A PUBLICATION OF VCU HEALTH The Beat PAULEY HEART CENTER

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Celebrating 50 Years of Heart Transplantation

On the afternoon of May 25, 1968, something mysterious was taking place on the 11th fl oor of MCV’s West Hospital. An elevator operator was prohibited from taking visitors to the fl oor, which was secured by guards.

Continued From a landing on the stairwell the future for heart transplantation.” outside the 11th floor, reporters caught We are experiencing a time of significant glimpses of doctors and nurses in blue growth. In 2016, the hospital’s surgical surgical scrubs moving rapidly down teams performed 30 heart transplants and the corridors when the guards would were anticipated to complete between briefly open the stairwell doors to let 25 and 30 of the operations in 2017. The in interns and other hospital personnel. numbers include heart-kidney and heart-liver Later, they would learn that pioneering transplants. surgeon Dr. Richard Lower, had “If you look at the trajectory, transplants ABOVE: DR. DANIEL TANG (LEFT) AND DR. performed the first cardiac transplant are up 50% in just three to four years. Three- KEYUR SHAH, WITH A MODERN HEART- in Virginia—just the 16th in the world. fold from eight years ago. It’s a growing LUNG BYPASS MACHINE; BELOW RIGHT: DR. program with excellent outcomes,” said Dr. RICHARD LOWER (LEFT) AND DR. RICHARD Fifty years later, Lower’s legacy continues Keyur Shah, director of the advanced heart CLEVELAND, WITH ITS PREDECESSOR: THE in the innovative work at Pauley, where failure and transplantation program. PEMCO HEART PUMP. 581 cardiac transplants have since taken According to Kasirajan, “about 60-70% of place. While today the procedure is more our patients are still alive and fully functional mechanical assist device program under the commonplace—no reporters hunkering down after 10 years.” leadership of Drs. Keyur Shah, Richard Cooke in the stairwells—the event of human cardiac At the same time, the transplant program and Daniel Tang,” said Kasirajan. transplantation remains no less extraordinary. is limited in its growth by the inadequate Mechanical assist devices such as heart supply of donor pumps and total artificial hearts are “bridge- “If you look at the trajectory, transplants are up hearts. On any given to-transplants” that can buy time for patients 50% in just three to four years. Threefold from eight day, about 4,000 with advanced heart failure until a donor years ago. It’s a growing program with excellent people in the U.S. heart becomes available. outcomes.” — Dr. Keyur Shah are on the wait list The 1990s saw the boom of the left for a human heart, ventricular assist device. In 1994, Heart Mate Dr. Vigneshwar Kasirajan, chair of the but only 2,300 donor hearts are available I became the first such device approved by Department of Surgery, maintains his office each year. The wait time can range from six the FDA; VCU Medical Center implanted one on the 16th floor of the storied West Hospital. months to one year. Despite the greater that same year. A cardiothoracic surgeon, he holds great public awareness of the need for organ “Older LVADs were large, noisy and were respect for the physicians who developed donors, the shortage has remained constant only available to larger-sized people with large MCV into one of the first and foremost for some time. But Kasirajan, Shah and thoracic cavities,” said Shah. Today, LVADs centers for organ transplantation—Lower, others are not satisfied with the status quo— can fit in the palm of the hand and can be as well as Drs. David Hume, H.M. Lee, and instead they keep pushing for new solutions implanted in those of a slighter stature. others. to improve and extend the lives of patients in “They’re smaller, quieter and they’ve become “They were giants in the field,” he said, need of cardiac transplantation. more durable and longer lasting.” sitting at a conference table in an alcove off Another game changer was the total his office. At the same time, he is excited “The biggest thing that has happened artificial heart. In 2006, a surgical team led about recent developments. “I want to talk with transplantation at Pauley over the by Kasirajan implanted the first total artificial about what’s been going on at VCU Health last few years is the development of a heart on the East Coast at VCU Medical over the past few years and what’s ahead in comprehensive advanced heart failure and Center. Today, the program is the third largest in the country. “The biggest thing that has happened with labs and operating About 50 LVADs and total artificial hearts transplantation at Pauley over the last few years rooms for training, are implanted in patients at VCU Medical is the development of a comprehensive advanced as well as space Center each year. “The introduction of heart failure and mechanical assist device program ideal for testing and contemporary LVADs and the total artificial underthe leadership of Drs. Keyur Shah, Richard implementation heart has been nothing short of revolutionary,” Cooke and Daniel Tang. — Dr. Vigneshwar Kasirajan of new devices said Shah. “Prior to their development, developed by patients would often die while waiting for into other cell types and renew indefinitely. private industry. An additional $4 million is the heart transplant list. Now, these patients “When you have a heart attack, a piece of being raised for an endowment to fund such who are critically ill can live for a long period heart muscle dies and it scars. There’s also research in perpetuity. of time, with a good quality of life, on these this rim around it called the peri-infarction “The Cottrells’ gift is allowing us to mechanical devices.” zone, which is also not getting good blood continue to develop our space as a center for Six clinical researchers take part in the supply or working that well,” he explained. excellence for innovation in surgery and help busy heart failure program that prides itself “The idea is that by injecting stem cells our physicians really bring from the research on remaining at the