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If something has gone wrong in the world,

0:02

the chances are someone is trying to fix

0:04

it. And here on People

0:06

Fixing the World from the BBC World

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Service, we find the people who are

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trying to do just that. BBC

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Less Ordinary is the podcast from

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the BBC World Service, bringing you

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extraordinary personal stories from around the

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globe. Search for Lives

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Less Ordinary wherever you get your

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BBC podcasts. Welcome

0:41

to People Fixing the World from the

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BBC World Service with me, Myra Anoubi,

0:47

with a show that introduces you to

0:49

the people finding solutions to some of

0:51

the world's most pressing problems. This

0:54

week, it's all about an

0:56

innovation that just might revolutionise

0:58

the treatment of heart disease.

1:04

Every year, 18 million people

1:06

die from heart disease or

1:09

other cardiovascular complications, according

1:11

to the World Health Organization. It's

1:14

the biggest killer in the world

1:16

and, unfortunately, there's no real cure

1:18

for it. Cardiologists and

1:20

heart surgeons try to manage

1:23

the condition with medical devices,

1:25

surgery and drugs. But

1:27

really, the organ itself does not

1:29

heal and that's because it can't

1:31

regrow new cells. So

1:34

over the years, finding a way

1:36

to regenerate heart tissue has become

1:38

a holy grail for medicine. In

1:41

this programme, we're going to hear how

1:43

doctors in Austria believe that they've found

1:45

a new way to do exactly this,

1:48

using a very unusual

1:50

method called shockwave therapy.

1:53

And this is what it sounds like. We

2:00

can now. Thirty

2:07

Heard the couple's. Son

2:11

more about this I enjoy now in

2:13

studio by our global health cause for

2:15

didn't know me cleanly. Always great to

2:17

see you before we get started for

2:19

that sound. Yeah it's strange. has an

2:22

agenda bit like a metronome I think

2:24

let us know In fact it's the

2:26

sound of a specially made some plays

2:28

machine that the surgeons are using. Now

2:31

what is so qui therapy When I

2:33

have to confess this is needs of

2:35

the until I actually started doing this

2:37

story earlier this year. it's not. And

2:39

Alexis so. That's the key thing see

2:42

meds and isn't what it is is

2:44

a huge pressure wave that meeting at

2:46

the speed of sound and these waves

2:48

of we're gonna learn have the potential

2:50

to hill the human body. Well this

2:52

story is particularly interesting to me. Know

2:54

me because last year my father had

2:57

a heart attack and so I really

2:59

wanted to find out what exactly is

3:01

going on with a sock. We. Therapy.

3:04

I'm. Really sorry to hear that Mara,

3:06

How's he doing now? Will he find?

3:08

I mean he has to take lots

3:10

of medication and of course changes in

3:12

his diet and lots more. But like

3:14

we said earlier on, he just has

3:16

to manage it. Will it? It's really

3:18

about people just like your that this

3:21

program patients who have already had some

3:23

heart damage that doctors are helping them

3:25

to manage. As he said, there isn't

3:27

really a way to regenerate heart disease.

3:29

In the past it was hate that

3:31

stem cell treatments could help repair the

3:34

heart. But the results of days

3:36

clinical trials has been disappointing and

3:38

these are not routinely used. But

3:40

now a team at his Britain

3:42

Medical Universe seat think they can

3:44

use Shockwaves to do a similar

3:46

thing. And to be clear that

3:48

still gathering the evidence to say

3:50

that this works is it does.

3:52

It could mean. A break three for

3:54

the treatment of heart disease. Took to

3:57

get corp has saved me around. their lot

4:01

So what have we got here? Looks like

4:03

a vacuum cleaner. This

4:06

is not a vacuum cleaner, this

4:08

is our shockwave device. This is

4:10

the shockwave device with which we

4:13

made most of our research. We've

4:16

got a sort of corrugated tube and then

4:18

that is

4:20

attached to, I guess it looks

4:22

a bit like a hairdryer, could you pick it up? Oh

4:26

yeah. It is actually pretty similar to

4:28

a hairdryer. Just

4:31

from the handling, it looks a little bit

4:33

more like a space hairdryer.

