Department of Cardiac Surgery Program Description

Quick Links Clinical Case Volumes Excellence FY2008 FY2009 FY2010 FY2011 FY2012 Page 2 The Department of Cardiac Adult 1130 1216 1172 1034 1245 • Areas of Specialty Surgery, which includes Pediatric 439 462 481 517 480 Page 3 the Division of Pediatric • Teaching & Cardiac Surgery, provides Residency comprehensive surgical Academics and Research • Outreach services for patients with In addition to studying new ways to surgically treat • Alliances cardiovascular disease. We congenital and adult heart disease, we maintain a • Infrastructure focus on providing the national presence in several national clinical trials. most innovative surgical Online procedures that are safe, • The Department of Cardiac Surgery • View a listing of all state-of-the-art and of was chosen as only one of 15 major current and pending research the highest quality. Our academic centers involved in the first NIH projects here. adult surgical outcomes observational trial for hybrid coronary • View a listing of are ranked third best in the revascularization – the combination of publications here. country according to recent coronary stenting and bypass surgery. University HealthSystem Consortium (UHC) data. Our Pediatric program is one • Vanderbilt was chosen to be part of the of only 15 centers nationwide to be certified as a Pediatric first U.S. trial of the CoreValve® trans- Heart Transplant Center of Excellence by OptumHealth catheter aortic-valve system (Medtronic, Clinical Sciences Institute. We are recognized nationally as Minneapolis, MN). a pioneer in “hybrid” coronary artery revascularization; and • Vanderbilt was the largest enrolling site our program is also renowned as a leader in congenital and for the St. Jude Medical TrifectaTM Valve. acquired valvular heart disease, minimally invasive cardiac Vanderbilt is also participating in the Post- surgical techniques and cardiac transplantation. Approval Study. By partnering with the Vanderbilt Heart and Vascular Institute, the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Vanderbilt Transplant Center, our patients benefit from experienced surgeons who collaborate Groundbreaking Achievements with specialists in all areas of cardiovascular disease to • Vanderbilt Cardiac surgery celebrates busiest determine the most appropriate care for each individual. year in history Informatics • New stent helps diabetic heart patients By fully incorporating Informatics into the Department, • Vanderbilt offers new aortic valve technique we have developed the Cardiovascular Outcomes Research • Vanderbilt performs 100th transcatheter Enterprise and and Workflow Efficiency Tools. aortic valve-replacement (TAVR) The Cardiovascular Outcomes Research Enterprise is a collaborative effort of clinicians, nurses, statisticians, • Trial tests novel treatment for heart failure epidemiologists, researchers and scientists from patients Informatics to enable academic queries of clinical • Cardiac surgeons study genetics of heart databases, comparative effectiveness evaluations, quality condition to uncover new treatments improvements and dashboards. Workflow Efficiency Tools include real-time dashboards • Pediatric cardiac tissue bank aims to solve that facilitate OR scheduling, real-time reminders heart disease mysteries and notifications and enhanced tools for electronic documentation. Areas of Specialty

Acquired (Adult) Heart Disease Coronary Revascularization Program Our surgeons perform advanced techniques in coronary revas- cularization, including off-pump coronary bypass, minimally invasive coronary bypass, coronary endarterectomy and trans- myocardial laser revascularization, and multiple artery bypass grafting. Cardiac Valve Program The Vanderbilt Cardiac Valve Program unites a multidisci- plinary team of cardiologists, radiologists, anesthesiologists and surgeons trained in diagnosing and treating all disorders of cardiac valves. Guided by diagnostic techniques, includ- ing cardiac MRI and trans-esophageal echocardiography, TAVR Program our surgeons perform all types of aortic, mitral, pulmonary Vanderbilt began using trans-catheter aortic valves and tricuspid valve operations including: mitral valve repair, (TAVR) in adult patients in July 2011 when it embarked mitral valve replacement with biological or mechanical valve on a clinical trial of Medtronic’s CoreValve. Vanderbilt is prostheses, aortic valve replacement using stented or stentless one of a few medical centers in the country to offer both tissue valves or mechanical valve prostheses, tricuspid valve the CoreValve and the SAPIEN valve, and we are the repair or replacement, aortic root replacement with tissue most experienced hospital in Tennessee at replacing heart or mechanical valves, valve-sparing aortic root reconstruc- valves using TAVR. tions and pulmonary autograft switch operation in younger patients. In addition, Vanderbilt Heart’s hybrid OR allows thoracic aorta, including acute aortic dissections, aortic aneu- minimally invasive valve surgery to be performed in patients rysms, and Marfan’s syndrome. Also, as on the of the leading with concomitant coronary artery disease. This allows percu- trauma centers in the Southeast, we perform surgical repair of taneous approaches to coronary disease to be combined with traumatic aortic rupture. minimally