Annual Report 2011

Research

Research conducted at the VCU Pauley Heart Center profoundly impacts our collective knowledge of heart disease, its treatments, and its cures. Prominent physician-scientists are paramount to our strength as a national heart center. These clinicians engage in research to help us meet and resolve some of our most pressing challenges. And equally as important, they instruct, guide, and mentor current fellows—the leaders of tomorrow.

Our basic and clinical research programs focus on novel pharmacological therapeutic approaches and optimizing outcomes for patients with cardiovascular disease using the latest devices and imaging and pharmacologic techniques. These programs boast a group of world–renowned researchers, including:

  • Rakesh C. Kukeja, Ph.D., the Jeanette and Eric Lipman Chair in Cardiology, runs a nationally recognized program in molecular cardiology with research interests in cellular and molecular mechanisms of myocardial ischemia-reperfusion injury, gene therapy, and cell signaling.
  • Anindita Das, Ph.D., assistant professor of cardiology, investigates and develops novel pharmacological and genetic therapeutic approaches to reduce injury in the heart following myocardial ischemia.
  • Lei Xi, M.D., assistant professor of cardiology, possesses expertise in hypoxia physiology and pathophysiology, myocardial ischemiareperfusion injury, anti-cancer drug–induced cardiotoxicity and heart failure, cardioprotection by pharmacologic agents, and cellular signal transduction.
  • Antonio Abbate, M.D., assistant professor of cardiology, serves as principal investigator or co-investigator on three clinical studies and a number of basic science projects, and is founder and senior consultant for the Metaanalysis and Evidence-based Medicine Training in Cardiology Group.
  • Qun Chen, M.D., assistant professor of cardiology, studies the role of mitochondrial dysfunction in myocardial injury during ischemia and reperfusion, with a major interest on the identification and characterization of proteins located within the mitochondrial intermembrane space.
  • Edward J. Lesnefsky Jr., M.D., professor in the departments of Internal Medicine and Biochemistry and Molecular Biology and chief of cardiology at Hunter Holmes McGuire VA Medical Center, investigates the mechanisms of myocardial cell death during ischemia and reperfusion.
  • Mark A. Wood, M.D., professor of cardiology, focuses on catheter ablation research and spearheads an innovative research program that exposes young students to the rigors of science.

A recent $5 million National Institutes of Health construction grant gave the VCU Pauley Heart Center an unprecedented opportunity to renovate 8,900 square feet of outdated laboratory space for basic cardiovascular research. The renovation allows us to grow and expand our existing research base, recruit physician-scientists, and form additional research partnerships with other health sciences schools at VCU and throughout the United States.

Clinical

Each year thousands of patients trust the Pauley Heart Center with their care. We return that trust with the most knowledgeable, compassionate cardiac care available, using the most advanced procedures and treatments in our region. For more than four decades, our physicians and scientists, nurses, and technicians have saved and improved the lives of people with heart disease.

Cardiology Research Grants*

Grants Total Support
FY06 66 $1,058,714
FY07 71 $815,216
FY08 76 $884,123
FY09 70 $1,608,772
FY10 63 $1,725,360

* American Heart Association, federal government, and individually sponsored

Clinical Procedures Numbers

FY06 FY07 FY08 FY09 FY10
Catheterizations 2,874 2,743 2,681 2,851 3,211
Electrophysiology procedures 1,432 1,336 1,379 1,413 1,485
Echocardiography and stress testing 11,095 11,687 12,167 13,131 13,779
Cardiothoracic surgeries 1,013 1,117 1,032 1,005 1,111
Mechanical circulatory assist devices 9 9 8 24 36
Heart transplants 12 6 16 22 16
Inpatient discharges 3,177 3,282 3,003 2,937 2,927
Outpatient encounters 19,659 20,132 20,382 22,053 22,218

Gift Supports Cardiology Research

Established in memory of his late wife, Natalie, Mr. Congdon’s generous gift is specifically dedicated to the Division of Cardiology’s Visiting Scholars program.