4:40

So I'm going to put my hands on this shockwave

4:43

machine. Okay,

4:46

so it just feels like a vibration. Exactly.

4:53

What you should feel now when you put

4:56

your hand on it is a sort of

4:58

strange sensation in

5:00

your joints. Yeah,

5:03

that's quite strong. I mean it's still just

5:06

a vibration though. It's not like a

5:08

laser or anything or an electric shock.

5:10

No, it's not harmful but

5:13

it's still a weird

5:15

kind of feeling. Yeah, it's not going to do

5:17

anything to my fingers. Make me

5:20

grow a small finger. A

5:22

six finger. Well

5:25

this machine is not there just to

5:27

look cool or give the researchers the

5:29

occasional tickle. For the last

5:31

12 years, the team here at Innsbruck

5:33

have been trying to work out exactly

5:36

what's going on when shockwaves come into

5:38

contact with the human body. The

5:40

story of shockwaves begins some 80

5:43

years ago in a very different

5:45

setting than the calm laboratory in

5:47

Innsbruck. They were in fact

5:49

first noticed in the Second World War. During

5:56

sea battles, thousands of dead soldiers

5:58

were recovered from the water. Evidence

8:01

Based Medicine. In. Sought

8:03

some place to be taken seriously.

8:05

Doctors have to go back to

8:07

the lab and it's here that

8:09

the universe even sprit becomes important

8:11

still to you Must have felt

8:13

a surgeon and the head of

8:15

the cardiac surgical lap fast became

8:17

interested. In shock waves as a medical

8:19

students. No one knew

8:22

how this is working and that's

8:24

question of the virtue mechanism is

8:26

what's. Really has driven

8:29

me and my research group

8:31

to elucidate home chef reefs

8:33

are working to gain more

8:36

credibility and acceptance for this

8:38

new treatment. You're

8:42

listening to people fixing the welds

8:44

on the Bbc well service and

8:46

know me. Let's recap here. Simply

8:48

put, so please. Therapy is when

8:51

a sound Presley's is applied to

8:53

a part of the body to

8:55

help wounds and bones heal. But

8:57

I have to stop my asking.

8:59

Is this definitely safe? Yes it

9:01

does appear it is. The Us

9:03

has been using it millions of

9:05

times to remain kidney stones at

9:07

higher prices Them what we talking

9:09

about said this treatment for the

9:11

hearts and lots. Of tests have been

9:13

done in labs and on animals to make

9:15

sure it is safe. But. You

9:18

were just saying that other doctors

9:20

were also quite skeptical about the

9:22

treatment that site so please. The

9:24

now in regular use the some

9:26

elements but acceptance has been flu

9:28

especially outside Austria. Yaneth whole failed

9:30

saw the potential of the treatment

9:32

to transform his own specialism heart

9:34

surgery and to address the issue

9:36

we were talking about which is

9:38

that a heart does not seem

9:41

to heal but he knew that

9:43

the scientific community needed to know

9:45

much more about his say for

9:47

the. Last decade he's been studying

9:49

some place at the lab attains

9:51

broke with his team using that

9:53

special space hair dryer that we

9:56

heard about earlier, right? So how

9:58

does it work? Well, Oh

10:00

let's yeah, Hanna's explain that. Part

10:02

the. Sonic. Pressure

10:04

wave is setting off

10:07

Microbus. it'll small bubbles

10:09

from the sensor faces

10:11

and those bubbles to

10:13

stimulate. And. A

10:15

receptor of the innate immune system of

10:17

the neighboring sell. Same. In layman's

10:19

terms, the Silk Quaids kickstarter complicated

10:22

clinical T V accents and the

10:24

thought a long as he looked

10:26

through a microscope you can see

10:28

the different sets in the cells.

