Cardiothoracic Surgery


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Cardiothoracic Surgery

  1. 1. The Section of Cardiothoracic Surgery Surgery at Cincinnati Children’s Hospital Medical Center and the Divisions of Cardiology, Pulmonary Medicine, and Oncology of the Department of Internal Medicine offer both young and adult patients a multidisciplinary approach to cardiac and thoracic disease. Walter H. Merrill, MD In 2004 the ACGME granted accreditation for a residency John B. Flege, Jr. Professor training program in cardiothoracic surgery. The first resident in the program, Dr. John Mehall, began his training on July 1, 2004. Chief, Section of Dr. Mehall was elected President of the Thoracic Surgery Cardiothoracic Surgery Residents Association (TSRA) and was one of three course directors for the TSRA Cardiothoracic Technology Symposium 513.584.3278 held May, 2006, and again in May, 2007, at the University of Cincinnati (see the website at Dr. Mehall completed his training in cardiothoracic surgery The Section of Cardiothoracic Surgery, comprising the June 30, 2007.Division of Cardiac Surgery and the Division of ThoracicSurgery, continues on the forefront of advances in the treat- Our second cardiothoracic surgery resident, Dr. Jeffreyment of patients with cardiothoracic diseases, including the Garrett, continues his training, and our newest resident,application of minimally invasive techniques for cardiac and Dr. Julian Guitron, began his training July 1, 2007.thoracic disorders such as atrial fibrillation and lung cancers. The residency training program provides three continuous The Section’s experience and expertise continues to grow years of clinical training in cardiothoracic surgery, with onein minimally invasive cardiac and thoracic surgery, including new resident starting each year. Residents rotate on adultrobotic-assisted surgery and minimally invasive treatment for cardiac surgery at The University Hospital and at the Goodatrial fibrillation, lung cancer and other disorders.The increased Samaritan Hospital, on general thoracic surgery at Thereferral of patients from throughout the country for the University Hospital, and on pediatric cardiac surgery atspecialized care offered at the University of Cincinnati has Cincinnati Children’s Hospital Medical Center.resulted in the ongoing growth in clinical programs involved intreating tumors of the mediastinum, minimally invasive The Division of Cardiac Surgeryremoval of lung tumors, and specialized treatment of heart dis- The Division of Cardiac Surgery leads the region in theease, including the insertion of left ventricular assist devices for discovery and advancement of innovative treatment forthe failing heart, heart transplantation, and other procedures. patients with cardiac disease. Programs in robotic-assisted and minimally invasive surgical techniques, as well as the develop- The UC Heart & Vascular Center and the Cincinnati ment and application of bio-tech advances such as the growthChildren’s Hospital Medical Center provide the only two of new blood vessels, have made the cardiac program at thecardiac transplant programs in the region. Collaborative University of Cincinnati a state-of-the-art referral center forrelationships with the Division of Pediatric Cardiothoracic both standard and complex cases. The Section of Cardiothoracic Surgery | Page 48
  2. 2. Patient Care The UC Heart & Vascular Center includes the only adultcardiac transplant program in the region. Cardiac trans-plant volume has been steady, and 20-30 transplants peryear are expected in the coming years. This multidisci-plinary treatment effort has met with excellent clinicalresults. Clinical services are performed at The UniversityHospital, the Veterans Affairs Medical Center, and theCincinnati Children’s Hospital Medical Center. The Division performs a wide variety of operativeprocedures in patients with cardiac and vascular diseases,including off-pump coronary revascularization, modifiedMAZE procedure for atrial fibrillation without the need fora sternal incision, left ventricular assist device (LVAD) inser-tion, heart transplantation for severe heart failure, as well asall-arterial myocardial revascularization and mitral valverepair.The Division is alone in the Tristate in offering chron- nurses, pharmacists, nutritionists, rehabilitation providers,ic long-term LVAD support for heart failure, and it serves as social workers, clergy, and family in one place at the samea hub