“It’s so gratifying to contribute to the work of the renowned cardiologists at the VCU Pauley Heart Center,” said Mr. Congdon. “To honor my wife in this way is equally as moving. She would be pleased to be a part of the development of the creation of new procedures and techniques for patient treatment.”

“Cardiologists who receive their training at VCU are at the forefront of the fight against heart disease and stroke,” said Dr. Kenneth Ellenbogen, Chair, Cardiology Division, VCU Department of Internal Medicine. “The Congdon Visiting Scholar endowment enables the VCU Pauley Heart Center to create and perfect new potentially life-saving procedures. We are so very grateful to Jack for his generosity and trust.”

Visiting Scholars attracted to the VCU Pauley Heart Center will spend one to two years at the Center working with faculty members and sharing their research.

“Research helps distinguish us as an academic medical center of the highest caliber,” said MCV Foundation President William P. Kotti, Ph.D. “Jack Congdon’s generous financial support helps students, faculty, and our entire scientific community as we move toward creating solutions to humanity’s toughest health challenges.”


MCV Physicians Distinguished Clinician Award

In today’s high-tech world of medicine, you might picture a cardiac electrophysiologist at work completely surrounded by advanced machinery, engrossed in printouts, monitors, and the other medical technology required to make accurate diagnoses and provide state– of–the–art patient care. In contrast, here is how the colleagues of Dr. Mark Wood, 2011 MCV Physicians Distinguished Clinician of the Year, describe him at work:

“He is never looking at his cell phone or being distracted by a smartphone or other electronic distracters. When he is with a patient, he is completely and totally focused on them. He is a marvelous listener. He makes his patients feel that they are the only one that matters, the only one in the room, and that all of their concerns are appreciated and heard.” says Dr. Ken Ellenbogen, M.D., Hermes A. Kontos Professor of Cardiology and Chair of the VCU Division of Cardiology, Pauley Heart Center.

“It is my great fortune to be in the clinic at the same time as Mark and to share patients with Mark on a regular basis. His patients view him as a caring and compassionate clinician.” shares Dr. Michael Hess, M.D., Professor of Cardiology and Chairman, Division of Cardiopulmonary Laboratories and Research. “He is both a joy to work with and an excellent physician in his care for patients.”

A native of Memphis, Dr. Wood came to MCV for his residency training and three fellowships in research and clinical cardiology as well as cardiac electrophysiology. He completed an additional fellowship at U.Va. before returning to VCU as Assistant Director of the Cardiac Electrophysiology (EP) Laboratories and Assistant Professor of Internal Medicine in 1991, rising to the rank of Professor in 2004.

In addition to being a skilled and compassionate physician, Dr. Wood has been a pioneer in patient safety. Dr. Ellenbogen recalls that “Mark introduced me and all our partners and trainees to a method for caring for our patients that involved developing a “checklist” manifesto for performing clinical procedures. In other words, Mark decided that all of our patients should benefit from an organized and thoughtful approach to a complex procedure.” As Dr. John Nestler, William Branch Porter Professor and Chair, Department of Internal Medicine explains, “Mark is an internationally acknowledged expert in his field … and has instituted quality systems and processes that have resulted in a remarkable zero percent procedural complication rate in the EP laboratory over the past ten years.” Dr. Wood also instituted a daily meeting in which all patient providers, including physicians, fellows, nurses, and students participate and discuss patients to improve communication and support the best patient care.

Dr. Wood’s accomplishments include a long history of federal and private industry funding, authorship or co-authorship of more than 300 research papers, serving as editor for five textbooks, and recognized excellence as a teacher, with nearly 200 presentations locally, across the country, and around the world. His students awarded him the Clinical Cardiology Fellows Faculty Teaching Award in 1998, the Department of Medicine Distinguished Faculty Teaching Award in 2004, and the Outstanding Teacher in the Cardiovascular Course Undergraduate Medical Education Award from the second–year medical students for six years.

