Fighter Pilot or a Heart Doctor

Heart surgery, Top Gun and a father's influence to innovate.

In May 2021, CentraCare's Jacob Dutcher, MD, became the first cardiologist in the world to use a live 4D hologram to guide an interventional structural heart procedure. The new technology, called Holographic Therapy Guidance (HTG) by EchoPixel, uses a special software program and display monitor to produce a live and interactive hologram of the human body that can be visualized without special headgear or glasses. HTG has dramatically reduced procedure times, increased precision, optimized results and made it possible for cardiologists to work with much greater confidence. HTG is now routinely used in many structural heart procedures at the CentraCare Heart & Vascular Center.

But to get the whole story of Dr. Dutcher's journey to this remarkable breakthrough, you must go all the way back to preschool, when he was diagnosed with his own heart defect.

"They didn't know exactly what it was, because back then they didn't have all the tools and technology we do today," Dr. Dutcher recalled. "All I knew was that when my family went to Colorado on vacation, I felt very winded and had no energy. I couldn't keep up with my cousins. I was told this was from some sort of hole in my heart and it needed to be fixed."

A concerned father

Jacob's father, Bob Dutcher, as it happened, is a biomedical engineer and invents technologies to advance heart care.

"At that time, open-heart surgery wasn't in its infancy, but it was still pretty young," said Bob. "That was one of the most stressful things I've encountered in my life, choosing for my 5-year-old son whether to undergo open-heart surgery. Because of my background I knew everything that could go wrong. We were told there was at least a 5% chance Jacob wouldn't survive the surgery."

Jacob's parents granted permission and he proceeded to open-heart surgery. When the surgeon cut open Jacob's chest, he found multiple abnormalities including a large hole in the upper two chambers of the heart, as well as mispositioned pulmonary veins. These abnormalities resulted in an abnormal mixing of oxygenated and deoxygenated blood, as well as oxygenated blood from his right lung returning to the wrong side of his heart. The defects were corrected and surgery was deemed a success, which was the beginning of Jacob's journey.

"It was difficult for all of us, but young Jacob did great! In fact, just one week after surgery he was running around the store picking out toys," said Bob. "After his recovery, he told us, ‘I want to fix hearts when I get older.' I thought well, okay, a kid will do that, you know, but it was amazing — he never got away from that — he stayed with it."

Jacob did have one other interest, but it wasn't meant to be.

Top Gun

"When I got to high school, the two things I wanted to be were either a pediatric heart surgeon or a fighter jet pilot for the U.S. military," said Dr. Dutcher.

Inspired by the movie "Top Gun," Jacob met with an U.S. Air Force recruiter to find out what was necessary to become a fighter jet pilot. The recruiter reviewed Dr. Dutcher's application and at first glance said he would make a great pilot; he was athletic, had excellent grades in school, had perfect eyesight and had superior hand-eye coordination. However, there was one little problem.

"You've got a scar on your chest," said the recruiter. "There's no way someone with prior heart surgery is going to command a $50 million fighter jet for the U.S. military." So that was the end of Jacob's dream to become a fighter jet pilot. "However, it was a blessing in disguise. While I probably would have enjoyed piloting jets and serving my country in that way, I don't think it was where my real passions lay. It took that experience of rejection to turn me in another direction. From that moment on, I decided that, God willing, I'd become a heart surgeon and take care of patients to give back what was given to me, a second chance at life," said Dr. Dutcher.

"In the field of heart medicine, things were evolving rapidly — not that cardiovascular surgery was a dying field, but there wasn't as much growth in that area as compared to interventional cardiology," explained Bob. "A lot of heart procedures were shifting towards minimally invasive techniques, and the field of interventional cardiology was growing very rapidly. So it was that wisdom I wanted to share with my son."

Full-circle invention

Jacob went to the University of Minnesota for medical school, Mayo Clinic for his residency and William Beaumont in Detroit for his cardiology training. While he was pursuing his studies, his father continued to work on new technology while serving as CEO and president of Possis Medical. He developed a tool called the "AngioJet," which uses miniaturized, high-pressured saline jets to remove blood clots from vessels in the body.