cutting edge of device directly into this peri-infarct area, you might arena into the clinical practice exciting and pharmaceutical encourage that heart muscle to work better new innovations in preservation and heart research. and improve the patient’s outcomes.” transplantations,” said Kasirajan. “We have participated Known as CardiAmp Therapy, the The new lab will support the work of in clinical trials to implant process begins by taking bone marrow out researchers like cardiothoracic surgeon devices through smaller of a patient’s hip and placing it in a spinning Dr. Mohammed Quader, who is focusing incisions and are looking device called a centrifuge. “This will give us on Donation after Circulatory Death—or forward to participating back just the best cells, the ones we want “DCD”—hearts. “These are the hearts in a study, hopefully this to use,” he said. Those healthy cells will be donated by individuals whose life support has year, that will evaluate the transported to the heart by way of a catheter been withdrawn due to futile outcome; they smallest LVAD we’ve ever placed in the upper thigh. “There’s a second sustain cardiac arrest during this process,” implanted in a person,” catheter that screws into 10 spots in that said Quader. Currently, these hearts are said Shah. “It’s been region encircling the area where the heart not used for transplantation, “other than in studied in Europe, but this attack occurred. You can then inject the cells maybe two or three centers in the world, that would be the first U.S. trial.” into each of those spots.” too on a very small scale.” Another study soon The trial covers some potentially Brain death donors, who are the current to come is that of the groundbreaking territory. “We’re going to standard heart donors for transplantation, Carmat heart, which encourage the reinvigoration of nearly dead continue to have blood flow to the heart was designed by noted heart muscle. No one’s been able to ever even after pronouncement of brain death. French cardiologist really do that before,” he said. “If it works, it They are the current standard heart donors and valve designer Dr. Alain Carpentier, in will be pretty amazing.” for transplantation. When blood flow ceases conjunction with EADS, the company behind to the heart and cardiac arrest ensues, as it aerospace leader Aerobus. Dubbed the “Dr. Lower’s research and clinical efforts, does in the DCD process, the heart sustains world’s first self-regulating total artificial heart, before the first transplant, during the early cellular damage. the device uses embedded sensors and days, and for decades afterward, shaped Researchers at VCU Health hope to microprocessors to attune the rate of blood the field of heart transplantation. It affected halt that process. Quader is the principal flow to patient needs—beating faster during things from surgical techniques to early investigator of three different research grants exercise, for instance. It’s also designed immunosuppression, and he defined how to and leading teams focused on mitigating the to be more biocompatible, with bovine detect rejection and address complications ill effects of DCD heart injury. In collaboration pericardium tissue on all surface areas that after transplant. Dr. Szabolcs Szentpetery and with Dr. Stephano Toldo, he has successfully contact blood. This pump is electrically he were involved in the first long-distance developed an animal DCD heart model and powered and has a quiet operation. procurement of the heart—and the list goes gathered fundamental data to further the study According to cardiothoracic surgeon Dr. on and on,” said Dr. Shah. of DCD outside of the body. Through a Pauley Daniel Tang, “this would be the first U.S. trial Sadly, since Lower’s time, little progress Pilot Grant, he is comparing three different for the device. They’ve done seven patients so has been made in heart preservation, said preservation solutions to determine which one far but none in the U.S. Our successful trials Kasirajan. A heart can still only be stored will best protect the DCD heart. Finally, with with SynCardia [another TAH manufacturer] is for three to four hours. “There are 30 Dr. Edward Lesnefsky, he received a four- why Carmat reached out to us.” hearts that are discarded every year in year Merit Review Grant through the Hunter Puerto Rico because they’re never used for Holmes McGuire Veteran Affairs Medical Is it possible to stop or even reverse heart transplantation. I can’t transfer a heart from Center to study a drug that temporarily failure before it progresses? That’s a question Hawaii to the U.S., even if it’s the best match paralyzes the mitochondria of DCD cells in an that will be explored via a new trial that will for a patient,” he said. animal model to prevent cellular damage. soon begin in the cardiac catheterization lab. VCU Health’s new Christine B. and His passion for finding alternative sources Dr. Zachary Gertz, director of the structural David E. Cottrell Surgical Innovation of heart donors is driven by the patients he heart disease program, is investigating a Laboratory will be created with the intent sees every day, especially those who are therapy that may repair tissue damaged by of not only improving heart preservation awaiting donor hearts. “I take care of these heart attacks. but also expanding the available donor patients. Not being able to use a DCD donor “We are about to be involved in the first pool. A $1 million donation by the Cottrells heart, which I feel has the potential to be real pivotal trial of interventional stem cell provided the lead gift as the Department of used successfully, bothers me,” said Quader. therapy,” said Gertz. Now in its third phase, Surgery aspires to raise $4 million for the “If I can make these hearts available for the trial involves the injection of stem cells, a modernization and expansion of the ninth transplantation, the future will be better for class of undifferentiated cells that can morph floor of Sanger Hall, to include sophisticated our patients.” Medical Team Helps Patients, Trains Physicians in India