Dr. Wood’s philosophy of clinical practice is that at every encounter, the patient deserves your undivided attention. sit down, listen to the patient, and before acting, ask, “Is this what I would want for myself and my family?”

Isn’t this approach what all of us would want for ourselves and our families? His rare combination of patient-centered care, compassionate bedside manner, and masterful clinical and technical skill make Dr. Mark Wood most deserving of the 2011 MCV Physicians Distinguished Clinician Award.


Heartfelt Thanks: Ken & Dianne Wright

“All of us at the VCU Pauley Heart Center are grateful to Ken and Dianne for their ongoing support and their friendship,” said Dr. Kenneth Ellenbogen, chairman of Pauley’s division of cardiology. “Their generosity is truly an inspiration. The C. Kenneth Wright Professorship will help us recruit an outstanding scholar to our faculty.”

The couple has previously supported the MCV campus with generous gifts to the Massey Cancer Center and the Cardiology Division.

The Wrights’ deep-rooted commitment to VCU includes the Monroe Park campus as well. They gave a transformative, $10.5 million gift to the School of Engineering Foundation and also created the C. Kenneth and Dianne Wright Freshman Merit Scholarship Fund for engineering students. A $1 million gift by the Wrights established the Trani Scholars program, which provides full tuition and fees to exceptional, deserving undergraduate students.

Dianne Wright is the former owner of Ambassador Travel & Tours, Inc. Ken Wright is the president and owner of Wright Properties and Wright Investments. He is the retired chairman of Rent-A-Car Company, Inc., an Avis franchise that he started in 1954. Over the next 45 years, he expanded the business to more than 24 locations in Virginia, Maryland, and Delaware. In 1999, the Wrights began their philanthropic relationship with VCU by donating the building that once served as Rent-A-Car’s headquarters to the VCU Brandcenter.

Over the years, the Wrights have donated more than $17 million in gifts and pledges to the university, and have also provided valuable leadership support. Ken is a member of the VCU School of Engineering Foundation’s Board of Trustees. Dianne is a Trustee of the MCV Foundation and is serving her second term on the Massey Cancer Center’s Advisory Board.

In June, VCU honored Ken with its highest accolade—an honorary doctorate.

“There is nothing more meaningful to us right now than our affiliation with VCU,” he said, upon receiving the award.


Consortium Ties Donors to Pauley Heart Center

Dr. Kenneth Ellenbogen welcomed the guests and made some introductory remarks prior to the dinner. Following the dinner, Dr. George Vetrovec spoke about several friends and supporters of the Pauley Heart Center who passed away in recent months and asked for a moment of silence in their memory. He gave a special tribute to Dr. Howard McCue, who died in December at the age of 93. Dr. Vetrovec then introduced the guest speaker, Bruce S. Stambler, M.D., Professor of Medicine at Case Western Reserve University.

Dr. Stambler earned his A.B. and M.D. degrees from Duke University. He completed his internship and residency at Beth Israel Hospital in Boston and was a Clinical Fellow at Harvard Medical School, Beth Israel Hospital, Massachusetts General Hospital, and New England Regional Primate Research Center.

From 1991 until 1995, Dr. Stambler was on the faculty at MCV as an Instructor in Clinical Medicine and as an Assistant Professor. Dr. Stambler expressed his gratitude to the guests and spoke fondly about the time he spent in Richmond training under Dr. Ellenbogen. He mentioned that his oldest daughter was born at MCV Hospital and just completed her first year of college. Dr. Stambler remarked how pleased he was to return to Richmond after so many years and see such dramatic changes on the MCV Campus. He commented on his current research interests and activities and spoke specifically about atrial fibrillation, the most common type of arrhythmia, or abnormal heartbeat.

Following Dr. Stambler’s remarks, Dr. Ellenbogen announced that Ken and Dianne Wright pledged $250,000 to establish the C. Kenneth Wright Professorship in Cardiology. Ken and Dianne are longtime supporters of VCU and the MCV Campus and are among the University’s most generous benefactors.