invasive techniques for valve replacement surgery. Atrial Fibrillation/Arrhythmia Repair Program Heart Failure and VAD/Transplant Program Vanderbilt Heart’s hybrid OR allows us to combine catheter- Vanderbilt Heart has extensive experience treating patients based procedures with minimally invasive surgical approaches with heart failure and advanced cardiomyopathies. Our team to achieve optimal results. Our multidisciplinary team of includes cardiac and transplant surgeons, specially trained cardiologists and surgeons provides comprehensive treatment and certified cardiologists, nurse practitioners, social workers, of atrial fibrillation, including optimal medical management, dieticians, psychologists, pharmacists and infectious disease catheter-based ablation procedures, and minimally invasive doctors. Many studies have shown that this multidisciplinary surgical ablation. approach makes for better outcomes and improved quality of life for our patients. This team gives heart failure patients op- Congenital (Pediatric) Heart Disease tions including: optimal medical management, investigation- al drugs, bi-ventricular pacing, conventional (non-transplant, Adult Congenital Cardiac Surgery non-assist device) surgical procedures (ventricular restoration As patients who have previously had congenital cardiac sur- procedures), mechanical assist devices as a bridge to transplan- gery reach adulthood, a significant number will require surgi- tation and heart transplantation. Recently, Vanderbilt Heart cal or percutaneous repair of associated congenital lesions. As received Advanced Certification in Ventricular Assist Devices one of the leading pediatric cardiac surgery programs in the from The Joint Commission, allowing us to provide Destina- nation, Vanderbilt Heart provides state-of-the-art surgical tion Therapy for patients for whom transplantation is not an repair of these lesions, frequently with newer non-operative, option. percutaneous approaches. Our surgical and interventional teams work together to recommend the more appropriate Aortic Surgery Program treatment. In our “Hybrid OR,” we can combine traditional The Vanderbilt Aortic Surgery Program offers diagnosis and surgical and percutaneous approaches when appropriate. state-of-the-art treatment of aortic root, ascending, arch and • Closure of atrial or ventricular septal defects descending thoracic aortic pathology, including aortic aneu- • Norwood procedure rysms and dissections. By using a multidisciplinary approach • Fontan procedure involving cardiac surgeons, cardiologists, radiologists and • Hybrid surgical strategies vascular surgeons, we are able to treat all conditions of the • Robotic, minimally invasive procedures Teaching and Residency We are committed to training the next generation of cardiac surgeons through an ACGME-approved cardio- thoracic (CT) training program. In the future, we envision an Integrated Six- Year CT Residency Program, a paradigm which has been successful at a number of academic centers through the U.S. This six-year CT program ideally would incorporate General Surgery, Cardiology, Vascular Surgery, Thoracic Surgery, and Cardiac Surgery. Very shortly, the Department of Thoracic Surgery and the Department of Cardiac Surgery will apply for ACGME approval of this six-year integrated program format. We believe this format will attract an elite group of medical students who could complete the program in six years instead of the traditional seven or eight. Outreach Infrastructure Outreach is an integral component of Cardiac Surgery’s Providers and Partners growth. Our dedicated physician liaison works with our physicians to strategically ensure continued market • Cardiologists development by: • Cardiac Anesthesiologists • Establishing and maintaining a network of strong (all perform Intra-op TEE) relationships with physicians throughout Tennessee • Perfusionists and adjacent states, • Intensivists • Access • Orchestrating and implementing educational programs for physicians in the community, and Operating Rooms • Collaborating with new physicians to assist in • 3 Traditional Cardiac ORs + 1 Cardiac developing and executing a marketing plan to build Hybrid Suite their brand equity and referral network. • OR staff combination of Surgical Technologists and Registered Nurses Cardiac Surgery/Cardiology • First assistant staff of PAs and RNFAs • Dedicated cardiac call team providing Programmatic Alliances 24/7 coverage Cardiac Surgery Cath Lab Established • Currently 4 Cath Labs, 2 EP Labs, • Veterans Affairs Tennessee Valley HealthCare System expanding to 5 Cath Labs, 4 EP Labs • Maury Regional Medical Center in January 2014 Pending • Cath volume ~6,000 cases/year • NorthCrest Medical Center • EP volume ~2,000 cases/year • West Tennessee Healthcare/Jackson-Madison County General Hospital CVICU Cardiology • Cardiac Anesthesia as Intensivists that work in an integrated fashion with Established Clinics • Tennessee: Byrdstown, Columbia, Crossville, Midlevels, Critical Care Fellows, Franklin, Hohenwald, Johnson City, Knoxville, Cardiac Surgery Fellows and Cardiac Lawrenceburg, Lebanon, Lewisburg, Livingston, Surgery Attendings Murfreesboro, Pulaski, Shelbyville, Spring Hill, Step-down Waynesboro, Winchester • Cardiac Surgery Step-down is adjacent • Kentucky: Franklin, Powderly to the CVICU, on the same floor.