10:30

They did start forming tube

10:32

like structures which means they

10:34

try to form new blood

10:36

vessels of the shop with

10:38

therapy whereas untreated sales obviously

10:40

don't to that. I mean

10:43

this sounds like something I'd have in

10:45

my science homework. I thought that he

10:47

said his highness is a says it

10:50

will he is he's a research scientist

10:52

but he thought they were working certain

10:54

says hey say no wonder he does

10:56

end up working sixty hours every week

10:59

your went through the tests to say

11:01

that so place to safe to use

11:03

in operations and he since been gathering

11:06

evidence to say that the treatment can

11:08

help regenerate heart. He's currently the only

11:10

certain to perform some place therapy. In

11:13

heart operations while he was in

11:15

in spread time met one of

11:17

his pace since jesus they'd know

11:19

who is sixty. Eight years of age.

11:24

December would be among the from. Harper

11:27

life has been kind to me or had

11:30

the good fortune to be an entrepreneur more

11:32

than three decades. I worked a lot of

11:34

was a lot of stress and many problems

11:36

but a lot of joy to my hobby

11:39

was worth soy happily to this in my

11:41

free time as well. In

11:43

line with his enjoyable but stressful

11:45

life, Gates has had high blood

11:48

pressure steals a space, sandy have

11:50

diabetes, all of which puts him

11:52

at higher risk of a heart

11:54

attack and unfortunately. that's what he

11:56

experienced a few years ago and

11:58

pup dog I

12:03

felt a tingling, then a stabbing pain and an

12:06

ache that moved into my left hand. Then

12:08

I was short of breath. I phoned

12:11

the paramedics and went to the hospital

12:13

emergency department. Then the heart

12:15

attack was detected. I

12:17

stayed for three days in the clinic and then was fit

12:19

enough to go home again. I didn't

12:21

take it seriously. I carried on

12:23

with my life, although I was forced

12:25

to make some small changes. I still

12:27

continued my stressful life. I'm

12:29

very happy. Jozef isn't living

12:32

a full life because he struggles

12:34

to walk or climb the stairs.

12:36

He still sleeps badly and he

12:38

finds it difficult to concentrate or

12:40

work for extended periods. Johannes

12:42

Holfeld, his doctor, is clear about

12:45

the cause. He's a man suffering from

12:47

a severe heart failure.

12:50

The heart failure is due to an earlier

12:52

heart attack. The heart attack occurs

12:54

when the blood supply to the heart

12:56

is blocked and then parts

12:58

of the heart get scarred. The

13:01

heart mass literally dies. The

13:04

remaining heart function is reduced and

13:06

this is what causes a heart

13:09

failure. Tomorrow, Johannes will

13:11

perform a quadruple bypass operation

13:13

on Jozef's heart to free

13:15

up blocked arteries. It's

13:18

a major operation that's performed around

13:20

the world, but Johannes is planning

13:22

to use something extra that only

13:24

happens here in Innsbruck. He's going

13:26

to treat Jozef's heart with a

13:29

shockwave machine. The bypass surgery

13:31

itself can only preserve this heart

13:33

function but not improve it. And

13:36

additional shockwave therapy induces

13:38

regenerative effects but its

13:41

own regenerative mechanisms get

13:43

stimulated and thereby the

13:45

heart function improves. What

13:48

does Johannes explain to you

13:50

about the procedure tomorrow? and

14:00

I'm glad that I'll be one of the

14:02

few patients to receive this at this time.

14:06

So the day of use this bypass has

14:09

arrived. I've come back to the hospital. This

14:11

time I need to change into the right

14:13

medical garb, so I'm wearing those kind of

14:16

blue pyjamas you see in operating theatres, and

14:19

I've got plastic shoes on the kind that you might be

14:21

gardening in. So let's go and see what's going

14:23

on. So

14:26

we've got an operating theatre we've around 10

14:28

people in at the moment, and

14:31

Johannes is visiting the

14:33

heart bypass, this is the operation at the moment, so

14:35

that of course is where I think... Yes, have a

14:38

look. I'm now cutting open

14:40

a coronary vessel. We

14:44

have earlier on harvested a

14:47

vein from the leg of the patient,

14:49

and what I'm doing now is to

14:52

sew this vein to

14:54

the coronary artery. This

14:57

is a very delicate

15:00

but beautiful operation, a

15:04

type of heart operation most of

15:06

us like best, such

15:09

a fine thing to do.