"I'll never forget… one night I got a call from Jacob and he said ‘Hey dad, guess what? I just used your AngioJet to save the life of a heart attack patient who had a massive clot in his right coronary artery!'" recalled Bob. "I'll never forget that conversation."

Dr. Dutcher completed his training and joined CentraCare in the summer of 2007. Soon thereafter, with the help of Dr. Wade Schmidt, they started the Structural Heart Program at CentraCare Heart & Vascular Center. Initially, the most common procedure was repairing holes in the heart. However, unlike open-heart surgery performed on 5-year-old Jacob, now the procedure was done without cutting open the chest. Instead, a small catheter was inserted into a blood vessel of the groin. From there, a mesh-type device was advanced and implanted in the heart to close off the hole. This was a tremendous advancement in the field of heart care.

As Dr. Dutcher's career progressed, many other structural heart procedures were developed and introduced to CentraCare. One of those major advancements occurred in 2015 when a novel device called Watchman, made by Boston Scientific, became available.

"Atrial fibrillation is a very common heart rhythm disorder that can greatly increase a person's risk of stroke," said Dr. Dutcher. "Historically, we reduce that risk by prescribing our patients' blood thinners. However, blood thinners themselves have potential consequences, specifically bleeding. Up to 50% of all patients with atrial fibrillation cannot tolerate a blood thinner or have significant bleeding complications related to them. The Watchman is a one-time, implantable device alternative for those patients."

Dr. Dutcher went on to explain that a small sac attached to the left atrium of the heart, called the left atrial appendage, is the primary location of clot formation in patients with atrial fibrillation. Blood thinners are used to reduce the chance of clot forming in the left atrial appendage. Alternatively, Watchman is a device implanted within the left atrial appendage, kind of like putting a cork-in-a-bottle. In closing off the appendage, the risk of stroke is greatly reduced, much like a blood thinner, with the added benefit of not having to be a blood thinner.

"However, the Watchman procedure is not necessarily easy to perform. Left atrial appendages come in all sorts of shapes and sizes, it's not a one-size-fit-all scenario," said Dr. Dutcher. "We have names used to describe them such as windsock, chicken wing, broccoli, cactus and lobster claw… just to name a few. You can see by these names that we're describing a complex three-dimensional structure. In addition, the left atrial appendage is actively contracting and moving within the human body. Trying to precisely implant the correctly sized device in a very specific location of the appendage, while its moving, is not easy."

Dr. Dutcher then explained, "One of our greatest challenges at the time was performing this complex procedure with only two-dimensional imaging. While it's great that we have all these new tools and devices to help patients, the medical imaging used to guide these procedures is underdeveloped. We needed a better way to visualize our equipment and heart structures during the Watchman procedure." Leveraging his connections with Boston Scientific, Dr. Dutcher was introduced to Sergio Aguirre, CEO and inventor of a novel 3D holographic imaging technology called EchoPixel.

Transformative technology

Working with Sergio, Dr. Dutcher has spent the last several years helping to develop and incorporating 3D- and 4D–holographic imaging in the cath lab at CentraCare. He says the technology has completely transformed how he works.

"It's like I'm standing inside a person's heart. I can see the appendage and where the catheter and device are located. If I don't like the angle I'm at, I can easily rotate the image to look at it from a different perspective," Dr. Dutcher explained. "If I want to move the device higher, I just pull back on the catheter, much like a fighter pilot does in his jet. The goal of holographic therapy guidance is to align catheter movements with instinctive hand motions that feel natural to perform. Now I walk away from a Watchman procedure with extreme confidence that I placed the device in the optimal position!"

Once a heart patient himself, interventional cardiologist Dr. Dutcher is now a key player in a technological revolution on how to mend the human heart. He credits his father's influence with much of his success.

"He's a genius, but yet so humble," said Dr. Dutcher. "You'd have no idea just talking to him what he's done in his life. He's just so humble about everything — he's really an amazing man. He is my idol!"

Bob is just as impressed by his son.

"He got a little bit more than I was able to pass on — he's pretty remarkable. He was always that way to us."