At the conclusion of the evening, Dr. Ellenbogen recognized Dorothy and Stan Pauley for their extraordinary support and presented them with special gifts—a VCU Pauley Heart Center scarf and a VCU Pauley Heart Center tie, both designed and produced by Vineyard Vines. All the guests at the event received scarves and ties.


In the Spotlight: Michael L. Hess, M.D.

“To steal a line from Lou Gehrig, today, I’m the luckiest guy in the world,” he said of the award. “The university has been phenomenally good to me in my career.”

VCU President Dr. Michael Rao presented the award to Dr. Hess at the university’s annual Opening Faculty Address and Convocation in September. Dr. Hess was previously honored with VCU’s Distinguished Clinician, Distinguished Scholarship, and Distinguished Clinical Care Awards and received the Outstanding Teacher Award from six medical classes.

Dr. Hess joined VCU’s faculty in 1975, after serving two years in the U.S. Navy as a clinical cardiologist. He currently is a Professor of both Cardiology and Physiology. Dr. Hess attended medical school at the University of Pittsburgh, where he met and married his wife, VCU cardiologist Dr. Andrea Hastillo. At Pittsburgh, in addition to his work in cardiology, he embarked on a number of pivotal studies in the physiology of the heart with Dr. Norman Briggs. He completed his fellowship in cardiology at VCU, and then began working with the post-transplant patients of Dr. Richard Lower.

“He played a key role in early research with Dr. Lower, as it applies to the care of the modern transplant patient,” said Dr. Keyur B. Shah, Medical Director of the Mechanical Circulatory Support program at VCU. “We often lean on him for guidance, thanks to his wealth of experience with heart transplant patients.”

Dr. Hess said he used to spend Tuesday nights on Dr. Lower’s porch with esteemed colleagues like Dr. H. M. Lee, “trying to pound out the problems that we were having at the time.”

The problems in the 1970s and 1980s included high mortality rates for transplant patients and the fact that “the world of cardiac transplantation was so young that there were no rules, no guidelines,” he said.

The desire to share information with others in the transplant field led Dr. Hess, in 1981, to create the International Society of HeartLung Transplantation. Dr. Hess served as the society’s first president. Today, the organization is the world’s leading scientific society of transplant physicians and surgeons and operates the International Registry for Heart and Lung Transplantation, the only database of its kind in the world.

Dr. Hess has published more than 200 research papers, and currently focuses his studies on responses to the rising epidemic of heart failure.

“There are five million people in the United States with symptomatic heart failure,” he said. Given the limited availability of donor hearts, he sees the development of mechanical assist pumps as the future. As a physiologist, he ponders how the body will be affected by the pumps, especially some of the continuous–flow styles that replace the body’s natural pulse.

“What does this do to the human body? Does it change things? What are the long-term effects? What are the short-term effects?” he said.

When asked if such matters might be contemplated on Dr. Lower’s porch today, he responded enthusiastically.

“Oh, we would be talking about it.”


A Cut Above

At many hospitals, cardiac transplants are a rare and dramatic event; at Vcu’s Pauley heart center, “they’re a routine thing for us,” said dr. Vigneshwar Kasirajan, Pauley’s chairman of cardiothoracic surgery and director of heart transplantation and mechanical circulatory support.

The routine begins like this: When a good donor match is identified for a patient, the surgeon on call contacts the transplant coordinator. The coordinator works out the logistics with the organ procurement agency and the hospital’s staff, and then assembles the operating, critical care, and ICU teams. Two surgeons and their assistants scrub in for every transplant, along with a team that comprises cardiac anesthesiologists, operating room nurses, and perfusionists to operate the heartlung machine. One surgeon travels to the donor hospital to procure the heart. After returning to VCU, the surgeon makes any needed repairs to the heart before surgery. When the heart is ready, the surgeons can begin the transplant.

Once a heart is removed from a donor, the transplant team has only a four-hour window of time in which to work.

“That time frame is very critical. If you cross four hours, the outcomes are definitely worse,” said Dr. Kasirajan.

But with their experience, and their routines and procedures already in place, the VCU transplant team swings easily into action.

