Repairing Valves Replacing Valves Saving Lives vanderbiltheart.comCardiac Valve Surgery and Interventional Cardiology
VANDERBILT VALVE P ROGRAMCardiac Valve SurgeryThe surgical treatment of diseased heart valves has seen manyadvances in the past several years. Vanderbilt Heart is proudto be a leader in this field. We offer our patients the latestinnovations in cardiac valve surgery. Most of these surgeriesare performed on the aortic or mitral valves. These valvesare the inflow and outflow valves respectively, of the leftventricle which receives blood from the lungs and pumpsblood to the entire body. The tricuspid and pulmonic valvesare on the right side of the heart.The Cardiac Valve Program unites a multidisciplinaryteam of cardiologists, cardiac surgeons and cardiacanesthesiologists trained in diagnosing and treating alldisorders of cardiac valves. If surgery is the best option fora patient, Vanderbilt surgeons perform all types of cardiacvalve procedures including aortic, mitral, pulmonary andtricuspid valve surgery. When minimally invasive surgery isappropriate, patients often have less pain and recoverquicker than with traditional surgery.Vanderbilt Heart. A Pioneer in Valve Surgery.Vanderbilt Heart has developed a new model forcardiovascular care. In our image-guided surgery program,we utilize a hybrid operating suite where patients undergoimage-guided open-heart procedures. An angiogram can beperformed immediately after surgery within the same suite.This allows physicians to use real-time imaging to help guidethe conduct of the operation, ensuring the most completeand ideal results possible.The hybrid operating suite allows the Vanderbilt team toperform minimally invasive valve surgery in the presence ofcoronary atherosclerotic disease (CAD) by usingpercutaneous intervention, such as angioplasty and stenting,instead of CABG surgery. Vanderbilt is one of the select fewhospitals in the region to offer percutaneous valvuloplasty(also called valvotomy) to treat mitral stenosis, aortic valvestenosis and pulmonary valve stenosis.
T YPES OF VALVE S URGERYValve surgery involves two major categories - valvereplacement and valve repair. Valve replacement involvesremoving the native valve and replacing it with an artificialvalve made of either mechanical parts or biological tissues.The choice between a mechanical valve vs. a biological valveis based on many factors, including patient preference,patient co-morbidities and life expectancy. T YPES OF P ROSTHETIC VALVES U SED IN VALVE R EPLACEMENTMechanical ValvesThese artificial valves are made ofgraphite and pyralytic carbon, orother synthetic materials, which arenon-reactive and tolerated well in thehuman body. While designed to last aslong as 30 years, mechanical valvesrequire lifelong blood thinningmedications to avoid blood clots Mechanical Valveforming on the valve which can causestroke and other complications. Because of the need forlife-long blood thinning medications, patients with amechanical valve carry a higher risk of bleedingcomplications following surgery.Biologic (Tissue) ValvesThese valves are made from animaltissue (pig or cow) or a donatedhuman heart.The animal tissue valves are sterilizedand chemically treated for human useand sewn onto a frame (stented) orleft intact (stentless). They last Biological Valveapproximately 10-20 years or longer,depending on the age of the patient at implant.However, these valves may wear out over time and needre-replacement, particularly in younger patients. Long-termblood thinning medications are not required following valvereplacement with biological valves, but may be neededin the first 4-6 weeks following the surgery.
A ORTIC VALVE S URGERYMechanical vs. Biological Aortic Valve ReplacementMechanical valves are typically recommended for youngerpatients who can safely take blood-thinning medications,while biological valves are often used in older patients.A typical patient in whom a mechanical valve may beindicated would be a patient in their 40s or 50s, in whom acongenitally bicuspid or calcific valve has becomedysfunctional. Such a patient may wish to avoid repeatsurgery in 10-15 years, but accept the low but finite risk oflifelong blood thinning medication. This decision is basedon an understanding of the long-term risk of each choice.This is the balance between the risk of lifelong bloodthinning medication and its potential complications versusthe risk of reoperation if a biological valve is chosen.A typical patient in whom a biological valve may be indicatedwould be a patient who wishes to avoid lifelong bloodthinning medication, but who accepts the risk of reoperationin 10-15 years, depending on the age of the patient atimplant. Older patients (>60-65 years), however, shouldprobably receive a biological valve because it lasts longer inolder patients. Biological valves are also typically used inwomen of childbearing age to avoid blood thinningmedications, which can cause birth defects.
