HEART FAILURE AND HEART TRANSPLANT CENTRE ANNUAL REPORT 2001-2002 PREPARED BY: Dr. Nadia Giannetti Medical Director and Dr. Renzo Cecere Surgical Director
MandateThe McGill University Health Centre Heart Failure and Heart Transplant Centre in its currentconfiguration was founded in February 2000. It is located at the Royal Victoria Hospital in the Epavillion. The mandate of the Centre is to provide a multi-disciplinary approach to optimize carefor heart transplant, heart failure and mechanical cardiac assist patients and to provide cutting-edge medical and surgical therapy to this population. The Centre serves as a back-drop forinnovative research and teaching for patients, residents and colleagues. It serves as drop-in Centrefor patients with acute medical problems with the intention of decreasing emergency room visits.PatientsPatients followed at the Centre include heart failure, heart transplant and mechnical assist devicepatients. Patients either present at scheduled visits or can present without appointments Mondayto Friday from 8:30 AM to 4:00 PM. Those who are acutely ill can receive intravenous perfusionsin the Centre thus bypassing the emergency room. Over the past year, there were 3262 patientvisits. This was an increase of 17% over 2000-2001.There are over 400 heart failure patients currently followed at the Centre and 150heart transplant patients. At any one time, there are 5-7 mechanical assist device patientsfollowed.StaffThe clinic is staffed with a medical secretary and ward clerk. There are 3 full-time nursecoordinators and 1 half-time coordinator. The coordinators share call such that someone is on call7 days a week and 24 hours a day. This allows rapid access to care for ailing patients and ensuresthat donor hearts get rapidly processed. There is also one full-time research nurse coordinator inthe Centre.The medical staff includes Dr. Giannetti who sees patients in the clinic 5 days a week and Dr.Cecere who evaluates both scheduled and unscheduled patients weekly. Dr. Elstein and Dr.Brophy , both in the division of cardiology, assess patients in the clinic one half day per month.Dr. Cantarovich, a member of the division of transplantation, sees heart transplant patientsconcurrently with Dr. Giannetti 1 to 2 half days per week. Dr. Kimoff, a member of the divisionof respirology, with an interest in sleep apnea and heart failure follows patients with heart failureand pulmonary problems in the Centre twice per month. On a weekly basis, Sonia Page, adietician with an interest in heart failure assesses patients in the clinic.
CasesThe following is a list of patients who received heart transplantation or mechanical circulatorysupport from April 1, 2001-March 31, 2002Transplants April 01, 2001 – March 31, 2002Initials Age Transplant surgeon OutcomeTR (on VAD pre- 14 R. Cecere Alive and welltransplant)AR 51 R. Cecere Alive and wellCD (on VAD pre- 32 R. Cecere Alive and welltransplant)RD 55 R. Cecere Alive and wellJF (on VAD pre- 60 R. Cecere Alive and welltransplant)GZ 37 R. Cecere Alive and wellSO (HEART AND 38 R. Cecere Alive and wellLUNG)RS 60 R. Cecere Alive and wellCM 58 R. Cecere Alive and wellVL 7 R. Cecere Alive and wellJP 67 R. Cecere Alive and wellAD (HEART AND 19 R. Cecere Deceased: multi-organ failureLUNG)Mechanical Circulatory Support April 01, 2001 – March 31, 2002Initials Age Sex Where from Surgeon OutcomeCD 31 M LAKESHORE R. Cecere TRANSPLANTEDJF 60 M HALIFAX R. Cecere TRANSPLANTEDAE 62 M RVH R.Cecere DIED OF CVAEJ 2 M MCH R. Cecere/C. TRANSPLANTED TchervenkovMB 47 M RVH R. Cecere DIED OF MULIT-ORGAN FAILURERC 37 M QUEBEC CITY R. Cecere D/C HOME ON LVADSN 42 F RVH B. D/C HOME ON LVAD DeVarennes/R. Cecere *RN 58 M RVH R. Cecere D/C HOME ON LVADDD 61 M CHARLES R.Cecere D/C HOME ON LVAD LEMOYNEGM 61 M INSTITUE DE R.Cecere D/C HOME ON LVAD CARDIOLOGIE* Post-cardiotomy failure to ween from heart-lung bypass