“Everybody knows exactly what their roles and responsibilities are, and there’s not a lot of hand wringing,” he said. “And I think that’s important, because if it’s not routine, and everything is a big production, there’s more room for error.”

Donor hearts can become available at any time; the hospital has even performed two cardiac transplants in a single day. A transplant surgeon’s life is composed of late–night phone calls, long and unpredictable hours—and unimaginable rewards.

“I did a transplant on Sunday on a woman who had been in the hospital for a long time,” he said. “It was very gratifying to see her get a heart, get well, and go home.”

“Vig,” as he is often called, grew up in india, the son of a cardiologist and a homemaker.

“My dad was a cardiology fellow in the United states in the 1960s, and he was at Maimonides [Medical Center in Brooklyn] when the first human heart transplant in the United States was performed by Dr. Adrian Kantrowitz,” said Dr. Kasirajan.

He grew up listening to his father’s stories of heart surgery and transplantation. “It was a big thing,” he said. “The ’60s and ’70s were when heart surgery was rapidly exploding, and it was very exciting.”

Inspired by his father, Dr. Kasirajan attended Madras Medical College in India. As a young medical student, he watched his first open heart surgery. That’s when he decided to become a cardiac surgeon.

“I saw the heart and it was kind of bouncing in and out,” he said, his eyes lighting up. “It was beating—it was actually beating. It was a dynamic organ.”

He went on to serve his fellowship in cardiothoracic transplantation and mechanical assist devices at the Cleveland Clinic Foundation and remained there for his residency in thoracic and cardiovascular surgery.

He has helped to create a vibrant environment at VCU, where he has been since 2003.

“Vig has been very instrumental in the resurrection of the heart transplantation program here,” said Dr. Keyur B. Shah, Medical Director of the Mechanical Circulatory Support Program.

In addition to his work with transplant patients, Dr. Kasirajan is at the forefront of a new frontier in cardiac surgery that includes artificial hearts and mechanical assist devices.

In 2006, he led the first surgical team on the East Coast to implant the SynCardia Total Artificial Heart, the only device of its kind approved by the FDA Since that time, he has implanted a total of 50 of the devices, and his work has helped establish VCU as one of the leaders in the realm of artificial hearts.

Data presented to VCU by SynCardia last fall establishes Dr. Kasirajan’s reputation as “one of the best total artificial heart surgeons in the world,” said Dr. Michael Hess, Director of Pauley’s Heart Failure Program. “He now has the largest and best experience with the SynCardia total artificial heart.”

Artificial hearts enable patients to improve their health, and even prolong their lives, as they await cardiac transplantation. The current wait time for a donor heart is six months to two years or more, depending upon the patient’s priority status.

Patient care plays a critical role in recovery. After receiving an artificial heart, the patient is transported first to the ICU and then to Pauley’s special device-dedicated, stepdown floor. Working in the unit are biomedical engineers and nurses specially trained to take care of patients with artificial hearts, left ventricular artificial devices (LVADs), and other heart–assist technologies.

As patients recover on the step-down floor, they begin to get stronger almost immediately. “The artificial heart has dramatically improved patient outcomes,” said Dr. Kasirajan. “We went from taking really sick patients who might have had only a 20 to 30 percent chance of survival to over 85 percent survival to transplant,” he said.

Based upon his experience and success with artificial hearts, Dr. Kasirajan was selected to be the lead investigator of a national clinical trial for the freedom driver, a small, portable air compressor that keeps artificial hearts pumping.

“With the Freedom Driver, the goal is to take selective patients who meet the criteria and ultimately let them go home to wait for a transplant,” he said. “Until now, when a patient went on an artificial heart and was waiting for a transplant, they couldn’t go home because they were attached to a large driver.”

VCU’s large driver, “Big Blue,” weighs more than 400 pounds. The Freedom Driver, by contrast, weighs about 14 pounds and can fit in a backpack.

Six patients at VCU have received the device, and “the ones that have been able to go home have been very happy, because a lot of them have spent months in the hospital,” he said.

