Stony Point Opening

Coming soon: The Pauley Heart Center will begin offering outpatient services at a new VCU Health building located at 9000 Stony Point Parkway, Richmond, VA. 23235. Cardiology, cardiothoracic, and vascular services will be offered, using state-of-the-art imaging. VCU cardiologist Phoebe Ashley, M.D., will serve as the facility’s medical director. Stay tuned.


First in Our Hearts

1968 – First heart transplant in Virginia (and 9th in the country,16th worldwide) takes place at MCV; 557 completed to date
1972 – MCV wins landmark Tucker Trial involving a human heart transplant; for the first time, death can be defined by “brain death”
1977 – First long-distance heart transplant in the world occurs at MCV
1981 – International Heart Lung Society created by MCV physician
1986 – First heart-lung transplant in Virginia takes place at MCV
1994 – First LVAD implanted at MCV
2006 – First total artificial heart implanted on the East Coast at VCU
…………

VCU Health has the longest-running cardiac transplantation program on the East Coast and the second oldest in the nation.


In the News

In December, the Journal of Heart and Lung Transplantation will publish an issue dedicated to the 50th anniversary of the first human heart transplant, performed by Christiaan Barnard, M.D., in Cape Town, South Africa, on Dec. 3, 1967. VCU cardiologist Michael Hess, M.D., and Sharon Hunt, M.D., of Stanford University, are co-authoring the special issue’s first chapter, “Early Challenges in Cardiac Transplantation.”


Letter from the Chairman

Kenneth Ellenbogen, MD

Friends and Supporters,

Welcome to the fall issue of The Beat. In this issue, you’ll visit some of our innovative programs and meet some of the talented physicians and teams who are making a difference in the lives of our patients.

Our cover story will bring you up close and personal to a truly terrifying experience: cardiac arrest. In the story, you will meet two patients who lived to tell their tales and, like so many, are grateful to Pauley’s world-class ARCTIC program, led by Dr. Mimi Peberdy and Dr. Joe Ornato.

In electrophysiology news, you can read about Dr. Jay Koneru and Dr. Gautham Kalahasty, the first physicians in central Virginia to implant the world’s tiniest, and first leadless, pacemaker. We have also completed the new EP suite, which provides an optimal setting for both exploration and patient care.

Longtime heart center innovator Dr. Michael Hess recently retired. But he leaves behind many important legacies—including his innovative work with cardiac transplant patients. I hope you will enjoy reading about his memories of working with pioneering transplant physician, Dr. Richard Lower, in the early days of the program.

One of the things that’s fantastic about this place is the people that we’re surrounded by—including the many Advanced Practice Providers—nurse practitioners and physician assistants–who are so expert in cardiology and patient care. In this issue, you can read about the many ways they are helping patients in the divisions of cardiology, cardiac surgery and vascular surgery.

There are so many phenomenal things occurring on this campus, and some of the best are the result of our doctors, researchers, nurses, and other team members working together to provide the best care possible to our patients. They, together with friends like you—who make so much of our work possible—are truly what makes this place great.

Sincerely,

Kenneth A. Ellenbogen, M.D.
Chairman, Division of Cardiology


Reaching Out, Saving Lives

Beyond their walls, VCU Health and the Pauley Heart Center participates in many community events. Here are a few coming up:

VCU Health is sponsoring the Retreat and Refresh Stroke Camp for stroke survivors and their loved ones. The camp will be held Sept. 8–10 at Airfield Conference Center in Wakefield. Offered throughout the U.S., the nonprofit camp was started by a stroke survivor and his loved one. This will be the first time the camp is offered in Virginia according to Kristina Gooch, a nurse with the VCU Stroke Program who is helping to coordinate the effort.

During camp, survivors and caregivers will have the opportunity to meet and interact with others in their situation. “There will be activities to retreat and relax from the daily struggles they face,” said Gooch. As participants talk about their problems and triumphs, “the value is it provides everyone with a new sense of purpose in the community.” For more information, visit StrokeCamp.org.

VCU Health is a sponsor for the American Heart Association’s Life Is Why Richmond Heart Walk, which will take place Saturday, Oct. 7, at West Creek Parkway. The annual 1- and 3.1-mile walk supports education and research for heart disease and stroke, with the Richmond chapter hoping to raise 
$1.6 million this year.

Last year, the Pauley Heart Pumpers, led by co-captains Lorraine Witzke, RN, and patient Greg Lowe, raised $11,830 and were the number-one VCU fundraising team. The team included transplant survivors and several patients who took part in the walk from inside the heart center (see article “Walk of Fame: Patient Leads ‘Virtual Heart Walk.’”). To sign up or support a VCU Pauley Heart Center team, please visit RichmondVaHeartWalk.org.