Teaching/supervisionCardiology fellows see patient in the Centre during non-invasive rotation (2 half days per week).A number of residents in internal medicine have rotated through the clinic as part of an elective.These have included Drs. Maggie Nguyen and Angeline Law from the MGH and Dr. Jean-Francois Dorval from the RVH.There has been supervision of fellows for research projects. This has included Dr. DominiqueJoyal who presented a poster at the Canadian Society of Transplantation conference in February2002. “Low dose daclizumab post-cardiac transplantation. Also, cardiology fellow Dr. ReginaHusa presented an oral abstract at the International Society of Heart and Lung Transplantationconference, April 2002: “Acute heart transplant rejection associated with late steroidwithdrawal.”Dr. Cecere has established Novacor and Thoratec training programs at the MUHC. Through thesethree days programs, teams of clinicians receive theoretical and practical instruction on the use ofventricular assist devices. Practice implants are performed on a unique swine model at the animalfacilities of the Montreal General Hospital site. This year, groups from Halifax and Quebec Citywere trained.Conferences and PresentationsDr. N. GiannettiMarch 22, 2001: McGill University Continuing medical education conference (Thursday eveninglecture series) “Heart failure in the elderly”April 22, 2001: Association des Medecins Haitien du Quebec. Continuing education. “HeartFailure Therapy”May 3, 2001: McGill University continuing education drug therapy course. “Heart Failure drugs”May 10, 2001: Medical Grand-Rounds at St. Mary’s Hospital. “Chronic heart failure: advances intherapy.”September 2001: Primary panelist for Canadian consensus guidelines on Cardiac Transplantation.Presented at the Canadian Cardiovascular Society meeting 2001, Halifax.September 2001: Invited expert panelist at the Canadian Cardiovascular Society meeting 2001,Halifax. For session on “New Therapies in Heart Failure” chaired by Dr. Peter Liu and Dr.Malcolm Arnold.September 29, 2001: Association des cardiologues du Quebec. “Heart failure in the Elderly.”Mont TremblantOctober 5, 2001: Symposium on Heart Failure and Transplantation. “Heart failure: Diagnosis,management and treatment” Royal Victoria Hospital
October 19, 2001: Cardiology nursing symposium. “Heart Failure Treatment”. Montreal GeneralHospitalFebruary 12th, 2002: Canadian Cardiovascular Society winter symposium. “When pills aren’tenough: Surgical Therapy for Heart Failure”. Mexico.February 27th, 2002: Cardiac Society of Transplantation , Sangstat fellows work-shop. “Updatesin cardiac transplantation”. Mont-Tremblant, Quebec.March 24, 2002: New Horizons in Heart Failure Symposium. “Refractory Heart Failure”.Chanteclerc , QuebecDr. R. CecereMarch 24, 2002: New Horizons in Heart Failure Symposium. “Surgical Therapy for HeartFailure”. Chanteclerc , QuebecMarch 2002: International Society for Heart and Lung Transplantation: Symposium onINTREPID “The role of destination LVAD therapy”. Washington DC.CommunicationsDr. N. GiannettiMarch 12th , 2002. Global television. Interview with Stuart Greer, the use of mechanical assistdevices for long-term therapy.March 21st , 2002. TVA. Live television interview with Jocelyne Cazin in television show “DansLamire” on organ donor awareness.April 16, 2002. Live radio interview on CJAD radio with Tommy Schnurmacher. “OrganDonation. “Dr. R. CecereMarch 12th , 2002. Global television. Interview with Stuart Greer, the use of mechanical assistdevices for long-term therapy.March 2002: The Gazette interview and feature on the use of LVADs as destination therapyMarch 2002: Feature on “Your Health” show with host Dini Petty, LVADs