PHOTOGRAPHY BY KELLY KINSEY PHOTOGRAPHY

CLOCKWISE FROM LEFT: IN AUGUST, DR. JAY KONERU AND NURSE PRACTITIONER CHARLOTTE ROBERTS WERE HONORED AT THE SILVER JUBILEE CELEBRATION OF THE SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES IN TIRUPATI, INDIA. KONERU AND ROBERTS CONSULT WITH THE LOCAL MEDICAL STAFF. THEY OFTEN WORKED 14-HOUR DAYS ATTENDING TO EP AND ICU PATIENTS AT THE WEEKLONG CLINIC. ROBERTS ENJOYED PARTICIPATING IN ROUNDS AND TRAINING WITH THE SVIMS NURSES.

Dr. Jay Koneru, and nurse practitioner is enthusiastically supported at Pauley. The percutaneous coronary interventions a year. Charlotte “Cha” Roberts recently planning was initiated six months in advance. While we were in the cath lab, we had the traveled to Tirupati, India, to help The day after our arrival, we attended the opportunity to see one of these cases. With patients and provide training to Silver Jubilee. The Vice President of India far different tools, the average door-to-balloon local doctors and nurses. Here, they inaugurated three state-of-the-art facilities time is 56 minutes, a metric that would make provide an account of the trip. specifically built for the advancement of any hospital in the U.S. proud. women in medicine. We were humbled Our visit also gave us a glimpse of After traveling for the better part of a day when he conferred to us visiting the expanding role of Indian women in and a half, our team from VCU Health arrived professorships in nursing and medicine. healthcare. From the Women’s School of in the bustling town of Tirupati, Andhra The week was filled with EP procedures Medicine and its wall dedicated to all the Pradesh, India—home to the Tirumala and rounds with the medical and nursing female Nobel prize winners to the joy and Venkateswara Temple and one of the holiest teams in the hospital. ICU rounds, serenity of the Child Care Center, which Hindu sites in all of India. The Eastern educational lectures and numerous ablations is free for all the staff, there is a new and Ghats and the Tirupati Seshadri Hills are an including Ventricular Tachycardia ablations, critical focus on empowering women. We Eparchaean Unconformity, representing a and pacer and defibrillator implantation with also witnessed the ever-present spirituality, geologically remarkable epoch of serenity in rudimentary tools, constituted our daily humility and charity of this institution. Each the tectonic movements and orogeny of the routine. Every working day seemed short for day in the main hospital courtyard, there is Asian subcontinent. When our small plane us, despite 14-hour workdays. a “soup line” that serves a hot meal to all of landed in these peaceful hills, we had little We were impressed with the quality those in need. inkling of what was in store for us over the of care that was being delivered. While Despite Tirupati being a serene zone for next week. the resources, especially technological seismic activity, this mission has generated Dr. Ravi Kumar, vice chancellor of the Sri resources, are significantly less than those tectonic thoughts and emotions for all Venkateswara Institute of Medical Sciences in the U.S., the patient care outcomes are of us who participated. The VCU-SVIMS (SVIMS), and Dr. Durgaprasad Rajasekharand, excellent. The nurses and physicians were collaboration is still in its infancy, but more chair of SVIMS’s division of cardiology, had eager to learn that the care they were trips are being planned. The next focus will brought us here as part of a celebration of delivering was consistent with the standards be the advancement of advanced heart the university’s 25th anniversary. We were in the U.S. failure services and the development of a to lead an intensive workshop for cardiac As coronary intensive care unit cardiac transplant program. We are hopeful EP and cardiac ICU care geared toward practitioners, we were particularly interested that in the future some of the SVIMS staff advanced heart failure and resuscitation in the care of patients with acute myocardial will also be able to spend time with us at therapies. Collaboration with the institute infarctions. SVIMS performs over 300 primary VCU Health. Welcome, New Faculty!

Dr. Nayef Dr. Santosh Dr. Jeremy Abouzaki, has Padala, has Turlington, joined the Pauley joined the has joined the team as an Pauley team as Pauley team as interventional a cardiac electro- a noninvasive cardiologist. He is physiologist. He is cardiologist with board certifi ed in board certifi ed in a special interest internal medicine, internal medicine, in critical care cardiovascular cardiology, echo- cardiology. He disease, cardiography, primarily attends echocardiography and nuclear cardiology. nuclear cardiology and cardiac electrophysiology. to patients in the coronary intensive care unit, His areas of interest include coronary artery “Dr. Padala’s clinical interests are wide- reads echocardiograms and electrocardiograms, disease, chronic total coronary occlusions, ranging and focus on advanced ablation and and sees outpatients. He is board certifi ed in acute cardiogenic shock, peripheral artery trying to measure the outcome of catheter cardiovascular disease and internal medicine. disease, and infl ammation and the heart. ablation. He is an amazingly talented “Dr. Turlington’s training and experience “The culture of innovation and research, electrophysiologist, and we look forward to make him one of a kind here at VCU Health. I along with partnership with great faculty, seeing him make important contributions to have watched Jeremy excel in his fellowships, are some of the characteristics that patients with cardiac arrhythmias,” said Dr. and I am excited to work alongside him as a attracted me here,” he said. Kenneth Ellenbogen. colleague,” said Dr. Hem Bhardwaj. He received his medical degree from Padala completed his medical degree and Turlington received his masters in public Eastern Virginia Medical School, where internship at Kamineni Institute of Medical health and his medical degree from Eastern he was elected to the Alpha Omega Sciences in Telangana, India, and his residency Virginia Medical School, then completed his Alpha Honor Society, then completed at University of Connecticut Health Center. residency and two fellowships (cardiology and his residency and fellowships in both He completed a fellowship in cardiovascular critical care) at VCU Medical Center. He was cardiovascular disease and interventional disease at Albany Medical Center, then in named chief resident and chief cardiology fellow cardiology at VCU Medical Center. clinical cardiac electrophysiology at VCU and received the Ohran Muhren Award for “I knew Nayef was special from Medical Center. He received the 2017 Outstanding Fellow. the fi rst day I met him on rounds in the Outstanding Fellow Award. “I have done all of my training here, and coronary intensive care unit. He was very “I would, without any reservations, say because of this, I feel a real bond to VCU Health,” knowledgeable and always prepared, and that VCU Health is one of the best places he said. “I was given a unique opportunity most importantly, the best patient advocate in the nation for cardiac electrophysiology to train in critical care as an extension from one could be,” said Dr. Antonio Abbate. “We training and patient care,” he said. “I am cardiology, and skills like this I think are best are very lucky to have him on faculty now.” very fortunate to be a part of this utilized in a large, academic, tertiary care facility. wonderful team.” So, what better place than VCU Health?”

