Improving the odds for pediatric cardiology patients

Even before Robin Shandas was an undergraduate student studying electrical engineering at the University of California, Santa Barbara, he just wanted to make a lot of money and drive fancy cars. Instead, he’s helping improve the odds for pediatric cardiology patients.

As chairman of the only bioengineering department in Colorado, Shandas is engaged not only in preparing the next generation of scientists and mentoring faculty, but also in research that has direct clinical application.

Shandas collaborates with local, national and international scientists, including working extensively with the pediatric cardiology group at Children’s Hospital Colorado and surgeons at the CU School of Medicine to improve outcomes of pediatric patients with congenital heart defects.

Among his research interests, Shandas has focused on developing an accurate means of measuring blood flow in children with pulmonary hypertension, or PH, a lung disorder in which the arteries that carry blood from the heart to the lungs become narrowed, making it difficult for blood to flow through the blood vessels. As a result, blood pressure in those arteries rises above normal levels and strains the heart.

When a child born with a congenital heart defect requires surgery to repair the defect, PH adds a complication that can be fatal. To improve patients’ chances of survival, Shandas and his colleagues have developed a means of assessing their cardiovascular status that is less invasive but more accurate than the more traditional method, which requires anesthesia and direct access to the blood vessels. Using this new method, cardiologists get a more accurate picture of how PH will affect the surgical outcome.

For patients with any form of PH, Shandas explains, “It’s critical to quantify the severity of the disease, whose origins are complex, to have an accurate measure of the disease before surgery and to be able to track the effectiveness of drug therapies to palliate symptoms and allow for the best possible post-operative recovery.”

There is no cure for PH, so managing the disease is the only clinical form of treatment, which, Shandas says, requires “cocktails of drugs to treat the various components. Thus, diagnostic approaches to accurately and quantitatively track the state of the disease are crucial. This is where we have made substantial impact.”

Shandas’s work in the physics of blood flow as a clinical metric has been well funded through NIH grants and is starting to gain acceptance at institutions in Boston, Toronto and at National Jewish in Denver. “It’s very gratifying to see it catching on,” he says.

Others are taking note, too. Late in the spring Shandas was invited to speak at the annual conference of the American Society for Artificial Internal Organs, whose mission is to promote “the development of innovative medical device technology at the crossroads of science, engineering and medicine.” Shandas was there to talk about his research into PH as well as how to use technology to improve the development of artificial hearts. “Both topics are related in that they both deal with the right side of the heart and how best to understand its function,” he says.

Shandas compares designing an artificial organ to designing an airplane engine. “Both involve risk, which is why in aviation there’s a reliance on the tried and true.” After all, he says, “if you have engine failure when you’re in the air, passengers will die, so you want to be conservative.” Still, to improve patients’ chances of survival, Shandas and fellow bioengineers have been seeking more accurate and faster ways to help cardiologists employ artificial organs.

But how do you accelerate the process and manage risk? It’s a great question, he responds. “There is danger in accelerating. You never know what’s going to happen.” That’s why Shandas is convinced that CAD—computer-aided design—is the way to more accurately predict outcomes in medicine, especially in cardiology.

With CAD, “we can create thousands of scenarios to measure the viability of an artificial organ so we can better predict the outcomes, and at much lower cost than the more traditional process,” he says. “Testing on animals, for instance, can cost millions of dollars, and there are only so many scenarios a researcher can create to predict success.” So far, CAD is being evaluated for in vivo use through animal studies.

In that bioengineering bridges engineering and medicine, scientists like Shandas “walk the talk,” as he says, to put engineering principles into clinical practice. The Department of Bioengineering offers students the opportunity to get involved in research, including product design, “from day one.”

Bioengineering and biomedical engineering are translational sciences, enabling researchers and clinicians to solve problems to save lives, but the word translation has another meaning. “You have to take engineering language and translate it into physics language, and then translate that into biology language, and then to clinical medicine. If you’re a bioengineer, you can’t work in isolation.”

Graduate studies in bioengineering at CU Denver are relatively new, but there are already about 60 students in the master’s and PhD programs in the three years since their inception. As the only stand-alone program in the state, bioengineering offers students research opportunities in the University of Colorado system, at the CU Anschutz Medical Campus and at local biomedical companies.

Despite the time consumed by cutting-edge research that can literally save lives, Shandas is actively involved in recruiting and mentoring students. “It’s essential if you want to bring high-quality students to the program,” he says.

“I tell potential students that we’re developing a bold and dynamic program with foundational integration with the medical campus and that this program will open many, many doors for them on the engineering and clinical sides. But it’s up to them to walk through those doors.”

In addition to his work with students, Shandas shows faculty how to mentor students effectively. “There are many rewarding things about mentoring,” he says, “but one of the most rewarding is seeing the mentee go off and be a successful independent scientist/researcher.”