ResearchFunding and studies:Non-industry funding and studies:1999-2001: Deane Nesbitt Award (Internal scholarship from the Montreal General HospitalResearch Institute)Awarded to Dr. Nadia Giannetti for research in heart failure$ 10 000.00 per year x 3 year2000-2001: The Gustav Levinski Foundation AwardsSonia Page and Dr. N. Giannetti. For research in nutritional therapy for heart failure$ 8597.002001: CIHR operating grantDr. M. Goldberg and Dr. N. GiannettiThe short-term effects of ambient air pollution on clinical signs and symptomsfor congestive heart failure: A pilot study$66,4902001: CIHR multi-centre studyAtrial Fibrillation in Congestive Heart FailureDr. N. Giannetti, Local principal investigator2000: Mayo Clinic FoundationGiant cell myocarditis treatment trial and registryDr. N. Giannetti, Local principal investigatorIndustry funded studies2000-2002: Candasartan in heart failure assessment of reduction in mortality and morbidity.(CHARM). Sponsored by Astra PharmaceuticalsDr. N. Giannetti, Local principal investigator2000-2002: Omepatrilat versus enalapril randomized trial of utility in reducing events in heartfailure (OVERTURE). Sponsored by Bristol -Myers-SquibbDr. N. Giannetti, Local principal investigator2000-2001: A Randomized Comparative Trial of Prograf versus Neoral in the treatment ofhyperlipidemia one year after heart transplantation.Dr. N. Giannetti, Local principal investigator and member of steering committee.
2000-2001: Randomized double-blind multi-center study of the efficacy and safety ofvalganciclvir vs. oral ganciclovir formthe prevention of cytomegalovirus disease in high-riskheart allograft recipients. Sponsored by RocheDr. N. Giannetti, Local co-investigator2000-2001: Biventricular pacing in heart failure (MIRACLE sub-study)Dr. R. Cecere, Local principal investigatorDr. N. Giannetti, Local co-investigator2001: Cardiac support device trial (ACORN)sponsored by Acorn cardiovascular inc.Dr. R. Cecere, Local principal investigatorDr. N. Giannetti, Local co-investigator2002: INTrEPID trial. Investigation of Non-Transplant-Eligible Patients who are InotropeDependant. (Novacor Left Ventricular Assist Device as destination therapy). Sponsored byWorldheart inc.Dr. R. Cecere, Local principal investigatorDr. N. Giannetti, Local co-investigatorPublications:Chan MC, Giannetti N, Kato T, Kornbluth M, Oyer P, Valantine HA, Robbins RC, Hunt SA.Severe tricuspid regurgitation after heart transplantation.J Heart Lung Transplant. 2001 Jul;20(7):709-17.Montoya JG, Giraldo LF, Efron B, Stinson EB, Gamberg P, Hunt S, Giannetti N, Miller J,Remington JS. Infectious Complications among 620 Consecutive Heart Transplant Patients atStanford University Medical Center.Clin Infect Dis. 2001 Sep 1;33(5):629-640.Giannetti N, Management of congestive heart failure: how well are we doing?CMAJ. 2001 Aug 7;165(3):305-6.Giannetti N, Heridity N, Alimollah A.,Gao S.Z., Shroeder J.S., Hunt SA, Valantine HA. Mildhyperhomocysteinemia is not associated with cardiac allograft coronary disease. ClinicalTransplantation 2001;15(4):247-252Cantarovich M, Metrakos P, Giannetti N, Cecere R, Barkun J, Tchervenkov J. Anti-CD25monoclonal antibody coverage allows for calcineurin inhibitor "holiday" in solid organ transplantpatients with acute renal dysfunction1.Transplantation 2002 Apr 15;73(7):1169-1172Cantin B, Giannetti N, Parekh H, Panchal SN, Kwok BW, Najem R, Woodman K, Hunt SA,Valantine HA. Mycophenolic acid concentrations in long-term heart transplant patients:relationship with calcineurin antagonists and acute rejection.Clin Transplant. 2002 Jun;16(3):196-201.