center for referral of patients requiring specialized time. Studies conducted by Harvard confirm improvedcardiac care. An additional focus is the treatment of adults patient care, outcomes and satisfaction.with congenital heart disease. As part of the collaborative effort, the CICU nurses have Surgeons and physicians at the UC Heart & Vascular collaborated with the diabetes specialists at The UniversityCenter continue their innovative treatment of heart Hospital and with the cardiac anesthesiologists to developpatients with a growth factor protein (FGF1) in an attempt patient care protocols that are aimed at controlling bloodto grow new myocardial blood vessels (angiogenesis). glucose levels in patients undergoing cardiac surgicalThe procedure involves injecting the growth factor directly procedures. This multidisciplinary team approach has ledinto the heart to trigger new blood vessel growth to to improvement in blood glucose values, and there isincrease blood flow around blocked arteries and to relieve evidence to suggest that this will lead to better overallthe chest pain associated with coronary artery disease. The outcomes and especially a lowered risk of infection. AnUC Heart & Vascular Center is one of a small number of U.S. outgrowth of the effort to control blood glucose levelsmedical centers involved in an early-stage clinical trial to perioperatively has been an increased focus on postopera-test myocardial injection of FGF1 as a method to relieve tive follow-up and care of diabetic patients once they leavechest pain. the hospital. The collaborative rounds program established in 2005 Educationcontinues to be highly successful in raising the standard of PGY-1 residents and mid-level residents are offeredpatient care in the cardiac intensive care unit at The one- and two-month rotations, respectively, on the service.University Hospital. The collaborative round brings togeth- Third year medical students rotate on the service as part ofer everyone involved in the treatment and recovery of their surgery clerkship, and a month-long clerkship isheart surgery patients including the patient, surgeons, offered to 4th-year medical students. Members of the Division actively collaborate with colleagues in adult cardiology and pediatric cardiac surgery and offer a broad array of educational conferences and laboratory research opportunities. Dr. Peter Manning and his colleagues from Cincinnati Children’s Hospital Medical Center teach pediatric cardiothoracic surgery to residents both at that institution and at the University of Cincinnati College of Medicine. All the faculty participate in weekly cardiothoracic teaching conferences, cardiac catheterization conference, and roundtable discussions with the residents. The recent mandatory reduction in resident work- hours led to the recruitment of physician assistants and nurse practitioners to reduce the clinical workload of facul- ty and residents, allowing additional time for research and other academic pursuits. The Division of Cardiac Surgery | Page 49
  3. 3. The Section of Cardiothoracic Surgery and the University of Cincinnati College of Medicine offer a course called “Summer Surgery Experience at UC.” This two-week program teaches 24 undergraduates from various colleges the art and science of surgery. Participants are exposed to cardiac anatomy and physiology, learning cardiac diagnos- tic techniques, receiving hands-on experience in the clinical skills lab, learning about the DaVinci robot, and shadowing in the operating room. The students also perform library research on several clinical cases and give a presentation at the close of the program. John Flege Jr., MD, serves as director of the program. Research David Melvin, MD, PhD, continues to apply his advanced training in Biomedical Engineering to discover breakthroughs in ventricular performance and its enhance- ment and support with various mechanical techniques. The Division of Pediatric Dr. Melvin was chosen to serve on UC’s Intellectual Property Cardiothoracic Surgery Committee which will provide advice to the vice president Overview for research in numerous areas related to intellectual property and the administration of the university’s patent The Division of Pediatric Cardiothoracic Surgery at and copyright policies. Cincinnati Children’s Hospital Medical Center is comprised of two surgical faculty, one research faculty, four clinical Community Connections perfusionists, four nurse practitioners, one physician