2017 Best Bedside Manner Award 3rd Annual Heart Health in Women Symposium Congratulations, Exploring Women’s Dr. Kasirajan! Heart Health

OurHealth Richmond and CBS 6 recently Pauley hosted the third annual and a presentation of cases from the honored Dr. Vigneshwar Kasirajan with a “Heart Health in Women Symposium” cardiovascular genetics clinic. “2017 Best Bedside Manner Award.” He at the Virginia Historic Society Last year’s symposium drew an audience received fi rst place in the category of cardiac on Saturday, Feb. 3. The event of 70 physicians, nurse practitioners, surgery. This is the third year that readers was co-chaired by cardiologists physician assistants and nurses. of the publication selected Kasirajan for Drs. Phoebe Ashley, and Jordana “Past participants have been very the top award, which recognizes medical Kron, and was targeted to medical pleased with the highlight of women’s providers for their kindness, empathy and professionals. Participants received cardiovascular health and the nuances attentiveness. Winners were announced in Continuing Medical Education therein,” said Ashley. “We have had the December 2017 issue of the magazine. credits. wonderful, very positive feedback about the “Good bedside manners are a refl ection At the event, our faculty and conference, with some participants even of the compassion and care for our patients community experts presented the latest suggesting we move it to a full-day event.” and are an essential part of being a physician. fi ndings for women with heart disease. We must make patients feel comfortable at Topics included diabetes, valvular heart their most vulnerable time with an illness,” disease, peripheral arterial disease, carotid Read more at vcuhealth.org/pauleyheart. Kasirajan told OurHealth Richmond. artery disease, obstructive sleep apnea Beyond the Red Lines: Meet the Cardiac Anesthesia and Perfusion Teams

LEFT TO RIGHT: DR. AARON LIM, DR. JEFFREY GREEN, DR. MARK NELSON, DR. NIRVIK PAL, AND DR. PRANAV SHAH

Dr. Mark Nelson, and Harry problems or blockages, others have cardiac status, tweaking the dose or adding “Mac” McCarthy, certified clinical structural defects or advanced heart failure. supplemental medications if problems arise. perfusionist, work in an area Almost all require general anesthesia. “Anesthesia, in general, depresses cardiac carefully protected for their surgical Working in a tertiary medical center, he function, and so these patients require patients and separate from the rest sees many high-risk patients. “Our surgeries additional efforts by the anesthesiologist to of the hospital. The surgical suite often involve complex procedures, including create good outcomes,” he says. located in the VCU Medical Center’s partial and total artificial hearts and other Nelson also makes expert evaluation Critical Care Hospital has its own forms of artificial circulation, to stabilize of the heart both before and after the elevator that requires special access. the patient,” he said. “The margin of error repair procedure, using transesophageal in care provided is narrow as the patients echocardiography. This involves inserting an Upon arrival to the floor, visitors are asked to are already severely compromised by their ultrasound transducer endoscopically—that is, wear sterile coverings—a white “bunny suit,” cardiac disease at the time of surgery.” via a long, thin tube—through the esophagus. along with slippers and a cap. Once they are zipped up and ready, they can step over the “Dr. Mark Nelson has brought a world-class level of expertise, red lines that designate the surgical areas. It clinical experience, knowledge and rigor to cardiac anesthesia. He is is here that Nelson and McCarthy direct the an immensely talented individual who is a master at working with cardiac anesthesia and perfusion teams. different teams of cardiology professionals. He has given VCU Health Normally the fifth floor lunchroom is a top-tier cardiac anesthesia team.” quiet, but today a large group of co-workers — Dr. Kenneth Ellenbogen are gathered to celebrate someone’s last day. Pauley’s chief of cardiothoracic Nelson’s work begins with a review of “It was anesthesiologists who pioneered anesthesiology Dr. Mark Nelson, is sitting the patient’s medical records and surgical this technique in the 1980s, which is now at a nearby table. Dressed in blue scrubs, plan. Sometimes allergies are noted in the the standard of care for many cardiac Nelson is friendly and patient. Although history. Reactions are rare, he says, but procedures,” he said. All faculty members the room grows a little noisy, he smiles, when they happen, they can be controlled in his division have advanced certification in appreciating the camaraderie. Amid the with other medications. Nelson enjoys this area. busyness of the room, he stays focused meeting the patients and calming any Patients sometimes require blood on the interview questions. When he talks, anxiety they may have. and/or blood component transfusions. In he sometimes pauses to find the exact, “Probably the most common question we addition to the anticoagulation necessary precise word. encounter as cardiac anesthesiologists is, for cardiopulmonary bypass, the obligatory Precision and focus are integral parts `Are you going to put me to sleep?’ Well, the inflammatory response can result in of Nelson’s job. He and his seven-member cardiac anesthesiologist is going to do that, substantial bleeding post-op. team carefully measure and control the but much, much more.” “These blood issues are managed with anesthesia that they give to 800 cardiac During surgeries, Nelson carefully advanced methods of assessing clotting patients each year. Some have rhythm monitors the patient’s respiratory and status and administration of clotting factors Beyond the Red Lines: Meet the Cardiac Anesthesia and Perfusion Teams