T YPES OF A ORTIC VALVE P ROCEDURESAortic Valve ReplacementAortic valve surgery (replacement) is performed to treat thenarrowing (stenosis) and/or leakage (regurgitation) of theaortic valve. It is also used for infective endocarditis.The majority of diseased aortic valves require replacement,with the original valve removed and a new valve sewn tothe annulus.Other Aortic Valve ProceduresRoot Enlarging Procedure: particularly effective in smalleraortic valvesAortic Root Replacement: typically used for connectivetissue disorders, large aortic root aneurysms, endocarditis oraortic dissections, and valve-sparing root surgeryValve-Sparing Root: usually used for young patients withintact aortic valves, with isolated disease of the aortic root,who wish to avoid long-term blood thinning medication B IOLOGICAL A ORTIC VALVE R EPLACEMENTStented Biological Aortic ValvesStented biological valves are by far the most commonbiological valve used in aortic valve replacement. They areeither porcine valves removed from pig hearts, treated andmounted on an artificial stent(see illustration), or bovine valvesmade of cow pericardium which isalso mounted on a stent. Both porcineand bovine valves have a long trackrecord of excellent performanceand durability, particularly inolder patients. Stented Biological Aortic Valve
Stentless Biological Aortic ValvesStentless valves are biological valvesfrom pigs (xenograft) or humancadavers (homograft), which aretreated and structured such that theydo not need a stent. These valves aretechnically more challenging to placeinto patients, but they have certainadvantages in selected patients. Stentless Biological Aortic ValveThese valves are useful in patients inwhom a smaller stented valve may not provide adequateperformance because of the high gradient across thereplaced valve. Stentless valves perform more like our ownnative valves, but have limited durability, particularly inyounger patients.Homografts(Human Cadaver Valve)A homograft valve is a valve that wasremoved from a donated humanheart, preserved, treated withantibiotics and frozen under sterileconditions. This is one of the idealvalve options for aortic valvereplacement in the setting of infectiveendocarditis. Homograft valve can beplaced using either full root technique Homograft Valveof sub coronary methods. They lastabout 10-20 years.
A ORTIC R OOT R EPLACEMENTWhen the entire aortic root is diseased, or when aortic rootreplacement is deemed preferable for isolated aortic valvereplacement (see illustration), aortic root replacement isperformed. It involves thereplacement of not only the aorticvalve, but also the aortic sinus tissuedown to the valve. It also requiresreimplantation of the coronaryarteries. A composite valved conduit(mechanical or biological) includes anew valve as well as new aortic tissue.This procedure is typically used forconnective tissue disorders such as Root ReplacementMarfan syndrome, large aortic rootaneurysms, endocarditis or aorticdissections. The choice between mechanical vs. biologicalaortic root replacement is based on factors similar toisolated aortic valve replacement. VALVE S PARING R OOT S URGERY ( SPARING THE NATIVE VALVE )In valve sparing root surgery, the native valve is preservedand a tube graft is used to replace the diseased aorta.This often requires that the native aortic valve has preservedfunction (no significant leakage). If the native valve isdysfunctional, a fullroot replacementis often needed.Valve sparing rootsurgery is typicallyperformed for youngpatients with intactaortic valves, withisolated diseases ofthe aortic root, whowish to avoid long-term blood thinningmedication. Valve-Sparing Root
M ITRAL VALVE S URGERYThis surgery is typically performed formitral valve stenosis (narrowing) fromrheumatic heart disease. It is also usedto repair regurgitation (leakage) or forinfective endocarditis. Most diseasedmitral valves can be repaired, but A.replacement is occasionally needed.Like the valves in aortic valvereplacement, they can be mechanicalor biological. However, biologicalvalves in the mitral position oftendo not last as long as in theaortic position. B. T YPES OF M ITRAL VALVE R EPAIRValve repair allows a surgeon to C.reconstruct a faulty valve using thepatients’ own tissue. The advantages ofheart valve repair are lower risk ofinfection, decreased need for life-long blood thinner medications andpreserved heart muscle strength. D.Common Valve Repairs Mitral Valve SurgeryLeaflet Repair: leaflets are repairedby patching of holes or tears in valveleaflets, and/or by reconstructing leaflets to rebuild thenative valve. (see illustrations A-C)Ring Annuloplasty: a ring is attached to the tissue aroundthe valve to provide the needed support so that the valve canclose tightly. (see illustration D) T RICUSPID VALVE S URGERYThe majority of tricuspid valve disorders are due to leakageand can be safely repaired. There are multiple repairtechniques, each with certain advantages. Some are as simpleas “bicuspidalization” of the valve with a single suture, whileothers involve placement of a suture or ring around theannulus. Tricuspid valve replacement is occasionally neededin cases of severe tricuspid valve disease.