“The device could lead to tremendous savings in health care costs,” he said. For instance, before the Freedom Driver, “we had one patient who was in the hospital for over 400 days, waiting for a transplant.”

Not everyone can receive an artificial heart; only those who are candidates for donor hearts. The devices are approved only as a “bridge-to-transplant.”

LVADs, on the other hand, can be either a “bridge-to-transplant” or a “destination therapy.” That means patients can live with the implanted device instead of continuing on to a transplant. LVADs are small, batteryoperated pumps that patients can recharge off their car lighters.

“We have a number of patients living at home with LVADs who don’t want a transplant because they’re doing really well on them,” he said. To qualify for an LVAD, the right side of the patient’s heart must function well. As its name implies, the left ventricular assist device supports primarily the left side of the heart.

The movement from large, pulsating pumps like the HeartMate XVE to smaller, quieter, continuous flow machines like the HeartMate II “is perhaps the single most important surgical advance [in treating advanced heart failure],” he said.

Dr. Kasirajan is part of a seven-surgeon cardiothoracic team that treats patients at both VCU and the Hunter Holmes McGuire Veteran’s Hospital. Their busy practice performs about 1,000 cardiac procedures each year, from valve repairs and coronary bypasses to minimally invasive surgeries for atrial fibrillation. They implant about 60-80 mechanical assist devices like LVADs, artificial hearts, and other temporary devices each year.

“We offer a comprehensive list of options for patients requiring heart surgery,” he said.

With its Medical College of Virginia campus, VCU operates the longest-running cardiac transplant program on the East Coast and the second–oldest in the nation. The program began with the hiring in 1965 of Dr. Richard Lower, an early pioneer in cardiac transplantation, who performed Virginia’s first human heart transplant in 1968. The university was also the site of the state’s first heart-lung transplant in 1986.

“VCU is very rich in the history of transplantation. I’m very fortunate to be here,” said Dr. Kasirajan.

He hopes to see donor heart transplantation move further along the continuum. “Candidly, transplantation has not changed a lot since Dr. Lower started doing it,” he said. For instance, “we’re still limited to four hours of time, from the time we take out the heart to the time we put it in. It limits us to donors who are within 800 miles.”

He would like to see devices developed that can prolong the time a heart can be safely preserved. Additionally, he is interested in testing donor hearts prior to transplantation and an organ donor waiting list that considers antigen matching.

“Heart transplantation is still evolving compared to liver and kidneys and other organs because we match hearts based only on blood type,” he said. “But that is probably going to change very dramatically in the future as we learn more about organ preservation and matching.”

He also believes that, ultimately, artificial hearts will be approved as destination therapies for many patients who are not optimal candidates for transplantation.

He is impatient for these changes, and that’s why he enjoys working at VCU. “In additional to doing clinical work, being here gives us an opportunity to participate in some cutting edge research with people in other specialties,” he said. “We have a lot of opportunities to collaborate with them and come up with new ideas.”


Letter From the Chairman

The Pauley Heart Center continues to do well. We are excited to be in a building phase, and we are recruiting new physicians for our cardiac catheterization laboratory, electrophysiology laboratory, and heart failure program. We are continuing to live by the VCU moniker: “Every Day a New Discovery.”

In the following pages, we will share with you some of the exciting new developments in our Cardiac Surgery program. It is without question one of the best in the country. We are busy caring for patients from all over the state as well as from the Southeast and Mid–Atlantic. We tackle some of the toughest and most complex cases, and our results are excellent. Dr. Kasirajan has built a world–class team. We are performing procedures in Richmond, for which physicians from all over the country are coming to observe and trying to emulate our success.

Also, in this issue we recognize several of our generous benefactors and report on recent faculty accomplishments and accolades. These are truly exciting times at the Pauley Heart Center. Challenges continue to lie ahead, but I think with our loyal friends and our talented faculty and nurses, we will continue to make the Pauley Heart Center a leader in Cardiovascular Care and Research. We thank all of you for your support.

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