At the Heart Walk, VCU Pauley Heart Center staffers will take part in demonstrations of Hands-Only CPR. Promoting this simple rescue technique that does not require mouth-to-mouth resuscitation has been an important and frequent outreach effort for Pauley.

During CPR Awareness Week (June 1-7), Michelle Gossip, BSN, Advanced Resuscitation Cooling Therapeutics and Intensive Care (ARCTIC) Program Coordinator took part in one to two community events every day. At one function, she helped train 700 City of Richmond employees in Hands-Only CPR.

“It does save lives,” said Gossip. “People are afraid of doing CPR and we need to debunk that fear.”


Surgeons Explore New Heart Failure Devices

VCU Health Pauley Heart Center cardiothoracic surgeons Daniel Tang, M.D., and Mohammed Quader, M.D., are taking part in several clinical trials involving new devices for patients with advanced heart failure.

“The field of device therapy for advanced heart failure has certainly exploded,” said Tang. “Yet despite the marked improvement in outcomes with newer generation devices, patients still face significant potential for adverse events.” For that reason, “VCU remains actively engaged in being at the forefront of advanced therapies for end-stage heart failure.”

Here are some updates from some recent trials:
Momentum (Heartmate III) – Chair of Surgery Vigneshwar Kasirajan, M.D., is the primary investigator (PI) for this Phase III trial. Patients are implanted with the Heartmate III left-ventricular assist device (LVAD), which offers the use of a magnetically levitated rotor with wider flow pathways than previous models, along with other innovations. The device is being evaluated for its safety and effectiveness, and patients are compared to a control group using the Heartmate II.

The trial began in Jan. 2015, and short-term results from the trial’s first 1,000 enrolled patients were reported at the Nov. 2016 AHA Scientific Sessions.

“Overall, outcomes were relatively similar, but the Heartmate III group did demonstrate superiority compared to the Heartmate II in freedom from re-operation for pump thrombosis [the creation of blood clots, which increases the risk of strokes],” said Tang. “While we wait for further and longer-term results, the trial is currently enrolling another 1,000 patients.”

“VCU remains actively engaged in being at the forefront of advanced therapies for end-stage heart failure,” said Tang.

Heartware HVAD Lateral – This non-randomized study, which was conducted to explore the feasibility of using a minimally invasive approach to implant this continuous flow, centrifugal LVAD. The trial completed its enrollment of 145 patients in 2016, with preliminary six-month results reported at the recent International Society for Heart and Lung Transplantation meeting in April.

“The data is undergoing review and only very early results have been reported. It appears promising as there was 92 percent survival rate at six months,” said Tang. “Our experience and pretrial data suggests potential benefits of reduced blood loss and possible less right ventricular failure.”

Syncardia DT trial – Tang is the PI for this Phase III trial, which explores the Syncardia DT total artificial heart as destination therapy—that is, implanted permanently instead of as a bridge-to-transplant.

“The trial is ongoing, with very limited enrollment. We were the first center to enroll a patient—who was, for a time, the only patient,” said Tang. “It is a challenging trial due to a very narrow risk/benefit window. Nonetheless, it is an important trial as the total artificial heart may be the only device option for certain patients who are not candidates for transplantation.”

Syncardia 50cc trial – Tang is the PI for this Phase III trial, which is open for enrollment. “The current 70cc device offered by Syncardia is sized for large men. The smaller pump opens the total artificial heart to smaller-sized patients—namely, women and children,” he said.


Pauley Reveals Latest EP Lab

After nearly seven years in the making, the new VCU Health Pauley Heart Center interventional cardiology suite dazzles with eight bright, spacious rooms and state-of-the-art technologies, including fully integrated GE imaging systems.

“We worked very hard to make the rooms as functional and efficient as possible. We’ve tried to include everything the doctors and staff need to make the rooms work well,” said Ruth Williams, nurse manager of the Cardiac Catheterization and Electrophysiology Labs and Cardiovascular Progressive Care Unit.

“These rooms have advanced technologies that all communicate with each other. All rooms were equipped with booms that contain all cables to keep the rooms less cluttered, cleaner and safer for staff with no trip hazards,” said Williams.

Take EP2, the final ,room in the suite, which was completed in July. An x-ray table in the middle of the room is surrounded by the latest in technologies—from a GE Innova 620, with a C-shaped arm for imaging, to the multiscreen flat monitors and the three Stryker booms that suspend from the ceiling, containing outlets for medical gases, electrical outlets, and IT integration for all equipment.

“These rooms have advanced technologies that all communicate with each other. All rooms were equipped with booms that contain all cables to keep the rooms less cluttered, cleaner, and safer for staff with no trip hazards,” said Williams. “Additionally, each room is equipped with CleanSuite ceiling technology developed by Huntair. This is a custom, laminar air delivery system that continuously filters air in the procedure rooms, reducing airborne contaminants.”