Dr. Wolf and Dr. Flege recently launched the journal assistant, two research assistants and four administrative INNOVATIONS in Cardiothoracic Surgery, which is the support staff dedicated to the surgical care of children official journal of the International Society for Minimally with cardiac problems. Based completely at Cincinnati Invasive Cardiac Surgery (ISMICS). Dr. Wolf has served as an Children’s Hospital Medical Center (CCHMC), the Division Editor, and Dr. Flege remains as the Associate Editor. has formed a strong collaborative relationship with the Section of Cardiothoracic Surgery. As an integrated Dr. Merrill continues as chair of the Society of Thoracic component of The Heart Center, a multi-disciplinary Surgeons Workforce on Graduate Medical Education and business unit within CCHMC, the Division has enjoyed a Resident Issues. He also serves as a member of the Joint continually higher profile nationally as a leader in the man- Council on Thoracic Surgical Education, and he was recent- agement of cardiac problems in children. ly appointed to the Residency Review Committee for Thoracic Surgery. The goal of the Division is to be a national and interna- tional leader in pediatric cardiothoracic surgical care, surgi- The UC Heart & Vascular Center hosted a number of cal research and teaching. The clinical programs of the free educational lecture series for the lay public and for Division continue to provide excellent care, with morbidity local physicians and nurse practitioners, with a focus on and mortality rates rivaling any program nationwide. highlighting heart and vascular health and describing new technology and therapies to treat various heart and vascu- Members of the Division of Cardiothoracic Surgery lar conditions. function as key faculty of the Pediatric Cardiology and Pediatric Critical Care fellowship training programs at CCHMC. Close interaction with these fellows occurs on a daily basis, primarily in the Cardiac Intensive Care Unit, in500 400 400 2000 1000 350 350400 800 300 300 1500300 250 250 600 200 200 1000200 150 150 400 100 100 500 200100 50 50 0 0 0 0 0 The Division of Cardiac Surgery | Page 50
  4. 4. addition to a number of weekly teaching conferences inwhich the faculty participates. The Division serves as oneof the primary rotations of the Cardiothoracic Surgerytraining program, based at UC. The research efforts within the Division continue togrow with two basic science laboratories presently withinthe Division, as well as the collaboration of CardiothoracicSurgical faculty with Cardiology and other faculty on anumber of clinical research projects.Highlights The clinical programs in The Division of PediatricCardiothoracic Surgery focus on surgical management ofcardiac problems from birth through adolescence. TheDivision also has become more involved in the FetalCardiology program, participating in prenatal counselingof families with children with congenital heart defects. The reperfusion. An NIH R03 exploratory grant from thefocus is on complete correction of cardiac defects in the National Institute of Child Health and Humannewborn, management of complex single ventricle cardiac Development supports investigation into the use of geneanomalies, and techniques to limit transfusion exposures. therapy to temporarily raise the level of protective proteinsThe program has the capability of performing all levels in the heart and lungs of neonates undergoing heartof open and closed heart operations, including cardiac surgery. The data from these studies have been publishedtransplantation and the ability to perform ECMO support. in prestigious journals in the areas of surgery and critical care such as Annals of Thoracic Surgery, Critical Care The annual review of state-wide data for pediatric Medicine, Pediatric Critical Care Medicine, and Pediatriccardiac programs recently revealed that Cincinnati Research.Children’s continues to perform the highest volume ofnewborn open heart procedures in Ohio. The Heart Center Dr. Eghtesady’s lab has been productive and continuesEncyclopedia, posted on the internet, has received over his research in the field of experimental fetal open-heart15,000 hits per month. Renovations to the Intensive Care surgery in order to correct congenital malformations in thepods have allowed the Cardiac Intensive Care Unit to womb. Additional studies seek to understand the patholo-expand its intensive care capacity from 10 beds to 15 beds. gy of post-bypass placental dysfunction