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Philip Caves

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Philip Caves (1940–1978) was a Northern Irish cardiothoracic surgeon. In 1972, while at Stanford University, he pioneered the use of the bioptome and transvenous endomyocardial biopsy in the early diagnosis of heart transplant rejection. It was considered the most significant advance in antirejection therapy of the time.[1] Awarded the British American Research Fellowship in 1971, Caves worked with pioneering cardiothoracic surgeon Norman Shumway at Stanford and became staff surgeon leading the transplant programme by 1973. A year later he went to Edinburgh as a senior lecturer in cardiac surgery, where he became particularly interested in pediatric cardiac surgery.

Philip Caves
M.R.C.S F.R.C.S. (Eng) MB BCh BAO DObst RCOG
Born1940
Belfast, Northern Ireland, United Kingdom
Died1978 (aged 37–38)
Education
OccupationCardiothoracic surgeon
Notable workEndomyocardial biopsy in early detection of heart transplant rejection
SpouseMargaret
Children3
Awards
  • British American Research Fellowship, 1971
  • European travelling scholarship of the British Heart Foundation, 1974
  • Ballahouston and Lister Travelling scholarship, Glasgow University, 1978

By 1975, Caves had become a professor in the University of Glasgow honorary consultant surgeon and chair of cardiac surgery in Glasgow and with 'inexhaustible dynamism' involved in the organisation of cardiac surgery. His sudden death at the age of 38 years whilst playing squash was said to have shocked many of his colleagues. The International Society of Heart and Lung Transplantation (ISHLT) bestows one of its highest awards in his name.[2][3]

Early education

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Caves was born in Belfast, Northern Ireland in 1940. He attended the Royal Belfast Academical Institution and then studied medicine at Queen's University Belfast, from which he graduated with a MB BCh in 1964.[2]

Surgical career

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Caves achieved the DObst RCOG in 1966 and the FRCS for Edinburgh in 1968. That year, he began his early surgical training with the cardiovascular and thoracic unit at Royal Victoria Hospital, Belfast, continuing at the Brompton Hospital, London in 1970 after taking the English FRCS in 1969.[2] In 1971, the British and American Heart Associations awarded him and funded a research fellowship at Stanford University. After receiving the research fellowship to Stanford, Caves worked in the dog laboratory with Margaret Billingham,[4] who was the histopathologist at Stanford. Here, he perfected the technique of percutaneous transvenous endomyocardial biopsy using the flexible Stanford-Caves Schulz bioptome which transformed the management of heart transplant patients and helped in a significant improvement in the results of heart transplantation. Werner Schulz was an instrument maker and key to the modification of the bioptome. Until that time the only way of trying to detect early rejection was by the daily monitoring of summated EKG voltages which tended to decline as rejection developed but at a relatively late stage.[1]

However, by being able to examine small biopsies taken from the interventricular septum of the heart it was possible to detect early histological changes of rejection and increase immunosuppressive treatment earlier and more effectively. Likewise, repeat biopsy after some days could define whether the rejection was resolving and reduce therapy sooner. The device, a modification of one produced by Konno in Japan, was inserted through the right internal jugular vein and guided into the right ventricle of the transplanted heart.[1] A biopsy was then taken. This technique of allowing early detection of acute organ rejection and confirming absence of rejection eventually resulted in the establishment of a heart rejection grading system.[5][6][7] Cyclosporin was given if the biopsy result indicated early rejection. By the 1980s this was considered the best method of detection.[8][9] During his second year, Stanford's leading cardiothoracic surgeon, Norman Shumway had become impressed with what Caves had achieved and he promoted Caves to Chief Resident in 1972 and to Staff Surgeon in charge of the Transplant programme in 1973.[2][5]

Caves travelled to Edinburgh in 1974 to become senior lecturer in the Department of Clinical Surgery, where he was active in new techniques in coronary artery surgery in newborns and infants. He held the first chair of cardiac surgery at the University of Glasgow in 1975, and contributed to the development of the adult and paediatric cardiac surgical service for the west of Scotland.[10] A close friend who visited Caves in Stanford and later pioneered the cardiac transplant programme in Cambridge, Sir Terence English, described Caves in an interview as giving priority to the development of the paediatric and adult cardiac services and having "great enthusiasm for the future of heart transplantation".[11][12][13]

Caves was a left-handed surgeon who worked with specially designed left-handed instruments. Shumway made sure that Caves took his left-handed tools with him on return to Scotland.[14] His influence on attitudes at Glasgow's Children's Hospital in the 1970s has been described as "whirlwind" as he operated on newborns who were previously considered not fit for surgery.[5] According to his cousin, at one stage, Caves was performing up to one hundred operations a month.[15] Amongst colleagues, Caves is thought to have been the most likely surgeon to have started the UK's first heart transplant program had he lived.[5][12]

Caves was influential in the careers of future pioneering surgeons including John Wallwork, who joined Papworth Hospital's Heart transplant programme in 1981 and was experienced in the use of cyclosporin after heart transplant whilst a chief resident at Stanford, under Shumway.[12] His lecturing skills were highly regarded and sought after.[2]

Death and legacy

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Dr. Caves died unexpectedly in Scotland from a heart attack on 23 July 1978, while playing a game of squash in Helensburgh.[16][2][17] Since 1983, the International Society for Heart and Lung Transplant has awarded its highest award to a surgical trainee. $1,000 is awarded at the Caves Award session during the annual general meeting to the surgical trainee who gives the best oral presentation. Eligibility criteria include students / Residents / Fellows / Scientists in training who are first authors and presenters, must be current members of the Society and not having previously won the award.[3][5]

