping chamber and the lungs without open-heart surgery. This is especially valuable in the treatment of adult patients with congenital heart disease, and has helped us become the second site in Northern California to secure formal accreditation in the treatment of adult patients with congenital heart disease.
We have also been selected as a study site for the minimally invasive Tendyne™ transcatheter mitral valve replacement system—a minimally invasive mitral valve replacement, as well as minimally invasive devices to repair both the mitral and tricuspid valves. These research studies explore options that appear very promising in the care of patients with mitral and tricuspid valve disease.
- Collectively, how are researchers at Sutter Health applying the latest insights in research to develop new approaches to treating patients with diseased or damaged valves?
More than five million Americans are diagnosed with heart valve disease each year. Heart valve disease can occur in any single valve or a combination of the four valves, but diseases of the aortic and mitral valves are the most common. So we’re applying new research from our center to inform care for patients with these conditions.
For example, we were one of the first centers in Northern California to treat degenerated mitral valves with mitral clips: a procedure known as transcatheter mitral valve repair. The experience gained from that procedure enabled us to become one of the first centers to use TAVR valves originally designed for the aortic valve, to treat degenerated surgical mitral valve prostheses using transcatheter mitral valve replacement (TMVR).
During the procedure, we place a thin tube called a catheter into a large vein in the patient’s leg to reach the heart. We then cross the septum (which divides the right side of the heart from the left) to reach the mitral valve. Unlike open-heart surgery, both TMVR with the MitraClip™ as well as mitral valve replacement with TAVR valves are performed while the heart is functioning. The patient is typically out of bed that same day and discharged home after one stay overnight in the hospital. To date, we’ve performed approximately 200 TMVR procedures
- What current or upcoming interventional studies at Sutter Health are you most intrigued by? Why?
The mitral and tricuspid valves are our “next frontier” and I am excited to offer our patients clinical trials testing new devices for repair or replacement of these valves.
Dr. David Roberts: 25 years of cardiovascular diseases research expertise
- Stent trials for the treatment of myocardial infarction (heart attack)
- Drug eluting stent trials for coronary artery disease
- New treatment options for patients with restenosis after stent implants
- Carotid artery stenting for treating carotid artery stenosis
- New technologies to treat peripheral artery disease, including challenging patients with calcified plaque and completely occluded vessels
Transformative care: These types of new advances at Sutter may reduce hospital stays, lower the risk of infection, yield shorter recovery times, and improve overall symptoms, quality of life and life expectancy for some patients.
Innovation: Sutter sites are among a select group of medical centers across the U.S. using these minimally invasive approaches to replace or repair heart valves. These represent creative research solutions to help solve some of health care’s most pressing challenges.