15:13

I watch as Johannes completes

15:15

the delicate operation, making tiny

15:17

stitches one by one in

15:19

Josef's heart. After

15:22

the bypass is complete but before the

15:24

shockwave therapy can take place, there

15:27

comes a very special moment when

15:29

the heart is restarted. Now

15:33

you can see the first...

15:37

Do you see this motion? This is the

15:39

first muscle fibres

15:41

already contracted. Still

15:45

a little bit slow, the heart. The

15:48

doctors wait around 10 minutes and

15:50

then the shockwave therapy begins. Some

15:53

clinicians have tried applying shockwaves to the

15:55

outside of the patient's body, but

15:58

doing it that way, it's impossible to do that.

16:00

reach every part of the heart. So

16:02

the technique that Johannes has pioneered

16:04

is to apply the waves directly

16:07

to the organ. I watch

16:09

as he gently takes Joseph's heart in

16:11

his left hand and lowers

16:13

the shockwave applicator with his

16:15

right one. Okay so what I do

16:17

now is I

16:20

take the heart, the beating heart, and

16:23

we can now start. The

16:29

technician started the shockwaves.

16:32

I'm moving the applicator

16:35

around the predefined area

16:37

and listen how good

16:39

the waves are coupling. Not

16:44

all the heart can be repaired. The

16:46

scar tissue left from Joseph's heart attack

16:48

cannot be healed. The tissue

16:51

around the scar can be improved.

16:54

Yes, there are certain areas of the heart

16:57

which have been chronically undersupplied with

16:59

blood. And the cells of the

17:01

heart muscle in these areas are

17:04

not contributing to the heart region,

17:06

to the contraction of the heart.

17:08

And with this shockwave therapy,

17:11

we can recruit them. We

17:14

can make them regenerate. And

17:16

we can even induce angiogenesis

17:20

which is the new formation

17:22

of blood vessels to this

17:25

chronically undersupplied heart muscle. Well,

17:28

stood in the corner of the

17:30

operating theatre was a rather excited

17:32

observer, Wolfgang Schaden, whose early work

17:34

on shockwave therapy is the big

17:36

reason we're here. I

17:39

would not have expected that I can, that

17:43

I get old enough to really see

17:46

this thing happen because

17:48

there were so many obstacles

17:52

over the years. Johannes

17:54

is, in my eyes, he's a hero. And

17:58

That's it. The Whole place is. Love fairly

18:01

ten minutes. After

18:04

that intense experience in the operating

18:07

system, right com os into the

18:09

lovely sunshine to walk along the

18:11

river in and I'm on my

18:13

way to meet the pace. of

18:15

course. Martha see had a heart

18:17

attack about a year ago. He

18:19

actually sent shockwaves therapy after a

18:21

bypass and he's now policing fit.

18:23

So much so that we gonna

18:25

go running together. It's

18:30

pretty hard for me to believe of I

18:32

joke alongside you that you had a heart

18:34

attack a year ago, how long can you

18:37

run thought? Or

18:39

for your boss north from.

18:42

Most part them before the heart attack occurs.

18:44

Only run up to two hundred meters. Now

18:46

I can do ten kilometers without a problem.

18:49

Seems to me thrown to the dreams disabused.