following cardiopulmonary bypass. The perfusing your brain, your kidneys, your heart does to continue the circulation while the heart is often stunned or sluggish and will and lungs,” he says. “When your heart is heart is stopped.” require additional medications to restart stopped, you need something to take over “Harry McCarthy – `Mac’ as he is appropriately,” he explains. “This is often the perfusion.” known to the team—is the Man. When I very challenging.” He explains that when a patient requires joined the program 17 years ago, I knew Though the job is intense, he wouldn’t cardioplegia—a solution given to cause this was going to be a great program with have it any other way. “Being a team the intentional stopping of the heart for the outstanding perfusion group led by member in this endeavor is very rewarding, surgery, using a high-potassium solution—a Mac. With his help, we went to modern and seeing the patient complete the cardiopulmonary bypass machine fi lls that blood conservation, novel methods of operation, leave the ICU, and ultimately need. The machine draws the patient’s blood cardioplegia, switching to vacuum assist, leave the hospital with a repaired, out of a body to a reservoir, then to a pump, expanded the extracorporeal membrane mechanical or new heart is an extraordinary then into an oxygenator, where oxygen is oxygenation program, developed the total experience.” added into the blood and carbon dioxide is heart program and many other innovations… “Heart surgery would not be possible removed. Then it’s returned to the patient. without the help of Dr. Nelson and his team,” He says the blood leaves the body The perfusion team is the key to said Dr. Anthony Cassano, chair of the by special tubing—known as a cannula— cardiac surgery.” Division of Cardiothoracic Surgery. “They are that connects to the right atrium; the —Dr. Vigneshwar Kasirajan an integral part of every cardiac operation, blood returns to the body by a cannula and by far, some of the best physicians in that connects to the aorta. The direct In addition to tending to surgical the health system. I would let any one of connections allow the blood circulation to patients, McCarthy also operates them care for me or my family.” bypass the heart, creating as bloodless a extracorporeal membrane oxygenation (ECMO) pumps for those who need life support because their heart and lungs are not able to sustain them. The work brings him to the bedsides of patients across the state, who are brought to VCU by a special helicopter or MOBI, a mobile intensive care transportation rig. VCU Health has six heart-lung bypass machines. About 80-90% of the cases are scheduled, while 10-20% are emergencies. Ten perfusionists handle the 800 adult and pediatric cases each year, of which 420 involve cardiopulmonary bypass. They also help with an additional 60-90 ECMO cases each year. A perfusionist since 1979, McCarthy has seen a variety of changes, including improvement of safety features, miniaturization and more computerization. Additionally, “innovations in the cath lab have reduced the number of patients who come LEFT TO RIGHT: CCP TEAM MEMBERS GEOFF HALL, ADAM BLAKEY, HOLLY WILSON-LETTS, MAC to the operating room with coronary artery MCCARTHY, AND LISA ALTOMONTE blockages. So, the patients that we get tend to be sicker than those from previous years Chief perfusionist Harry “Mac” surgical fi eld as possible. and have more coexisting problems.” McCarthy, CCP, walks briskly down the fi fth- “The surgeon can then operate on a He saw his fi rst transplant in the early fl oor hallway. He is a slim man dressed in relatively motionless heart and can open 1980s; even today, “there’s always a feeling scrubs and a patterned surgical cap that ties the chambers of the heart to repair the of accomplishment when the new heart in the back. He slips on a mask before he structures within,” he says. starts to beat.” pushes open a door to an operating room, McCarthy points out a rolling console “You can’t say enough about Mac, as which is between surgeries. A few team with a canister, which stores blood well as the entire perfusion team. They are members mill about, setting things up. It’s collected during and after surgery in cases always enthusiastically accommodating in downtime, and MGMT plays on the radio. where a lot of blood loss is anticipated. The their role with respect to providing support Rolled against a wall, underneath a thick collected blood is rinsed and fi ltered prior for the cardiac surgery team. Also, they plastic cover, is a stainless steel console to being reinfused back into the patient. He are extremely involved and supportive with tubing and pumps. On this surgical also operates various cardiac assist devices in the growth of our in-house, as well as fl oor, one heart-lung bypass machine is kept that the patient may require during surgery. our Mobile ECMO and other outreach powered up, 24 hours a day. “What we do, in essence, is operate a programs,” said Dr. Patricia Nicolato, “Your blood perfuses your tissues and number of pieces of mechanical equipment director of the adult ECMO program. your organs, so your blood right now is to approximate what the patient’s heart Kron Targets Cardiac Sarcoidosis

Sarcoidosis “We collected data on 235 patients including diabetes, osteoporosis, increased involves the with cardiac sarcoidosis and showed that risk of infection and weight gain,” she said. growth of implantable cardiac defibrillators helped to “More research is needed to determine the granulomas— prevent the risk of sudden death,” she said. best treatment strategies for these patients.” small Kron, along with leaders from the To better understand the disease clumps of University of Michigan and University of and help patients, Kron, together with inflammatory Colorado, founded the Cardiac Sarcoidosis rheumatologist Dr. Huzaefah Syed, and cells. The Consortium, an international network of pulmonologists Dr. Aamer Syed and Dr. granulomas centers committed to collaborative research Thomas Iden, started the multidisciplinary most on cardiac sarcoidosis. Currently, there sarcoidosis clinic at VCU Health in 2015. The commonly appear in the lungs are 26 participating centers from the U.S., clinic, the only one of its kind in the mid- but can form in almost any Europe and Asia, who have more than 300 Atlantic region, allows patients to see as organ, including the heart. The patients with the condition enrolled, who many as three specialists in the same visit. inflammation can ultimately lead are tracked in a database. “In most sarcoidosis clinics, patients are to fibrosis, or scar tissue, which can Last May, the consortium presented seen only by a pulmonologist,” she said. permanently damage the organ. two abstracts at the scientific sessions The clinic is offered an average of four of the Heart Rhythm Society in Chicago. times per week, drawing patients from all “Cardiac involvement is very important to One study showed results that most over Virginia. Its 1,600 patients have cardiac diagnose and treat because it can lead to patients with cardiac sarcoidosis often and/or other forms of sarcoidosis. life-threatening rhythm problems,” said experience a significant delay in diagnosis. “Patients with sarcoidosis require close cardiac electrophysiologist Dr. Jordana Kron. The second study explored the use of management, so we work together as a Cardiac sarcoidosis is a rare, immunosuppression medications as a team to make sure we are looking at the inflammatory disease that has no known therapy. That study found that more than whole picture and treating all the involved cause or cure and can affect patients of half of the patients receiving therapy were organ systems,” she said. all ages. Kron began studying the disease treated with a steroid-sparing agent—most Through the clinic, Kron and her when she joined Pauley faculty in 2008. Her commonly methotrexate—either alone or in colleagues “are developing a unified first research project—a multicenter study— conjunction with steroids. approach to this complex disease, and we explored the safety and effectiveness of “While steroids are the mainstay of believe this will result in superior outcomes using implantable cardiac defibrillations to treatment to suppress inflammation, for patients,” said Dr. Ellenbogen. prevent cardiac arrest in patients. steroids have many negative side effects,