and the develop- ment of protocols and tools for successful translation of Research has continued to be active in the Division of fetal cardiac surgery into clinical practice. Dr. Eghtesady hasCardiothoracic Surgery. Dr. Duffy’s research lab has focused begun the patent process for a new, non-invasive methodon mechanisms underlying reperfusion and reoxygenation of monitoring placental oximetry during maternal/fetalinjury in the immature cardiopulmonary system. surgery.This work is supported by grants from the ThrasherContinuing NIH R01 funding from the National Heart, Lung, Research Foundation, the Children’s Heart Foundation ofand Blood Institute supports studies to determine the Chicago, an AHA National Scientist Development Grant,cellular and molecular mechanisms involved in the cardio- and additional funding from the Children’s Heartprotection offered by inactivating calpain activity andaugmenting the calpastatin pathway during ischemia and The Division of Cardiac Surgery | Page 51
  5. 5. Association. The lab also continues its collaborative effortswith Professor Kenneth Clark from the UC Department ofObstetrics and Gynecology. The lab was also productive in publishing in theJournal of Thoracic and Cardiovascular Surgery, AmericanJournal of Obstetrics and Gynecology, Perfusion, MedicalHypothesis, and has publications in press for the Annals ofThoracic Surgery and the ASAIO Journal. Research on fetalcardiopulmonary bypass, which the lab continues topursue aggressively, was accepted for oral presentation atfour prestigious international meetings this year. Studentsin the lab were also recognized, including first authorpublications and the Herman Schneider Medal awarded toChristopher Lam as the top UC Engineering co-op studentfor his experiences gained in the lab. Dr. Eghtesady continues to pursue clinical research intothe pathogenesis of congenital heart diseases and American Board of Surgery and the American Board ofhypoplastic left heart syndrome in particular. Dr. Eghtesady Thoracic Surgery.has begun enrolling patients in a clinical study to deter-mine if maternal exposure to or carriers of strep B areassociated with increased incidence of fetal congenital Faculty - Division of Pediatricheart defects. Cardiothoracic Surgery The Division continues to collaborate on a number of Peter B. Manning, MD, FACSclinical research projects with other members of The Heart Professor of Clinical SurgeryCenter, including cardiologists, intensivists, and anesthesi- Director, Pediatric Cardiothoracic Surgeryologists. The projects vary from heterogeneity cate-cholamine receptors in patients undergoing cardiac repairs Dr. Manning specializes in complete correction of newbornto a project analyzing different schedules for all pain cardiac diseases and blood conservation in cardiac surgery.medicines to maximize patient comfort after cardiac He is certified by the American Board of Surgery and thesurgery, and studies to evaluate novel approaches to assess American Board of Thoracic Surgery.renal function following cardiac surgery. Pirooz Eghtesady, MD, PhDFaculty Assistant Professor of Surgery(To view the full CV, visit our website at Dr. Eghtesady specializes in congenital heart surgery andWalter H. Merrill, MD, FACS fetal heart surgery. He is certified by the American Board ofJohn B. Flege, Jr. Professor Surgery and the American Board of Thoracic Surgery.Chief, Section of Cardiothoracic Surgery Jodie Y. Duffy, PhDDr. Merrill specializes in adult heart surgery, heart trans- Assistant Professor of Surgery and Pediatricsplantation, and congenital heart disease in adults. He iscertified by the American Board of Surgery and the Dr. Duffy’s research is focused on the areas of fetal develop-American Board of Thoracic Surgery. ment and the cellular pathways that regulate reoxygena- tion and reperfusion injury in the immature cardiopul-John B. Flege, Jr., MD, FACS monary system.Professor of Surgery Further information on the Division of Cardiac Surgery,Dr. Flege specializes in adult heart surgery. He is certified by including presentations and publications, can be viewedthe American Board of Surgery and the American Board of on our website Surgery.David B. Melvin, MD, PhDAssociate Professor of SurgeryProfessor of Biomedical EngineeringDr. Melvin specializes in heart transplantation and mechan-ical support of the failing heart. He is certified by the The Division of Cardiac Surgery | Page 52
  6. 6. The Division of Cardiac Surgery | Page 53