Many of the components in the room, such as the lighting, attach to the Huntair ceiling grid. Large flat-screen monitors angle wherever needed throughout the room, with additional screens in the procedure room and control room to optimize visualization for all team members.

“EP has a lot of very complex equipment. We were able to integrate all of that equipment so that the staff can see any modality, at any place in the room,” she said. “Everybody can see what everybody else is doing and keep a closer eye on the patient.” Additionally, “radiation exposure to our patients, as well as doctors and staff, has decreased.”

The four rooms that make up the EP surgical suite are connected by a hallway to the four new cardiac catheterization labs, which include a hybrid operating room. Near the EP labs, a conference room that will connect audiovisually to the procedure rooms is under construction. It will support the increasing number of clinical staff who want to watch the many innovative procedures taking place at the Pauley Heart Center.

An estimated 1,900 EP and 3,800 Cardiac Cath Lab procedures will take place at VCU this year. The labs will help VCU meet growing patient demand, including an increasing number of complex, high-risk cases.

“We are doing a lot more structural heart procedures that close abnormal openings in the heart or correct valve problems. In EP, we are performing left atrial appendage closures. We were doing those before the construction, but it’s much, much easier in these new rooms,” said Williams.

The process began in 2012 when the Pauley Heart team closely reviewed and meticulously tweaked the plans and helped select the equipment. “I think the biggest challenge has been the extreme number of details…When you’re trying to conceptualize new construction, you really have to put yourself into that room in your mind and think, `What do I need? What do I need where?’”

A daily challenge was keeping the departments up and running safely, she said. “We have a very vulnerable population, especially with our cardiac transplant patients. Everything has to be very tightly sealed in the construction areas, so we were constantly working with our epidemiology colleagues and assuring all quality and safety metrics were being met.

All the hard work has paid off. The custom design and equipment wows visitors, including those from other hospitals.

“I’ve even had people ask to see our blueprints,” Williams said with a laugh. “I think everybody has been really impressed.”


Hume-Lee Celebrates 60 Years

It’s a banner year for the VCU Health Hume-Lee Transplant Center. The transplant program at VCU—formerly the Medical College of Virginia—was once one of only three such programs in the U.S. In 1957, it was the site for Virginia’s first kidney transplant.

David Hume, MD and H.M. Lee MD

LEFT: H.M. LEE, M.D., AND DAVID HUME, M.D. / MARCH 12, 2002, THE TRANSPLANT CENTER LEE DIRECTED FOR TWO DECADES, WHICH OPENED IN 1964 AND IS NOW THE OLDEST TRANSPLANT UNIT IN THE UNITED STATES, WAS RE-DESIGNATED AND OFFICIALLY NAMED THE HUME-LEE TRANSPLANT CENTER.

The center is named after pioneering MCV transplant physicians David Hume, M.D., and H.M. Lee, M.D. Accomplishments at the center also include Virginia’s first liver transplant, one of the world’s first tissue-typing labs, and Virginia’s first vascular-access program. In May, the center completed its 5,000th transplant.

A 60th Anniversary Celebration for the VCU Health Hume-Lee Transplant Center will take place on Sat., Dec. 2 at 6 p.m., at the Virginia Museum of Fine Arts.


Raising Awareness of Women’s Heart Health

VCU Pauley Heart Center hosted the second annual Heart Health in Women Symposium on Feb. 4 at the Virginia Museum of Fine Arts. Phoebe Ashley, M.D., and Jordana Kron, M.D., co-chaired the event for the second year, and were among the many VCU cardiologists who spoke that day.

“Our goal is to update and educate healthcare professionals so that women receive state-of-the-art cardiovascular care throughout Virginia and the surrounding areas,” said Ashley.

The event, which began with breakfast and concluded at noon, drew 70 participants who were physicians, nurse practitioners, physician assistants, and nurses.

“One highlight of our program was Dr. Reavey-Cantwell’s discussion of stroke in women. He outlined the unique features of stroke in women, the high incidence of stoke, particularly in young women, and unique risk factors in women. He was very well-received,” said Ashley.

Other topics included exercise and cardiac rehab in women, pregnancy and the heart, and a panel discussion on “Survivorship: The Heart of the Breast Cancer Patient” that included specialists in cardio-oncology and heart failure.
“The participants seemed to really enjoy the program with many being interested in moving it to a full-day event,” said Ashley. “We plan to annually bring the most up-to-date information relating to women’s cardiovascular health to continue to advance heart health in our community.”