M INIMALLY I NVASIVE H EART VALVE S URGERYMinimally invasive heart valve surgery is performed througha small incision in the chest wall. Benefits from this type ofprocedure include faster recovery withless pain. Minimally invasive valveoperations are performed through anupper mini-sternotomy (AorticValve), or a small right thoracotomy(Mitral Valve).Minimally Invasive AorticValve Surgery Minimally InvasiveAortic valve replacement can be Aortic Valve Surgeryperformed through an incision 6 cmin length to open the upper part ofthe sternum.Minimally Invasive MitralValve SurgeryMitral valve and tricuspid valve repairsand replacements can be performedthrough a 5-7 cm incision in the Minimally Invasiveright chest. Mitral Valve Surgery I NTERVENTIONAL C ARDIOLOGYPercutaneos Mitral Valvuloplasty: Symptomatic mitral valvestenosis (narrowing) can be treated with balloonvalvuloplasty, which has emerged as an alternative to surgery.During valvuloplasty, a thin catheter (tube) with a balloontip is used to stretch or open the narrowed mitral valve.The catheter, threaded from the groin, is guided into placeby X-ray and ultrasound (Echocardiography). Theprocedure, which is done in the cardiac catheterizationlaboratory, takes 1-2 hours and requires an overnighthospital stay.Percutaneous Aortic Valvuloplasty: Although aortic valvereplacement is the treatment of choice for aortic valvestenosis, percutaneous balloon aortic valvuloplasty can beused as a bridge to aortic valve replacement in selected highrisk patients, in patients undergoing emergent non-cardiacsurgery, and in patients who are too ill to undergo cardiac
surgery. It may represent the onlytreatment for some frail elderlypatients or treatment of choice incertain adolescent congenital defects.In balloon aortic valvuloplasty, aballoon catheter is placed through thevalve and expanded in order toincrease the opening size of the valve Percutaneousand improving blood flow. Aortic ValvuloplastyVanderbilt Heart and Vascular Institute has amultidisciplinary (Interventional Cardiology, CardiacSurgery, Cardiac Imaging, and Cardiac Anesthesia) teamthat is experienced in these procedures and is the onlyhospital in the region to perform such procedures. K EEPING THE H EART P UMPING IS O UR PASSIONThe Cardiac Valve Program at Vanderbilt is committed tohelping its patients determine the optimal treatment fortheir valve condition. Whether this treatment involvesmedical therapies alone or surgery, our goal is to treat everypatient like they are our only patient. That’s why we give careto one person and one heart at a time. VALVE C LINICThe Vanderbilt Heart Valve Clinic is a multidisciplinaryteam of physicians and surgeons who evaluate unique heartvalve patients on Wednesdays. They follow this clinic with acomprehensive valve conference on Thursday mornings toreview the unique cases and determine the most appropriatetreatment plan. The team will then communicate the plan tothe patient and referring physician and arrange follow-upas needed.