Ross H, Hendry P, Dipchand A, Giannetti N, hirsh G, Isaac D, Singh N, West L, White M.Canadia Cardiovascular Society Consensus Conference on Cardiac Transplantation. www.ccs.ca(oct. 2001)Abstracts:M. Cantarovich, N. Giannetti, J. Barkun. Royal Victoria Hospital, McGill University HealthCenter,Montreal, Quebec, Canada. Neoral dose monitoring with Cyclosporine 2-hour post-doselevels results in a clinical benefit compared to trough levels in stable heart transplant patients.Oral presentation at the International Congress of the Transplantation Society; Rome, August2000.N. Giannetti, G. Bal, R. Cecere, M. Cantarovich. Late steroid withdrawal in post-heart transplantpatients is associated with a risk of significant rejection. Presented at the Canadian Society ofTransplantation meeting in Lake Louise in 2001.Cantarovich M, Giannetti N, Cyr E, Chartier R, Cecere R. Improvement of acute renaldysfunction in heart transplant patients during calcineurin inhibitor holiday without rejectionunder anti-CD25 monoclonal antibody coverage.J Heart Lung Transplant. 2001;20(2):233.Cantarovich M, Cyr E, Chartier R, Giannetti N, Cecere R.Correlation between the glomerularfiltratiion rate, serum creatinine, creatinine clearance and the calculated creatinine clearance inheart transplant patients. J Heart Lung Transplant. 2001 ;20(2):205-206.Cecere R, Ergina P, De Varennes B, Lachapelle K, Giannetti N. Single centre experience withpulsatile mechanical bridging to heart transplantation. The Canadian Journal of Cardiology 2001;17 (Suppl C): 168C.Cecere R, Giannetti N. Reducton annuloplasty and alfieri repair in the treatment of severe dilatedcardiomyopathy: Sustained improvement in clinical variable.The Canadian Journal of Cardiology2001 ; 17 (Suppl C): 200C.Cantarovich M, Giannetti N, Cecere R. Relationship between endomyocardial biopsy score andcyclosporin 2-hour peak levels during the first year after heart transplantation. Abstractpresentation at the Canadian Society of Transplantation meeting, spring 2002.Cecere R, Giannetti N. Reduction Annuloplasty and alfieri repair in the treatment of severedilated cardiomyopathy: Early improvement in clinical variables. Abstract presentation at theCanadian Society of Transplantation meeting, spring 2002.Cecere R, Ergina P, Lachapelle K, de Varennes B, Giannetti N. Successful outpatientmanagement of Novacor and Thoratec VAD patients. Abstract presentation at the CanadianSociety of Transplantation meeting, spring 2002.Cecere R, de Varennes B, Ergina P, Lachapelle K, Giannetti N. Biventricular mechanical supportand heart transplantation for anthracycline cardiomyopathy in a child. Abstract presentation at theCanadian Society of Transplantation meeting, spring 2002.
Cecere R, Ergina P, Lachapelle K, de Varennes B, Giannetti N. A bridge-to-a-bridge: using short-term mechanical circulatory support as a selection criterionfor long-term bridging to hearttransplantation. Abstract presentation at the Canadian Society of Transplantation meeting, spring2002.Joyal D, Cecere R, Cantarovich M, Giannetti N. Early experience with low dose daclizumab forthe prevention of acute rejection in cardiac transplantation. Abstract presentation at the CanadianSociety of Transplantation meeting, spring 2002.Husa R, Cecere R, Cantarovich M, Giannetti N. Acute heart transplant rejection associated withlate steroid withdrawal. Journal Heart Lung Transplant 2002 Jan; 21(1):167Future DirectionsHaving demonstrated the viability of the bridge-to-transplant concept with favorable results, webelieve it is appropriate at this time to offer mechanical assist services to a much broader patientbase. Our intent is to develop a network whereby non-transplant cardiac centers can requestmechanical support for their most critical or unstable patients with the option of subsequenttransfer and management at out Centre. This hub-and-spoke paradigm has proven to be effectiveat several hub-centres throughout the United States.In addition, we have been approached to participate in several upcoming clinical trials to evaluatenovel surgical procedures and devices aimed at heart failure patients.Due to the large volume of patients seen in our Heart Failure and Transplant Centre staffed byhighly skilled and motivated individuals, we remain very attractive as a site for carrying outbasic and clinical research.