Ulrich Sigwart

Ulrich Sigwart (German: [ˈziːkvaʁt]; born March 9, 1941) is a cardiologist known for his pioneering role in the conception and clinical use of vascular stents. He also introduced a non-surgical intervention for the treatment of hypertrophic obstructive cardiomyopathy.

Biography

Sigwart was born in Wuppertal. His family has its origins in Tübingen where several members played an important role at the local university. Most of his ancestors were doctors, philosophers, or theologians, and a street in Tübingen is named after one of them.[1]

He had his medical education in Freiburg (Germany), Basel (Switzerland) and Munster (Germany). After some years in the U.S. (Boston and Houston) followed by additional training in Zurich (Switzerland) he was charged in 1973 to set up an invasive cardiology program at the Gollwitzer-Meier Institute in Bad Oeynhausen in Germany, which became the nidus for the Heart and Diabetes Center North-Rhine Westphalia. From 1979 to 1989 he headed the section of invasive cardiology at the University Hospital in Lausanne (Switzerland). From 1989 to 2001 he was director of the department of invasive cardiology at the Royal Brompton Hospital in London and occupied the chair of cardiology at the University of Geneva (Switzerland) until his retirement in 2006.

Sigwart believed in the concept of intravascular scaffolding. In 1987, after several years of preliminary work in animals, he published a landmark paper on the use intravascular stents in humans to prevent occlusion and re-stenosis after angioplasty of coronary and peripheral arteries.[2] In 1994 he introduced percutaneous alcohol septal ablation (ASA, TASH, PTSMA), a non-surgical method for the treatment of hypertrophic obstructive cardiomyopathy, which often allows symptomatic patients to avoid open heart surgery.[3] During the years 1974–1978 he created the basis for the automated analysis of hemodynamic data and studied the repercussions of myocardial ischemia [4] and the performance of artificial heart valves.

Ulrich Sigwart's place in the history of arterial stenting

Self expanding mesh stent

Andreas Gruentzig had already recognized the problem of abrupt closure and restenosis after angioplasty. The need for a suitable form of intraluminal support in the hope of reducing or preventing this problem became obvious. Several investigators envisioned such devices during the first years of clinical application of angioplasty. Following reassuring animal work with self expanding mesh stents in Lausanne Sigwart reported the first human implants of such vascular scaffolds. These vascular stents, implanted in peripheral and coronary circulation, were multi-filament self-expanding, spring-like devices made of surgical steel. Sigwart's work made angioplasty predictable which significantly improved the outcome and offered a chance to overcome the problem of abrupt closure and recurrence.

Sigwart's early stenting work received great interest and many travelled to Lausanne to observe the technique in practice. In a 1987 paper entitled ‘Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty’, Sigwart et al. gave an interesting account of the clinical use of stents to prevent occlusion and restenosis. Sigwart's work also provided him with an opportunity to observe the outcomes and indeed the shortcomings resulting from stent therapy.

Very early after the launch of vascular stents Sigwart voiced caution regarding the purely mechanical support. One such case was that of a patient who, 3 months after implantation in the proximal left anterior descending artery, developed severe chest pain and angiography showed severe restenosis. Sigwart urged the surgeon to remove the stented segment and reported how ‘gazing at the massive tissue obstructing the stent lumen, the hypothesis of mechanical support for the prevention of restenosis looked like an illusion' and he suggested that a combination of mechanical and biologic factors would help to overcome the problem of recurrence.

In 1989, Sigwart took up the directorship of the Department of Invasive Cardiology at the Royal Brompton Hospital in London, England, and during his 12-year tenure at this post, he initiated the first randomized study aimed at comparing percutaneous coronary intervention employing stents with the relatively well-accepted coronary bypass surgery (SoS: Stents or Surgery).[5]

Awards

European Society of Cardiology Grüntzig Award 1996,

Doctor honoris causa of the University of Lausanne 1999,

Werner Forssmann Prize 2001,

Sven Effert Prize 2003,

King Faisal International Prize for Medicine 2004,

Swiss Society of Cardiology Grüntzig Award 2006,

Polzer Prize of the European Academy of Sciences and Arts 2007,

American College of Cardiology Maseri-Florio International Award 2007

American College of Cardiology Paul Dudley White Award 2012

American College of Cardiology Distinguished Scientist Award 2013

Books
  • U. Sigwart Automation in Cardiac Diagnosis: The Computer-Assisted Acquisition of Cardiac Catheterization Data, Schwabe 1978,
  • U. Sigwart and P. H. Heintzen (Editors): Ventricular Wall Motion, Thieme 1984,
  • U. Sigwart and G. I. Frank (Editors): Coronary Stents, Springer 1992 (ISBN 9780387545417) (Coronary Stents)
  • U. Sigwart: Endoluminal Stenting, W. B. Saunders 1996 (ISBN 9780702020469) (Endoluminal Stenting)
  • Ulrich Sigwart, Michel Bertrand, Patrick W. Serruys (Editors): Handbook on Cardiovascular Interventions, Churchill Livingstone, 1996

References
  1. "Profiles in Cardiology"
  2. Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L: Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 1987;316:701–706
  3. Sigwart U: Non-surgical myocardial reduction for hypertrophic obstructive myocardial infarction. Lancet 1995;346:211–214
  4. Sigwart U, Grbic M, Payot M, Goy J-J, Essinger A, et al.: Ischemic events during coronary artery balloon occlusion. In: Rutishauser W, Roskamm H, eds. Silent Myocardial Ischemia. Berlin: SpringerVerlag; 1984; 29–36
  5. The SoS Investigators: Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet 2002;360:965–970
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