P HYSICIANS AND S TAFFOF C ARDIAC S URGERYJohn G. Byrne, M.D.William S. Stoney Professor of Cardiac SurgeryChairman, Department of Cardiac SurgeryM.D. Degree: Boston University, 1987Post-Graduate Training: University of Illinois AffiliatedHospitals, Chicago; Harvard Medical School, Boston; Brigham andWomen’s Hospital, Harvard Medical School, BostonTarek S. Absi, M.D.Assistant Professor of Cardiac SurgeryM.D. Degree: American University of Beirut, 1995Post-Graduate Training: North Shore University Hospital,NYU School of Medicine, Manhasset; University School ofMedicine, St Louis; Vanderbilt University Medical Center,Nashville; Brigham and Womens Hospital, Harvard MedicalSchool, BostonRashid M. Ahmad, M.D.Assistant Professor of Cardiac SurgeryM.D. Degree: College of Physicians and Surgeons, ColumbiaUniversity, 1992Post-Graduate Training: The Cleveland ClinicFoundation, Cleveland; Harvard Medical School, Boston; The NewYork Hospital-Cornell Medical Center, New YorkJorge M. Balaguer, M.D.Assistant Professor of Cardiac SurgeryChief of Cardiac Surgery, Department of VeteransAffairs Medical CenterM.D. Degree: Universidad de Buenos Aires, 1985Post-Graduate Training: Finochietto Hospital, BuenosAires, Argentina; St. Vincent Hospital & University ofMassachusetts Medical School, Worcester; Brigham & Women’sHospital, Boston; Harvard Medical School, BostonStephen K. Ball, M.D.Assistant Professor of Cardiac SurgeryMD Degree: Mississippi School of Medicine, 1987Post-Graduate Training: University of Mississippi MedicalCenter, Jackson; Rush University Medical Center, Chicago
David P. Bichell, M.D.Professor of Pediatric Cardiac SurgeryChief, Division of Pediatric Cardiac SurgeryM.D. Degree: Columbia University College of Physiciansand Surgeons, 1987Post-Graduate Training: Brigham & Women’s Hospital,Harvard Medical School, Boston; Children’s Hospital Boston,Harvard Medical School, Boston; Barnes-Jewish Hospital,Washington University, St. Louis; Columbia-Presbyterian Hospital,Columbia University, New YorkKarla G. Christian, M.D.Associate Professor of Pediatric Cardiac SurgeryAssociate Chief, Pediatric Cardiac SurgeryM.D. Degree: University of Washington Medical Center, 1986Postgraduate Training: University of Washington MedicalCenter, Seattle; Vanderbilt University Medical Center, Nashville,James P. Greelish, M.D.Assistant Professor of Cardiac SurgeryM.D. Degree: Wake Forest University School ofMedicine, 1992Post-Graduate Training: Hospital of the University ofPennsylvania, Philadelphia; Institute for Human Gene Therapy,University of Pennsylvania, Philadelphia; Brigham and Women’sHospital, Harvard Medical School, BostonSteven J. Hoff, M.D.Assistant Professor of Cardiac SurgeryM.D. Degree: The Johns Hopkins University School ofMedicine, 1986Postgraduate Training: Vanderbilt University MedicalCenter, NashvilleBetty S. Kim, M.D.Assistant Professor of Cardiac SurgeryChief, Cardiac and Thoracic Surgery MauryRegional HospitalM.D. Degree: Yale University School of Medicine, 1991Postgraduate Training: Brooke Army Medical Center, SanAntonio; Walter Reed Army Medical Center, Washington, D.C.;Brigham and Women’s Hospital, Harvard Medical School, BostonMichael R. Petracek, M.D.Professor of Clinical Cardiac SurgeryM.D. Degree: The Johns Hopkins School of Medicine, 1971Post-Graduate Training: Vanderbilt University Hospital,Nashville; Johns Hopkins Hospital, Baltimore
VANDERBILT H EART AND VALVE I NSTITUTE A CCESS C OORDINATORS Bonnie Cook, RN Deborah Durrance, RNJudy Ludwig, RN Brandon Massey, RN Patty Rush, RN Jan Powers, RN Grace Vicente, RN 615-343-9188 or 866-VUMCHRT Fax: 615-343-6559 Our guarantee: We will answer the phone within two rings, 24 hours a day, 7 days a week. P HYSICIAN A SSISTANTSCraig Climberg, PA-C Thomas M. Stahl, PA-CEdmund J. Donahue, PA-C N URSE P RACTITIONERSNora Cobb, ANP-BC Megan Shifrin, ACNP-BCAnna Fong, ACNP-BC Sean Smithey, ACNP-BCRachel Forsythe, ACNP-BC Joshua Squiers, ACNP-BCApril Kapu, ACNP-BC Kristie Walker, ACNP-BCStacy Kelley, ACNP-BC Brian Widmar, ACNP-BCVeronica Rowan, ANP-BC