Dr. Szentpetery Recalls First Long-distance Transplant

Forty years ago, earlier that year. back here,” he recalled with a laugh. on May 8, 1977, The organization chartered a Lear jet, Szentpetery took part in the transplant VCU Medical which awaited him at the Richmond airport. with Lower. “There’s always a risk, ‘Is the Center, then There was just one problem: “We didn’t have heart going to work or not?’ We didn’t really known as MCV, an ice chest,” said Szentpetery. “Before we know. But it worked fine.” made history went to the airport, I had to buy one and that’s The transplant was one of 300 that when doctors what we ended up putting the heart in.” Szentpetery estimates he completed in his undertook When asked if he was nervous about the 30 years as a cardiothoracic surgeon. Before the first long- day, he said, “Yes and no. It was unusual but the early 1980s, transplants were undertaken distance we [Dr. Richard Lower and he] had already without the benefit of cyclosporine, a key anti- transplantation of a human heart. The done experiments where we had kept a heart rejection drug. Once cyclosporine began being retired cardiothoracic surgeon who on ice for up to eight hours.” He noted that used, “that made a tremendous difference” in made the 600-mile flight to Indianapolis three to four hours is the ideal. “You don’t mortality rates, he said. and back, and directed the transplant, want to go to the limit.” Szentpetery started the heart transplant recently sat down with The Beat to At the hospital in Indianapolis, Szentpetery program at the Hunter Holmes McGuire remember the day. removed the heart from the donor and put Veteran Affairs Medical Center in 1981, one it on ice. He then flew back to Richmond. of only five in the country, and the only one Two years into his career as a surgeon, The plane had left Richmond at 7:07 p.m. serving veterans on the East Coast from Dr. Szabolcs Szentpetery, had an exciting and returned from Indianapolis at 12:05 a.m. Virginia to Maine. He also started the heart assignment: To fly from Richmond to With time of the essence, the transplant transplant program at Sentara Norfolk General Indianapolis and bring back a donor heart. The coordinator, who usually handled kidney Hospital in 1989. trip had been arranged with the help of the transplants, picked up the young doctor at this From working in the lab and hospital South-Eastern Organ Procurement Foundation, airport. with Lower—“a great teacher and excellent a predecessor to UNOS. SEOPF established “He had this old car that wouldn’t go surgeon and scientist”—to starting the various the first computerized database to match much over 60, but he would drive at 80. So, programs and his first long-distance transplant, donors and recipients from different hospitals we were kind of shaky by the time we got “it was a fascinating period of my life.” VCU Health Offers Comprehensive Treatment Program for Amyloidosis

AT VCU HEALTH, PATIENTS WITH AMYLOIDOSIS BENEFIT FROM THE EXPERTISE OF A MULTIDISCIPLINARY TEAM: TOP: DR. KEYUR B. SHAH, DR. BEATA HOLKOVA, DR. JOHN MCCARTY, AND DR. R. TODD STRAVITZ/ BOTTOM: DR. EGIDIO DEL FABBRO, DR. DANIEL E. CARL, DR. JASON M. KIDD, AND DR. KATHLEEN PEARSON

Amyloidosis is a rare, but serious, nephrology, neurology and palliative care. (TTR). The condition affects up to one in four disease that is often hard to diagnose. “Over the years, as care became more people over age 80, and primarily men. complex, and multiple treatments and Familial amyloidosis is caused by an “The symptoms are sometimes vague and clinical trials were evolving, we realized inherited mutation of the TTR protein. The they often mimic other conditions like our common interest and started working condition can affect the heart, but more cancer, neuropathic conditions and heart together,” he said. “I believe we have one often the central nervous system causing disease,” says Dr. Keyur Shah. of the most comprehensive amyloidosis motor weakness, sensitivity to temperature, Abnormal proteins can clump together programs in the region.” and in later stages, dysfunction of the to form amyloid, which can build up in the Diagnosis can include blood and urine gastrointestinal system. In the U.S., familial body’s organs. When the buildup involves testing to help identify the presence of amyloidosis is especially prevalent in the heart, it is called cardiac amyloidosis. abnormal proteins; genetic testing; and African-Americans, where patients develop Over time, the condition can impair the MRI, echocardiogram and nuclear imaging. heart disease that is often misattributed to function of the heart and lead to abnormal “Ultimately, the diagnosis is confi rmed with a hypertension or diabetes. heart rhythms and congestive heart failure. biopsy to identify amyloidosis in the tissue,” VCU Health offers a broad spectrum Common symptoms for cardiac said Shah. of therapies for all forms of amyloidosis, amyloidosis include weakness, fatigue, including clinical trials, shortness of breath, weight loss and an Over time, the condition can impair the contemporary chemotherapy irregular heart rhythm. To separate it from function of the heart and lead to abnormal protocols, and bone marrow other cardiac conditions, “diagnosis of heart rhythms and congestive heart failure. and solid organ transplants. amyloidosis often requires an additional For select patients with clinical clue, such as low voltage on the Although the disease is rare, VCU Health hereditary amyloidosis, a combined heart EKG, an abnormal MRI or diagnosis of other physicians have seen hundreds of patients and liver transplantation may also be an conditions, such as carpal tunnel syndrome, with the condition, which comes in three option. which many patients develop,” he said. forms: “New imaging technologies have helped Shah, who has treated these patients for Light-chain amyloidosis, which begins identify more and more patients, and have years, became part of the multidisciplinary with excessive production of a protein in the led to earlier diagnosis and treatment,” said amyloidosis team two years ago. The team, bone marrow and can mimic the symptoms Shah. “Amyloidosis has now become a which is dedicated to seeking the latest of heart disease. Early identifi cation is disease that is manageable over a long in research and evolving therapies for the important for this rare but aggressive period of time, with many long-term condition, and assuring the best outcomes condition. survivors—whereas, it used to be a and quality of life for patients, also includes The more slowly progressing age- terminal disease only a decade ago.” physicians who specialize in hematology, related amyloidosis occurs from a protein gastroenterology and hepatology, developed in the liver called transthyretin New Pilot Program Supports Innovative Cardiac Research; First Four Grants Selected

L TO R: DR. SALVATORE CARBONE, DR. LEI XI, DR. MOHAMMED QUADER AND DR. STEFANO TOLDO SPOKE TO GUESTS AND SHARED DISPLAYS ABOUT THEIR PAULEY PILOT RESEARCH GRANTS AT THE AHA HEART BALL KICKOFF RECEPTION, HELD ON NOV. 30.

