Park Seung-jung
Professor in Department of Cardidology, University of Ulsan College of Medicine
Park Seung-jung is a reputable cardiologist who first treated an anginal patient using a stent in 1991, when less-invasive procedures were rejected by most doctors in Korea and overseas. He is also an innovator of coronary drug-eluting stents.
When Park Seung-jung proposed a new method using a stent as an alternative treatment for left main coronary artery stenosis, an abnormal narrowing of the aortic valve in the heart, at the American Heart Association’s meeting in 1997, most doctors, including Stephen Oesterle from Harvard Medical School, were skeptical. In recent years, however, less-invasive procedures have increasingly become accepted as an alternative to open-heart surgery. Today, transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure that involves replacing the faulty aortic valve of aortic stenosis patients, is performed in more than 50 countries, including the United States. Currently, TAVI is used mainly for those who face high surgical risk because its long-term safety has not yet been proved. However, Park, the interventional cardiology director at Asan Medical Center, believes the method will replace surgery for most aortic stenosis patients within 10 years. “It is just a matter of time. It might take less than 10 years,” he said in an interview. “Some surgeons still refuse to accept the new treatment. However, no matter how hard they fight it, the change will come.” Aortic stenosis is the most common valvular heart disease in the developed world, affecting about 2 percent of people aged over 65. Left untreated, the disease can cause chest pain, dyspnea and myocardial infarction as the heart’s own blood supply fails to reach the muscles that do the work of pumping blood around the body. “Once the patient starts to suffer overt symptoms, his or her probability of death within one year is as high as 50 percent,” Park said. Instead of opening the patient’s heart, as is required in surgery, in TAVI, the doctor inserts a new stent valve into the body via a small incision in the groin or chest wall. Then, the doctor moves the stent to anchor it to the targeted spot in the heart, pushing aside the old valve. The less-invasive procedure causes less damage to the body, which enables the patient to recover much faster; it only takes two to three days for the patient to get back to a normal life after an operation. Moreover, it is cheaper in Korea, thanks to its national health insurance system. Since his first TAVI operation in March of 2010, the first such operation in Korea, Park has treated more than 200 aortic stenosis patients using the method. Most his patients, including his very first, are still alive and healthy. “Interventional cardiologists and surgeons work as a team, sharing their expertise and learning with each other,” he said. Park is a pioneering Korean doctor who first treated an anginal patient using a stent in 1991, when less-invasive procedures were largely rejected by the mainstream medical communities in Korea and abroad. “There were times when I was insulted by people who disagreed with me and I almost gave up,” he said. “But I was lucky to have teachers and colleagues who trusted me when no one else tried to listen to me.” Starting with balloon angioplasty in the late 1970s, doctors and medical technicians have been struggling to improve treatment for patients with coronary artery disease, particularly left main coronary artery stenosis, which is considered more complicated and challenging than the right coronary artery stenosis. Balloon angioplasty evolved into safer procedures using bare metal stents and then to those using drug-eluting stents. Park, also currently a deputy editor of the Journal of the American College of Cardiology, has played a pivotal role in the improved treatments and their promotion to the medical communities by publishing hundreds of research papers in Korean and global journals. As discussed in his paper “Randomized Trial of Stents versus Bypass Surgery for Left Main Coronary Artery Disease,” published in the New England Journal of Medicine in 2011, Park proved that a less-surgical procedure is as safe as a surgical one in a two-year period. “While surgical methods have long remained unchanged, less-invasive procedures have been improved by new ideas and findings,” he said.
‘Prevention is better than cure’
Prevention is always better than the cure. In line with this belief, Park is focusing on two things. First, he wants to eliminate unnecessary treatment by enhancing diagnostic techniques and technologies, a goal that is already showing progress. Since Asan’s adoption last year of fractional flow reserve, a technique for determining whether the stenosis reduces blood supply to the heart muscle, the number of stenting cases has dropped by more than 30 percent, thanks to improvements in diagnosis. More studies will be conducted to keep improving diagnostic techniques and technologies, Park noted. In addition, ultimately, he wants to determine the factors that increase the likelihood of heart valve disease. “These are fundamental questions that we all have. ‘What causes the problem, and how do we know before the disease hits us?’” he said. “So far, no one in the field has dared to answer those questions. But I want to try.” “If we can identify high-risks groups more precisely, we can manage them more effectively. That is my next research topic.” It took him one-and-a-half years to prepare for the project, which just started with reputable researchers in other countries, including the United States and Italy. “I don’t know how long it will take to finish the project. Six years or it might not be that far off,” he said.
Cardiovascular Summit at Asan
Since 1995, Asan interventional cardiologists, led by Park, have held an annual international conference, the Cardiovascular Summit. The cardiovascular conference is the world’s third biggest, with about 4,000 participants from around the world visiting Korea every year, he said. “The purpose of the conference is to share the latest techniques and clinical expertise in the treatment of heart disease,” he said. “When I went abroad in the early 1990s, I thought Korea also needs such education and partnership. That’s why I started it.” “The greater communications and interactions with doctors have always been a great source of inspiration for me. I hope our conference also becomes an inspiration for other participants.”