G ENERAL C ARDIOLOGYBenjamin F. Byrd III, M.D.Professor of MedicineDirector, Adult Congenital Heart ProgramM.D. Degree: Vanderbilt University, 1977Post-Graduate Training: Vanderbilt University MedicalCenter, Nashville; Harvard University, BostonGeoffrey Chidsey, M.D.Assistant Professor of MedicineMD Degree: Indiana University School of Medicine, 1994Post-Graduate Training: Medical University of SouthCarolina, Charleston; Vanderbilt University MedicalCenter, NashvilleAndre L. Churchwell, M.D.Assistant Professor of MedicineAssociate Dean, Diversity in Graduate MedicalEducation and Faculty AffairsM.D. Degree: Harvard University, 1979Post-Graduate Training: Emory University, AtlantaKeith B. Churchwell, M.D.Assistant Professor of MedicineAssociate Medical Director, Vanderbilt Heart andVascular InstituteM.D. Degree: Washington University, 1987Post-Graduate Training: Emory University, AtlantaJulie B. Damp, M.D.Assistant Professor of MedicineM.D. Degree: Vanderbilt University, 2001Post-Graduate Training: Vanderbilt University MedicalCenter, NashvilleRob R. Hood, M.D.Assistant Professor of MedicineM.D. Degree: Tulane University, 1976Post-Graduate Training: Emory University AffiliatedHospitals, AtlantaWaleed N. Irani, M.D.Assistant Professor of MedicineDirector, Outpatient Clinical OperationsM.D. Degree: University of North Carolina, 1990Post-Graduate Training: University of Texas SouthwesternMedical School, Dallas; Parkland Memorial Hospital, Dallas;Veterans Administration Medical Center, DallasLisa A. Mendes, M.D.Assistant Professor of MedicineM.D. Degree: University of Connecticut Medical School, 1987Post-Graduate Training: Boston University MedicalCenter, Boston
I NTERVENTIONAL C ARDIOLOGY David X. Zhao, M.D. Associate Professor of Medicine Director, Cardiac Catheterization Laboratories and Interventional Cardiology M.D. Degree: Shanghai Medical University, 1985 Post-Graduate Training: Vanderbilt University Medical Center, Nashville; Brigham and Women’s Hospital, Boston; Harvard Medical School, Boston John H. Cleator, M.D., Ph.D Assistant Professor of Medicine M.D. Degree: Medical University of South Carolina, 1999 Post-Graduate Training: Cleveland Clinic Foundation, Cleveland; Vanderbilt University Medical Center, Nashville Marshall H. Crenshaw, M.D. Assistant Professor of Medicine M.D. Degree: Tulane University, 1982 Post-Graduate Training: Emory University, Atlanta Pete P. Fong, M.D. Assistant Professor of Medicine M.D. Degree: Vanderbilt University, 1998 Post-Graduate Training: University of Washington Medical Center, Seattle; Vanderbilt University Medical Center, Nashville Joseph L. Fredi, M.D. Assistant Professor of Medicine M.D. Degree: University of Tennessee, Memphis, 1983 Post-Graduate Training: University of Rochester – Strong Memorial Hospital, Rochester; Vanderbilt University Medical Center, Nashville Mark D. Glazer, M.D. Assistant Professor of Medicine M.D. Degree: University of Louisville, 1979 Post-Graduate Training: Emory University, Atlanta Henry S. Jennings III, M.D. Assistant Professor of Medicine Medical Director, Network Development M.D. Degree: Vanderbilt University, 1977 Post-Graduate Training: Vanderbilt University Medical Center, Nashville
John A. McPherson, M.D.Assistant Professor of MedicineDirector, Cardiovascular Intensive Care UnitM.D. Degree: University of California-Los Angeles, 1993Post-Graduate Training: University of Virginia HealthSystems, Charlottesville; Johns Hopkins Hospital, BaltimoreRobert N. Piana, M.D.Associate Professor of MedicineM.D. Degree: University of Pennsylvania, 1987Post-Graduate Training: Massachusetts General Hospital,Boston; Beth Israel Hospital, Boston; Harvard MedicalSchool, BostonThomas R. Richardson, M.D.Assistant Professor of MedicineM.D. Degree: University of Virginia, 1995Post-Graduate Training: University of Alabama,Birmingham; University of Texas Health Science, San Antonio;Vanderbilt University Medical Center, NashvilleMark A. Robbins, M.D.Assistant Professor of MedicineM.D. Degree: University of Mississippi School of Medicine, 1993Post-Graduate Training: Cleveland Clinic Foundation,Cleveland; University of