Pauley physicians and scientists center benefactor Stan Pauley). An internal fitness, nutraceutical therapy to alleviate have long sought novel solutions review committee led by Dr. Antonio Abbate, cardiotoxicity of chemotherapy and attempts to improving cardiovascular health. assembled an external review committee to increase the pool of potential donor hearts Now, VCU Health is helping to fund composed of alumni and retired faculty of for transplantation,” said Salloum, who exciting early-stage research by its the heart center as well as international served on the internal review committee. faculty through the Pauley Pilot experts to carefully review the applications. The projects began Dec.1. The grants Research Grants Program. In November, the following four grants will allow the investigators to pursue their were awarded a total of $112,229: ideas and possibly glean important data that “Despite the global realization that • Integrated in vitro-in silico-in vivo will make them more competitive for future cardiovascular disease remains the modeling of engineered tissue research funding. leading cause of death worldwide, efforts vascular growth, development and “Excellent ideas submitted to the NIH to increase research funding to improve function, by Dr. Stefano Toldo and Dr. and other federal funding organizations fall awareness, clinical outcomes and quality of Joao Soares (School of Engineering), short of funding if not substantiated with life in patients with cardiovascular disease $37,229. strong feasibility and preliminary data,” continue to fall short of meeting the • Unsaturated Fatty Acids-Enriched- explained Salloum. demands,” said Pauley researcher Dr. Fadi diet to Improve Metabolic Flexibility Annual fund donations to Pauley Salloum. “With continuous budget cuts to and Glucose Tolerance in Obese were critical to the funding of the new major funding sources, including the NIH, Patients, by Dr. Salvatore Carbone, program. An additional $115,000 has also promising new and mid-career investigators, and Dr. Francesco Celi (Division of been donated to the program by several in particular, are facing major challenges to Endocrinology), $25,000. individuals. secure grant funding for innovative research.” • Nutraceutical therapy for alleviating “The generosity of our donors is greatly The pilot grants provide funding for cardiotoxicity of cancer chemotherapy, appreciated,” said Salloum. “Numerous successful grants that meet three criteria: by Dr. Lei Xi, $25,000. meritorious grant proposals often go an innovative idea to improve cardiovascular • Optimal preservation condition for unfunded due to the lack of sufficient funds.” health, a project that is feasible in 12-18 the donation after cardiac death heart In the future, “we hope to further grow months and the potential to attract additional (transplant), by Dr. Mohamed Quader this program. Our goal would be to make funding. and Dr. Stefano Toldo, $25,000. sure that every meritorious proposal from The first grant applications were due on a Pauley researcher gets funded by a pilot Sept. 19 (in honor of the birthday of heart “The four projects are diverse in nature, grant.” ranging from a partnership If you would like to inquire about making “We are interested in this research which between tissue engineering and a donation to the Pauley Pilot Research advances knowledge in fighting heart small animal surgery to enhance Grants Program, please contact Carrie Mills, disease and prolonging life.” coronary artery bypass graft senior major gift officer, at cmills@vcuhealth. —Roger Boevé, who with his wife, Anne, surgery, dietary modifications org or (804) 828-0423. helped fund the pilot grant program to enhance cardiorespiratory VCU Health Offers Myriad of Options for Patients with Aortic Aneurysms Did you know…

An aortic aneurysm is an abnormal VCU Health offers genetic testing bulge due to weakening of the wall for patients with a family history of of the aorta, the body’s main artery, a collagen vascular disease such which runs from the heart to the as Marfan Syndrome, a condition abdomen. These aneurysms can tear that affects the connective tissue or rupture, causing a life-threatening of the body and causes damage to emergency. the heart, aorta and other parts of the body. For many years, aortic aneurysms were treated exclusively with open surgery. However, patients are increasingly offered endovascular procedures, in which stent Aortic Practice grafts are deployed to the aneurysm site via catheter. The catheter is inserted through to Debut at the groin. Benefits of endovascular aortic repair (EVAR) include shorter procedural Stony Point times, reduced hospital stays and faster recoveries. Pauley has recently opened a “I started my practice at the dawn of large, multidisciplinary outpatient the endovascular era in 2001, and since clinic on VCU Health’s Stony Point then the technology for minimally invasive Campus. Almost all of Pauley’s repair of aortic aneurysms has advanced DR. ROBERT LAWSON cardiologists and cardiothoracic several fold,” said Pauley vascular surgeon, and vascular surgeons will be Dr. Robert Larson. “Endovascular repair is Other patients, such as those with arch offering office hours at the new the standard for most patients, and new and descending thoracic aortic aneurysms, Stony Point site. Patients can have devices are on the horizon that will allow can be managed in the hybrid operating echocardiograms and vascular even more patients to choose this option.” room with endovascular interventions. In testing performed there, with According to Dr. Vigneshwar Kasirajan, these cases, a cardiac surgeon may take stress tests available in the future. one of the most common of these types part in the procedures or stand by scrubbed The surgeons are new to of surgeries performed at VCU Health is for in, should surgical intervention be required. Stony Point; in cardiology, “we’re an aortic dissection. This life-threatening “I predict sooner rather than later that probably quadrupling our capacity condition occurs when an injury allows most of the aortic diseases will be managed there. We’re also getting a blood to flow between the layers of the in the hybrid operating room with minimally dedicated space, which will allow aortic wall, forcing them apart. This injury, invasive techniques,” said Kasirajan. us to grow,” said Dr. Zachary Gertz, which requires emergency surgery, can be In 2016, VCU Health physicians performed who is serving as the medical handled through open surgery, sometimes over 100 open aneurysm repairs and about director. “Cardiology is outgrowing with a cardiovascular bypass machine, or 100 endovascular repairs of various types. the space downtown.” endovascularly. Many innovative procedures are conducted. In addition, “multidisciplinary For instance, VCU Medical care is great for patients. You don’t “Our access to the latest technology, Center is also the only just get one point of view, you endovascular devices and surgical techniques hospital in the Richmond get the input of the whole heart allows us to provide the widest possible array area to use fenestrated team.” Other benefits, he said, of treatment options.” — Dr. Robert Lawson aortic endografts to repair include “easy parking and better aneurysms involving the patient access.” While many patients can be treated renal arteries, said Larson. For more information, please via catheterization, some aortic aneurysm “VCU Health offers expertise in all visit vcuhealth.org/stonypoint patients still require traditional—usually aspects of complex aortic surgery from open-heart—surgery. This can include both the CT surgery and vascular surgery patients with a thoracic aneurysm who side, with a team approach to surgical may also have heart valve disease, disease management. We also have world-class of the aorta next to the heart or extensive preoperative care with dedicated cardiac aorta disease, leading into the abdomen or anesthesiologists and intensive care other major arteries. specialists,” said Larson. “Our access to “For those with thoracic aneurysms that the latest technology, endovascular devices are extensive or more complex, heart surgery and surgical techniques allows us to provide is sometimes performed at the same time the widest possible array of treatment as an open-chest aneurysm repair,” said options.” Kasirajan. “In addition, thoracic surgeons may work alongside vascular surgeons to complete a complex procedure involving the entire aorta or peripheral blood vessels.” Research Highlighted at Heart Ball Reception

