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Conversation

Dr. Richard J. Shemin

Dr. Richard J. Shemin - Chief of Cardiothoracic Surgery REGARDED AS ONE OF the country’s leading heart surgeons, Dr. Richard J. Shemin took over the helm this year as chief of cardiothoracic surgery at UCLA. He arrived in Los Angeles from Massachusetts, where he was professor and vice chairman of surgery and chief of the cardiothoracic division at Boston University School of Medicine and co-director of the Cardiovascular Center at Boston Medical Center. At UCLA, he will have similar titles: professor of surgery and chief of cardiothoracic surgery, vice chairman of the UCLA Department of Surgery and co-director of the new Cardiovascular Center at UCLA.

Dr. Shemin earned his M.D. from Boston University School of Medicine and did his general-surgery residency at Harvard Medical School and Brigham and Women’s Hospital in Boston, and he completed his training in cardiothoracic surgery at New York University Medical Center.

UCLA MEDICINE: You came to UCLA with a very clear vision of what you want for the Division of Cardiothoracic Surgery.
DR. SHEMIN: My vision is to build upon the strengths of the division, which already is one of the best in the country, but also to develop areas of cardiac care that have not traditionally received as much focus. UCLA’s heart- and lung-transplant programs, for example, are among the best in the world, and our device program for supporting the heart, and even replacing the heart in the future, is positioned among the leaders. But there are other areas that are also very important that need further development. These include expanding our programs for congenital heart disease as well as in the realm of adult cardiac surgery – particularly where it involves minimally invasive approaches to valvular heart disease and aortic disease. Those are areas where I have an extensive background and expertise that will further enhance our ability to provide those services.

UCLA MEDICINE: How will the new cardiovascular center you plan for UCLA set us apart?
DR. SHEMIN: Cardiovascular centers are a very important way to provide care that is integrated across traditional academic department lines to efficiently deliver treatment for cardiac and vascular diseases in the outpatient and diagnostic setting. From the standpoint of the patient, there is a better consultation and communication with the physicians, which signifi cantly improves the patient’s level of satisfaction. Another important focus of the cardiovascular center is to look for new ways that cardiologists, surgeons and vascular specialists can work together to provide training opportunities for residents across disciplines.

UCLA MEDICINE: Tell us about some of the signifi cant research taking place at UCLA and where it might lead.
DR. SHEMIN: There is a tremendous amount of work being done in arrhythmia control and ablation procedures. A major advantage of a cardiovascular center is having our surgical team work together with our Arrhythmia Center cardiologists to investigate new approaches to treating arrhythmias, both medically and surgically. With our interest in organ transplantation, we are working toward ways to improve methods to recover and preserve the organ until it is implanted into the recipient. We have pioneered technologies, not only to prolong preservation time, but also to reperfuse the organ with blood from the recipient once the organ is transplanted. We’ve also developed procedures to modify what is known as reperfusion injury, and UCLA has advanced techniques to help control organ rejection and to provide better ways to maintain and support the patient if severe rejection occurs. In genetic, tissue-engineering and stem-cell research, we’re looking at mechanisms to regenerate cardiac muscle so patients with damaged hearts won’t require transplantation, or to stimulate the heart to improve its own blood supply through angiogenesis.

UCLA MEDICINE: UCLA is advancing its robotic-surgery program. What are the advantages of using a robot?
DR. SHEMIN: The whole movement to provide patients with less-invasive surgery is based on the premise that the smaller the incision and the less trauma you produce to the body, the less pain there is, the quicker the recovery and the faster the patient gets back to his or her life. Through very small incisions, a three-dimensional, high-definition camera and robotic instruments are inserted into the patient. The camera system allows us to magnify parts of the heart up to 15 times, and that gives us very good defi nition of the anatomy so we can perform very complex and exacting procedures. As a result, we can do wonderfully effective repairs to heart valves or blood vessels with very tiny incisions and rapid recovery times, which also leads to lowered healthcare costs. We predict that robotics will play an increasingly signifi cant role in cardiac surgery.

UCLA MEDICINE: What other advances that will dramatically alter the field of cardiothoracic surgery are on the horizon, and where is UCLA poised to break new ground to advance the field?
DR. SHEMIN: Cardiovascular medicine continues to advance at a very rapid rate, and there are many new breakthroughs on the horizon. Probably one of the fi rst that will appear in clinical practice is the use of percutaneous valves to replace diseased valves. Instead of having to go through a major operation, a valve can actually be collapsed and put in through an artery and inserted into its appropriate position in the heart after dilating the diseased old valve. We will be in a wonderful position to provide this technology safely to patients. Teams comprising a surgeon and interventional cardiologist are poised to work with the rest of the support team members in our new hybrid-procedure rooms in the new Ronald Reagan UCLA Medical Center. In addition, we are collaborating on breakthroughs with our colleagues in the fi elds of nanotechnology and bioengineering. The Center for Advanced Surgical and Interventional Technologies (CASIT), a training and simulation center, focuses on advanced research and development of new surgical technology. And we are in the era of cardiovascular genomics. UCLA is conducting research in stem-cell medicine to provide opportunities to grow heart valves on scaffolds, to grow new heart muscle to replace scar tissue from heart attacks and to stimulate new blood-vessel growth in patients who have disease of their arteries.

UCLA MEDICINE: What are the most dramatic changes that you’ve seen in the fi eld of heart surgery?
DR. SHEMIN: I have witnessed the development of reliable artificial heart valves and the reproducibly effective techniques to repair or replace diseased heart valves. There have been exciting developments in devices that support the failing heart. Today we are on the threshold of a new generation of very small artifi cial devices to support the failing circulation or to assist in complex procedures. We are on the threshold of the next generation of devices to perform total replacements of the human heart. The surgical treatment of coronary-artery disease with the proven effective coronary-artery bypass operation and percutaneous approaches to the coronary arteries, particularly with stent technology, have made a successful impact on coronary-artery disease. There have also been major advances in our understanding of the basic mechanisms of disease that have led to new drugs, new therapies and new ways to prevent cardiac disease and disability. Finally, all these advances coupled with improved intensivecare units and less-invasive approaches have led to cardiac patients living longer, with less morbidity. Patients are more active and experiencing higher qualities of life. All this progress has been made in a relatively short period of time, but I firmly believe the future is clearly as bright as the accomplishments of the past for the care of the cardiovascular patient.

 





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