18:51

Well, I'm certainly having problems keeping up

18:54

with a safe enough respect. The first

18:56

getting back into running but the

18:58

fleet stopped for a break. I asked

19:00

Marcus what he thought. About receiving

19:02

the so quaint treatments. For

19:05

me to see a fortuitous this the tomb

19:07

and beside a so futuristic were assessed. Heard

19:10

about it said the doctor told me a

19:12

bit more on I thought to myself that

19:14

the chances it would help me were relatively

19:16

small city so either the treatment works are

19:19

feeling the effects of the operation in general

19:21

because it is major surgery is to get

19:23

some will go said anything to be. Marcus's

19:26

right to point out that his

19:28

impreza kinda since can't be put

19:30

down slowly to the need therapy

19:32

because of the bypass operation we

19:34

would subtly expected to be doing

19:36

much better than year ago that

19:39

following with sets this is yet

19:41

to be published yesterday. He says

19:43

that he found. Some

19:45

therapy. As part of that I paused

19:48

to see. Just do. Even better than

19:50

days He died. We. always

19:52

have to be very careful

19:54

in anticipating things but with

19:57

do indeed have the impression

19:59

that this could be a

20:02

historic moment in medicine as

20:05

for the first time regeneration of

20:08

the failing heart muscle will get

20:10

reality and it could help millions

20:12

of people thereby also having a

20:14

socio-economic impact to our healthcare systems.

20:20

Naomi it's great to hear that you managed

20:22

to get a jog in there. Oh yes,

20:24

gotta keep fit. Now I

20:26

just want us to be clear here this is

20:28

not a cure for heart disease is it? That's

20:31

absolutely right and we would expect

20:33

some of the patients who get

20:35

this treatment to still die of

20:37

heart disease unfortunately. It's really

20:40

about quality of life and

20:42

life expectancy. Do these patients

20:44

have extra years of life

20:46

expectancy added? You mentioned that

20:48

Johannes has done research that

20:50

is yet to be published so Naomi

20:52

what evidence do we have at this

20:54

moment that this is working? Well

20:56

there's no doubt that before this can

20:58

become a mainstream therapy more evidence is

21:01

needed and doctors will want to see

21:03

that. There has been

21:05

this randomized control trial which Marcus

21:07

and 64 other patients

21:09

were part of and Johannes says

21:11

that that showed there was a

21:14

significant improvement in those who'd had

21:16

shockwave therapy. Now that study they're

21:18

hoping will be published quite soon

21:20

in the coming months but

21:23

in the meantime the research has been presented

21:25

to a meeting of the European

21:27

Association for Cardiothoracic

21:29

Surgery and I spoke

21:32

to Patrick Myers the Secretary-General of

21:34

that organization who was at the

21:36

conference where it was presented and

21:38

who is not in any way

21:40

linked to Johannes's research. Now

21:42

this is very early this is a

21:44

limited number of patients were included but

21:46

the way the research has been done

21:48

is extremely well conducted and I'm very hopeful

21:50

for the future there's always breakthrough

21:53

therapies lots of hope etc in small trials

21:55

but once we get to larger trials there

21:57

are very few that that actually go through

21:59

all the way. Now here we're hopeful because

22:01

the data all seems to point in the

22:04

good direction, but of course until we've got

22:06

some clear evidence, we remain optimistic

22:08

but conscious. So

22:10

Naomi, how soon before we see this

22:13

in operating rooms around us? Well,

22:15

as Patrick Myers just said, they do

22:17

need to do bigger trials and Yohannes

22:20

is now very much focused on that.

22:22

I must say though that shockwave therapy

22:25

is already used in many different areas

22:27

of medicine. So in the US it's

22:29

used a lot for erectile dysfunction. It's

22:32

also used for athletic problems like tennis

22:34

elbow and tendon problems. And

22:37

there could be future possible applications

22:39

for something like cellulite.

22:42

Cellulite? Yes, cellulite. Yeah,

22:44

bring it on. Well

22:48

who knows how much more shockwave therapy can

22:50

do. I mean, this is really mind-blowing, but

22:52

thank you for what we've heard today, Naomi,

22:54

and we will definitely be keeping an eye

22:56

on this. That's

22:58

all from People Fixing the World

23:01

this week, but if you've enjoyed

23:03

what you've heard, go ahead and

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subscribe to us as a podcast.

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All you need to do is

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join me next week. But until

23:24

then, thanks for listening. I

23:50

was told to do that. I was not told to

23:52

murder him.