Mississippi Medical Center, Jackson;Vanderbilt University Medical Center, NashvilleJoseph G. Salloum, M.D.Assistant Professor of MedicineM.D. Degree: American University of Beirut, Lebanon, 1996Post-Graduate Training: Cleveland Clinic Foundation,Cleveland; University of Texas, Houston; Vanderbilt UniversityMedical Center, NashvilleDavid A. Slosky, M.D.Assistant Professor of MedicineM.D. Degree: University of Colorado School ofMedicine, 1976Post-Graduate Training: Duke University Hospital,Chapel HillN URSE P RACTITIONERSDebbie Drake-Davis, ACNP-BCCindy Giullian, ACNP-BCDeborah Haggard, ACNP-BCJason Jean, FNP-BCDebbie Martin, ACNP-BCMargaret Morrison, ACNP-BCHolly Pierce, ANP-BCCarol Scott, FNP-BC
C ARDIAC A NESTHESIOLOGY Robert J. Deegan, M.D., Ph.D. Associate Professor of Anesthesiology Director, Division of Cardiothoracic Anesthesiology M.D. Degree: University College Dublin, Ireland, 1986 Post-Graduate Training: Vanderbilt University Medical Center, Nashville Brian S. Donahue, M.D., Ph.D. Associate Professor of Anesthesiology Director, Pediatric Cardiac Anesthesia M.D. Degree: Emory University, 1992 Post-Graduate Training: Mayo Graduate School of Medicine, Rochester; Vanderbilt University Medical Center, Nashville Susan S. Eagle, M.D. Assistant Professor of Clinical Anesthesiology M.D. Degree: Medical College of Georgia, 1999 Post-Graduate Training: Medical College of Georgia, Augusta; Vanderbilt University Medical Center, Nashville Alexander K. Hughes, M.D. Assistant Professor of Anesthesiology M.D. Degree: University of Vermont College of Medicine, 1997 Post-Graduate Training: Maine Medical Center, Portland; Massachusetts General Hospital, Boston Mias Pretorius, M.D. Assistant Professor of Anesthesiology M.D. Degree: University of Pretoria, South Africa, 1993 Post-Graduate Training: Vanderbilt University Medical Center, Nashville Bernhard J. Riedel, M.D. Professor of Anesthesiology M.D. Degree: University of the Free State, South Africa, 1987 Post-Graduate Training: University of Cape Town, South Africa; Royal Brompton and Harefield NHS Trust, London Annemarie Thompson, M.D. Assistant Professor of Clinical Anesthesiology M.D. Degree: Duke University, 1995 Post-Graduate Training: University of California, San Francisco; Vanderbilt University Medical Center, Nashville Chad E. Wagner, M.D. Assistant Professor of Clinical Anesthesiology M.D. Degree: University of Texas-Houston, 1998 Post-Graduate Training: Wake Forest University, Winston- Salem; Cleveland Clinic Foundation, Cleveland Amr A. Waly, M.D. Assistant Professor of Clinical Anesthesiology M.D. Degree: Ain-Shams University, Egypt, 1983 Post-Graduate Training: Vanderbilt University Medical Center, Nashville; Emory University Hospitals, Atlanta
A PPOINTMENTS AND S CHEDULING FOR VALVE C LINIC To make an outpatient appointment for consultation, simply call 615-343-9195Monday through Friday from 8 am until 5 pm, CST. E MERGENCY C ALLS For urgent physician needs or for a patient transfer, please call: 866-886-2478 or 615-343-9188 Fax: 615-343-6559 to reach the access coordinator. Our guarantee: We will answer the phone within two rings, 24 hours a day, 7 days a week. The Vanderbilt Valve Surgery program is located inMedical Center East, South Tower. Parking is available in the East Garage located in the same building. Valet parking available. Remember to have your parking ticket stamped at the registration desk for complimentary parking. Red Coat Volunteers The Vanderbilt Heart Red Coats are volunteers from the community whowelcome you as you arrive. They are stationed in Medical Center East at thesecond floor entrance. Many of our Red Coat volunteers have been patients here themselves, or have had loved ones cared for at Vanderbilt. They are happy to escort you and your family members to your clinic appointment.
VA LV E S U R G E RY 1215 21st Avenue SouthMCE, 5th floor, South Tower, Suite 5209 Nashville, Tennessee 37232-8802 VanderbiltHeart.comVanderbilt University is committed to principles of equal opportunity and affirmative action. Illustrations provided by Dominic Doyle.