Corday Prize Winner Cribier Tells Heartfelt Story
Statue awarded for 2015 Corday Prize.
In the 1980s, recalled Alain Cribier, MD, he became "fed up" with watching his sickest heart patients die after being declared ineligible for surgery. So he resolved to do something about it. His determination drove a decades-long quest for nonsurgical solutions that revolutionized cardiac medicine — and led to his winning the 2015 Eliot Corday, MD, International Prize in Heart Research from the Cedars-Sinai Heart Institute.
Cribier, emeritus professor at the University of Rouen, France, was awarded the prize April 7. At a ceremony in Harvey Morse Auditorium, he recounted the dramatic story of his inventions, previewed future advances and credited Cedars-Sinai with launching his illustrious career in science.
"I met two of my heroes of medicine here," said Cribier, referring to the late pioneering Cedars-Sinai cardiologists William Ganz, MD, and H.J.C. (Jeremy) Swan, MD. "They transmitted to me the formidable virus of research." Cribier encountered the two scientists, co-inventors of the widely used Swan-Ganz Catheter for assessing heart function, as a cardiology fellow in Ganz's laboratory in 1976-77.
Cribier's accomplishments include performing, in 1985, the first aortic valvuloplasty for the treatment of calcific aortic stenosis, or narrowing of the aortic valve opening, the most common acquired valvular disease in adults. In this technique, a catheter is placed into an artery in the groin and threaded to the heart, where it deploys a balloon that is placed across the valve and inflated to widen the opening.
In 2002, Cribier also performed the first nonsurgical implantation of an aortic valve prosthesis, known as transcatheter aortic valve replacement (TAVR) or implantation (TAVI), in humans. In this technique, a replacement valve, also delivered with a catheter, is wedged into the aortic valve's place. In 2012 Cribier was awarded the French Legion of Honor.
In introductory remarks, Eduardo Marbán, MD, PhD, director of the Heart Institute and professor of Medicine, described the impact of Cribier's innovations.
Alain Cribier, MD, delivering the Corday Prize lecture.
"Before Cribier, you had to have open-heart surgery for a leaky valve," Marbán explained, which he said can entail lengthy recovery time and mortality rates up to 20 percent for older and sicker patients. "Today, sometimes our patients go home the next day. It's a dramatic change in how we practice medicine."
But in the beginning, Cribier's concepts faced a steep uphill battle. For five years in the 1990s, he unsuccessfully sought sponsors to help him develop nonsurgical valve replacement. Critics said the procedure was either impossible or would pose unacceptably high risks of stroke or other complications, he explained.
Even Cribier at the time thought that using a catheter-delivered device to replace a valve in a beating heart was "the most challenging, crazy concept." But for him, that was part of the idea's appeal. He cited a favorite quote from Edwin H. Land (1909-1991), founder of Polaroid Corp. and inventor of the instant camera: "Don't undertake a project unless it is manifestly important and nearly impossible."
In 1999, Cribier and partners founded their own company, Percutaneous Valve Technologies Inc., to refine the TAVR technique. A breakthrough came in April 2002, when, in an attempt to save the life of 57-year-old man dying from heart disease, they nonsurgically replaced his aortic valve. Within eight days, Cribier said, the patient was "totally resuscitated. This was the most fantastic adventure of my life in my career."
(left to right) Stephen Corday, MD, son of the late Eliot Corday, MD; Corday Prize donor Brindell Gottlieb; 2015 winner Alain Cribier, MD; and Cedars-Sinai Heart Institute Director Eduardo Marbán, MD, PhD.
Since then, working with Edwards Lifesciences Corp. of Irvine, California, which acquired his company in 2004, Cribier has steadily worked to improve the effectiveness and safety of TAVR. He said the technique is used in about 75,000 procedures worldwide each year.
For now, the technique in the U.S. is limited to a relatively low number of patients, i.e., those who are high risk or too frail to undergo open-heart surgery. But Cribier said he hopes that within 10 years, TAVR might become the prevalent operative therapy for aortic stenosis.
In an interview after his lecture, Cribier said that even today he draws on his experience with his early mentor Ganz, who died in 2009, for inspiration. "He was one of the greatest human beings I ever met," he said. "He had strong opinions. He defended his ideas."
The annual Corday Prize honors a physician or scientist who has conducted groundbreaking research leading to fundamental changes in the practice of cardiology or cardiac surgery. Established in 2012, it is named for the late Eliot Corday, MD, who was an attending physician with Cedars-Sinai, a member of its board of directors and chief of Cardiology for 11 years. Corday helped pioneer invasive cardiology.
The prize is funded by a gift from Brindell Gottlieb and her late husband, Milton.