Passing of Renowned Stanford Cardiothoracic Surgeon
Dr. Randall B. Griepp
The Stanford Department of Cardiothoracic Surgery is sad to announce the passing of Randall B. Griepp, MD, who died on September 8, 2022, at the age of 82. Dr. Griepp was a world renowned cardiovascular surgeon whose clinical and research contributions advanced the surgical treatment of thoracic aortic aneurysms, aortic dissections, and heart transplantation. A pioneering surgeon and researcher, Dr. Griepp’s laboratory and clinical efforts concerning brain and spinal cord protection led to major advances in the field.
Dr. Griepp was born in Minnesota, raised in Monterey County, and attended the California Institute of Technology in Pasadena, Calif. He received his medical degree from the Stanford School of Medicine in 1967, where he was mentored under the aegis of heart transplant pioneer Norman E. Shumway, MD, PhD. Dr. Griepp went on with Dr. Shumway’s blessing to complete a medical internship at Bellevue Hospital in New York, where he met his future wife, Eva Botstein, a New York University medical student who subsequently trained in pediatric cardiology; they became scientific collaborators for life.
Early days at Stanford
In 1968, Dr. Griepp returned to Stanford for his general and cardiovascular surgical residency training. It was during this time that, along with another early trainee of Shumway's, Edward B. Stinson, MD, he conducted laboratory and clinical research that led to the successful worldwide adoption of heart transplantation. Together, the pair helped to position Stanford's heart transplant team as a leader within the transplant community after the initial novelty phase (punctuated by poor results) had waned.
According to Dr. Stinson, Dr. Griepp’s profound interest in cardiac surgery had its beginning during his medical school years. Immediately upon entering residency, he integrated himself into the activities of the cardiac surgery team. His interest only intensified with the first cardiac transplant procedure at Stanford in January 1968, and he began to pursue an almost parallel dual residency in cardiovascular surgery and general surgery - at that time, a totally informal and unique arrangement. His talent and intellect were highly evident, and he shared major responsibility for the intraoperative and postoperative care of transplant patients from late 1968 onwards.
Indeed, as a testimony to his skill and dedication, Dr. Griepp, with the assistance of Dr. Stinson, performed his first cardiac transplant procedure in January 1970, six months before he would even begin his formal training in cardiac surgery, which he completed from 1970 to 1972. During this period, he also took over major responsibility for the clinical transplant program and functioned as a junior attending on the cardiovascular surgical service while Dr. Stinson was at the National Institutes of Health (NIH).
Over the four years after his completion of cardiac surgery residency, Dr. Griepp's somewhat staccato schedule continued until he finally had completed the required general surgery residency requirements and joined the cardiovascular surgery faculty. Thus, in a way, Dr. Griepp’s story presaged the subsequent formal transformation of the pathway for optimal training in cardiovascular surgery in 2006, the so-called “I-6” structure (integrated 6-year residency) with a major emphasis on cardiovascular diseases.
The famous yellow canoe for surface cooling used in the early days.
Stanford legacy and beyond
Along with Dr. Stinson, Dr. Griepp was interested in profound hypothermic circulatory arrest (PHCA) to protect the brain, which at the time was employed for cardiac surgery in infants. Dr. Griepp pioneered and developed methods for successful total arch replacement using PHCA, a monumental advance that changed the entire world of thoracic aortic surgery after 1975.
In that era, the primitive heat exchangers in the cardiopulmonary bypass (CPB, or heart lung machine) circuit were inefficient so Dr. Griepp would have the patient anesthetized first and then placed in an inflatable yellow canoe filled with ice for an hour or more of surface cooling - after which the chest was opened, and the patient placed on CPB for the operation. Needless to say, with rewarming taking about twice as long, these were truly “all day” operative procedures.
In 1974, Dr. Griepp was asked by Dr. Shumway to start a dedicated Vascular Surgery service. The Vascular Surgery residency training year became integrated into the Cardiovascular Surgical Residency Program as an extra year of training, along with its own accreditation for certification by the American Board of Surgery Sub Board in Vascular Surgery, until 1992.
Dr. Griepp also contributed to the early development of mechanical cardiac assist devices, including research with Philip Oyer, MD, PhD, another Shumway trainee, and research scientist Peer Portner. Their investigation helped advance the field, including the world's first clinical use of a left ventricular assist device (Novacor LVAD) as a successful bridge-to-transplant at Stanford in 1984.
In January 1978, Dr. Griepp was recruited to join the State University of New York (SUNY) faculty in Brooklyn as professor of surgery and chief of cardiothoracic surgery. Unexpectedly and involuntarily, he soon became interim Chair of the Department of Surgery from 1977 to 1979 after the current chairman died suddenly. In 1985, Dr. Griepp was appointed chief of cardiothoracic surgery at the Mount Sinai Hospital in New York City. In 1988, he served as the inaugural chair of the hospital's newly formed Department of Cardiovascular Surgery, a position he held through 2001.
At Mount Sinai Hospital, Dr. Griepp started a cardiac transplant program (actually commencing before the New York State regulatory authorities had given final approval) and built a world renowned cardiovascular surgery program, which included one of the most prominent thoracic aortic surgery programs worldwide. This was coupled simultaneously with a vigorous, NIH-funded experimental laboratory that improved the understanding of neurological protection of the spinal cord during thoracic aortic operations.
Lifetime impact in cardiovascular surgery
Throughout his career, Dr. Griepp impacted the field of cardiovascular surgery in numerous additional ways. He received several large grants from the National Heart, Lung, and Blood Institute (NHLBI) for his work in aortic thoracic surgery and hypothermia. He served as chairman of the NHLBI Surgery and Bioengineering Study Section for two years. He also trained many residents and surgical fellows, and he was proud that many of them went on to distinguished careers and leadership roles of their own in cardiovascular surgery. Dr. Griepp’s clinical practice in pediatric cardiac surgery and thoracic aortic surgery spanned several decades.
Dr. Griepp with Drs. Norman E. Shumway and Bruce A. Reitz
Dr. Griepp with his wife, Eva (2002)
Dr. Griepp authored a number of key papers in the field, including his work on brain and spinal cord neurological protection using PHCA for thoracic aortic and arch operations. He founded the American Association for Thoracic Surgery (AATS) Aortic Symposium, which is still considered the premier aortic surgical meeting, and served as its program director from 1988 to 2012. His wife, Eva, contributed to much of the laboratory and clinical productivity throughout Griepp's career, as well as the organization and editing of manuscripts for the biennial AATS Aortic Symposium meetings.
Dr. Griepp received several honors and awards for his outstanding scientific and scholarly contributions to the field. In 2019, he received the Lifetime Achievement Award from the AATS. In both 1998 and in 2013, Dr. Griepp delivered the prestigious Norman E. Shumway Lecture at the Stanford School of Medicine.
Dr. Griepp will be remembered for being a rigorous - yet humble and thoughtful – true surgical scientist with an unassuming and reserved personality and an unwavering dedication to his patients and trainees.
He is survived by Eva and his son, Matthew M. Griepp, MD, a psychiatrist.
Thank you to Drs. D. Craig Miller and Edward B. Stinson for their contributions to this tribute.
Randall B. Griepp, MD