ABOVE: DR. INNA TCHOUKINA, DR. DEBORAH KOEHN, DR. HEM BHARDWAJ, DR. PHOEBE ASHLEY, DR. JORDANA KRON, DR. JENNIFER SALLUZZO, DR. SUSAN WOLVER, AND DR. JOHN REAVEY-CANTWELL WERE AMONG THE SPEAKERS AT THE HEART HEALTH IN WOMEN SYMPOSIUM. THE EVENT RAISED AWARENESS ABOUT THE UNIQUE FEATURES OF WOMEN’S HEART DISEASE, THE NO. 1 KILLER OF WOMEN AND THE CAUSE OF DEATH IN 1 OF 3 WOMEN.

  Heart Health in Women’s Symposium on Saturday, February 3, at the Virginia Historic Society Museum.


Chain of Survival Saves Runner

Jeff Stover was steps away from the finish line of the Monument Avenue 10K this April when he collapsed.

Stover, 48, has little memory of the race—
a family tradition that he undertakes each year with his eldest son. “I remember starting, and then I remember at the very end, I could see the finish line. I remember thinking to myself, `Should I pick up the pace a little bit—you know, finish strong?’ And then I remember saying to myself, `No, I’m good.’”

“Every person in that chain is extremely important,” said ARCTIC Medical Director Mary Ann Peberdy, M.D. “The early care that those patients get really sets the tone for how well they’re going to do afterwards.”

His 15-year-old son, Harrison, had already completed the race and was waiting for his dad at Monroe Park with friends when Stover went into cardiac arrest and collapsed about 10 yards from the finish line. Fortunately, he had some helpful—and well-trained—strangers who jumped in to help. Running behind him was an emergency physician from University of Virginia, who immediately began administering CPR. A paramedic bystander, who was waiting for his wife to complete the 10K, also rushed over to help. Nearby in a tent at the finish line were Richmond Ambulance Authority paramedics, who used a defibrillator to quickly regain a heartbeat and then brought him to VCU for the ARCTIC program.

Stover underwent ARCTIC therapy at VCU, then required surgery to fix the problem that had led to his cardiac arrest.
“My issue was a bicuspid aortic valve. It’s hereditary, but I didn’t know I had it,” he said. Most people have three flaps on this valve, but Stover had only two. “So, it already isn’t working as efficiently as it should. And then it tends to calcify more.”

Looking back, he realized that a doctor had detected a murmur during a high school physical—but no testing was ever done, which would have revealed his condition. He also remembers that he got more out of breath training for the 10K this year than in the past.

As to his care, Stover benefited from the perfect experience of what the American Heart Association calls the out-of-hospital Chain of Survival for Cardiac Arrest. The five links in this chain are:
• Recognition of cardiac arrest and activation of the emergency response system
• Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions
• Rapid defibrillation
• Basic and advanced emergency medical services
• Advanced life support and post-cardiac arrest care

“Every person in that chain is extremely important,” said ARCTIC Medical Director Mary Ann Peberdy, M.D. “The early care that those patients get really sets the tone for how well they’re going to do afterwards.”

“Every person that I come into contact with through the ARCTIC program has either been saved by CPR or potentially saved by knowledge of CPR,” said Michelle Gossip.

ARCTIC Program Nursing Coordinator Michelle Gossip, who assisted in coordinating Stover’s care in the hospital, said VCU trained about 2,000 community members in Hands Only CPR last year. She is passionate about this outreach. “Every person that I come into contact with through the ARCTIC program has either been saved by CPR or potentially saved by knowledge of CPR,” she said.

Stover, whose path ran smoothly from immediate CPR all the way through to the care he received at VCU (“I can’t speak highly enough of the folks at VCU”) knows he is fortunate.

“All the stars aligned—almost as perfectly as they could have.”

Note: According to cardiologist Joe Ornato, M.D., exercise is very beneficial to the heart. A very small percentage of cardiac arrests occur during exercise, usually as the result of a previously unknown blockage or other form of heart disease. Most cardiac arrests—88 percent, according to the AHA—occur at home, but your chances of survival are much better if your arrest is witnessed, in a public place, and bystanders call 911 immediately, perform CPR, and apply an AED before EMS arrives.

LEFT: ON JUNE 2, CARDIAC ARREST SURVIVOR JEFF STOVER REUNITED WITH VCU ARCTIC PROGRAM COORDINATOR MICHELLE GOSSIP AND FIRST RESPONDERS DR. DEBORAH VINTON, FLIGHT PARAMEDIC HUGH CLINE, AND PARAMEDICS FROM THE RICHMOND AMBULANCE AUTHORITY WHO HELPED SAVE HIS LIFE. / RIGHT: JEFF STOVER WITH MICHELLE GOSSIP WHO HELPED COORDINATE HIS CARE AT VCU.