It was recorded at the 50th anniversary of the annals of thoracic surgery in 2015, that Caves' approach to early organ rejection "remains the gold standard for today".[14][18]

Awards

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  • 1971 – British American Research Fellowship[2]
  • 1974 – The British Heart Foundation's European Travelling Fellowship[2]
  • 1978 – The Ballahouston and Lister Travelling Fellowship from the University of Glasgow[2]

Family

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Caves was married to Margaret. They had three children, a daughter and two sons.[2] Caves was a religious man who was an active practising Christian, supporting his church.[2][19]

Selected publications

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  • "Percutaneous Transvenous Endomyocardial Biopsy in Human Heart Recipients". The Annals of Thoracic Medicine, Vol. 16, Issue 4 (October 1973), pp. 325–336, doi:10.1016/S0003-4975(10)65002-3. Co-authored with Edward B. Stinson, Margaret Billingham and Norman E. Shumway.[20]

References

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  1. ^ a b c Westaby, Stephen; Marais, David (2014). "7. Christiaan Barnard and Norman Shumway: The heart transplant pioneers". In Thompson, Gilbert R (ed.). Pioneers of Medicine Without a Nobel Prize. London: Imperial College Press. p. 124. ISBN 9781783263837.
  2. ^ a b c d e f g h i j k "Caves, Philip Kennedy (1940 - 1978)". livesonline.rcseng,ac.uk. The Royal College of Surgeons of England. 21 November 2014. Retrieved 21 January 2019.
  3. ^ a b "ISHLT: The International Society for Heart & Lung Transplantation". www.ishlt.org. Retrieved 30 June 2018.
  4. ^ "Dr. Margaret Billingham dies at 78; Stanford heart pathologist". Los Angeles Times. 30 July 2009. ISSN 0458-3035. Retrieved 17 October 2017.
  5. ^ a b c d e "2012 April ISHLT Links Newsletter – Philip K Caves, by John Dark and John Wallwork". www.ishlt.org. Archived from the original on 5 February 2018. Retrieved 1 September 2017.
  6. ^ "Heart Transplant Timeline". Retrieved 4 September 2017.
  7. ^ Chopra, H. K.; Nanda, Navin C (15 June 2013). Textbook of Cardiology; A clinical and historical perspective. Jaypee Brothers Medical Publishers (p) Ltd. p. 706. ISBN 978-9350900819.
  8. ^ Pugh, Peter (17 September 2015). The Heart of the Matter: How Papworth Hospital transformed modern heart and lung care. Icon Books Ltd. ISBN 9781848319431.
  9. ^ Reitz, Bruce A (June 2015). "50th Anniversary Landmark Commentary on Caves PK, Stinson EB, Billingham M, Shumway NE. Percutaneous transvenous endomyocardial biopsy in human heart recipients: experience with a new technique. Ann Thorac Surg 1973;16:325–36". Annals of Thoracic Surgery. 9 (6): 1875–1876. doi:10.1016/j.athoracsur.2015.04.071. PMID 26046852.
  10. ^ "Orbituary- Philip Caves". British Medical Journal. 2 (6134): 438–440. 5 August 1978. PMC 1609065.
  11. ^ wscts_videos (22 January 2014). "Interview with Sir Terence English". YouTube. Retrieved 2 September 2017.
  12. ^ a b c English, Terence A. H. (2011). Follow your star : from mining to heart transplants – a surgeon's story. Milton Keynes: AuthorHouse. pp. 90–105. ISBN 9781456771317. OCLC 702329534.
  13. ^ "Eskind Biomedical Library - History of Cardiac Surgery: Sir Terrence English". library.vanderbilt.edu. Retrieved 2 October 2017.
  14. ^ a b Reitz, Bruce A. (2015). "50th Anniversary landmark commentary on Caves PK, Billingham M, Shumway NE, Percutaneous transvenous endomyocardial biopsy in human heart recipients: experience with a new technique. Ann Thora Surg 1973;16:325–36". Annals of Thoracic Surgery. 99 (6): 1875–8. doi:10.1016/j.athoracsur.2015.04.071. PMID 26046852 – via Elsevier.
  15. ^ "Honouring the memory of popular medic". Belfast Telegraph. 22 November 2011. Archived from the original on 22 October 2017. Retrieved 20 November 2017.
  16. ^ "At 38, the surgeon who gave hope to hundreds is dead; But pioneering work of Professor Caves lives on", by Gordon Airs, Daily Record (Glasgow, Scotland), July 25, 1978, p.9
  17. ^ Tesler, Ugo Filippo (2020). "9. The history of heart transplantation". A History of Cardiac Surgery: An Adventurous Voyage from Antiquity to the Artificial Heart. Newcastle Upon Tyne: Cambridge Scholars Publishing. p. 378. ISBN 978-1-5275-4248-8.
  18. ^ Cunningham, K S; Veinot, J P; Butany, J (February 2006). "An approach to endomyocardial biopsy interpretation". Journal of Clinical Pathology. 59 (2): 121–129. doi:10.1136/jcp.2005.026443. ISSN 0021-9746. PMC 1860308. PMID 16443725.
  19. ^ Cave, Philip; Stinson, EB; Billingham, M (1973). "Percutaneous transvenous endomyocardial biopsy in human heart recipients". Annals of Thoracic Surgery. 16 (4): 325–36. doi:10.1016/S0003-4975(10)65002-3. PMID 4583546.
  20. ^ Myat, Aung; Gershlick, Tony (2012). "16. Cardiac failure and transplantation". Landmark Papers in Cardiovascular Medicine. Oxford University Press. p. 272. ISBN 978-0-19-959476-4.
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