In anticipation of the upcoming 26th funded by the AHA. Just this year, we Larry Little, vice president of Support Annual Richmond Heart Ball, VCU received $7 million from the AHA for Services and Planning and 2018 AHA Heart Health hosted a reception that raised specific innovative research.” Ball chair; and Deborah Davis, CEO of VCU awareness of the critical research In addition to the AHA grants, he said, Hospitals and Clinics and AHA’s board made possible by the American VCU Health researchers would also have president. Heart Association and Pauley. Over access to a new source of funding, the Following the short speeches, the 60 guests attended the event, which Pauley Pilot Research Grants program. guests enjoyed a dinner catered by Mosaic. took place at the McGlothlin Medical “Pilot grants may sound like something They then had the opportunity to mingle Education Center in November. every academic medical center is doing, but with Pauley researchers, who had set up as healthcare budgets get tighter across posters about their studies. “Pauley has a long history of partnership the country, we are extremely fortunate to “The evening was an opportunity for with the AHA,” said Dr. Kenneth Ellenbogen, rely on the philanthropic support of our those who support the American Heart one of the evening’s speakers. He noted Pauley Heart Center donors. The Pauley Association to see the commitment that AHA’s first grant to VCU Health was Pilot Research Grants program is and discoveries that are being made at awarded in 1972 to Dr. Richard Lower, to completely funded by gifts from grateful VCU Health to cure heart disease,” said study how to more successfully reanimate patients, alumni, faculty and staff.” Ellenbogen. “It is exciting to receive the heart during a transplant. “Since that Other speakers that evening included recognition for all the great work going on study, 138 Pauley researchers have been Patti Jackson, AHA’s executive director; in Richmond.”

Prescription for Living: Dr. Patricia Uber Assists Heart Failure and Transplant Patients

Each year that changed our immunosuppression therapy heart failure program.” passes is a from cyclosporine [a groundbreaking, highly At VCU Health, Uber enjoys working with celebration for effective drug for other groups] to tacrolimus, other team members to tackle the challenges the patients of and we saw a dramatic improvement in the of these complex patient populations. With Patricia Uber, survival rates of African-Americans.” transplant patients, “their immune systems PharmD. She and a colleague left Ochsner to are not normal and their medications are very help Mehra build the heart transplant and specialized, so the interactions with other “My youngest pulmonary arterial hypertension programs medications can have severe consequences,” patient was 13 at University of Maryland. In 2009, Mehra she said. days old. He’s now became editor of the prestigious Journal of Even a virus can wreak havoc on their 15 years old,” she said. “He plays tennis and Heart-Lung Transplantation, and Uber the systems. “What I explain to the patient is runs track and field for the Transplant Games executive editor—a position she has held that they live the rest of their life walking a of America.” ever since. fine line between rejection and infection,” The patient was one of many she met she said. The risk of rejection is highest while working for Dr. Mandeep Mehra, at the “Patricia Uber is an expert in the field in the first year. During this time, the Ochsner Clinic’s busy Cardiomyopathy and of transplant pharmacotherapies and patient is closely monitored through Heart Transplantation Center in New Orleans, world-renowned in her work with the regular visits and biopsies. “That’s where from 1997 to 2005. Surgical teams performed journal.” — Dr. Keyur Shah we’re doing the most adjustments of 50 to 60 heart transplants each year at the their anti-rejection meds. If they can hospital, which was also involved in trials for Dr. Keyur Shah, who had met Uber when make it through the first six months to one the early heart pumps. he was a fellow at Maryland, successfully year without any major rejection episode, At the Ochsner Clinic, she was concerned recruited her to come to VCU Health in 2015. then things are looking pretty good for what’s by the mortality rates of African-American “Patricia Uber is an expert in the field of going to happen over the next 5,10, 15 years.” transplant patients; few survived more than transplant pharmacotherapies and world- Uber has celebrated birthdays and two to three years. “A lot of them died by renowned in her work with the journal,” weddings with patients and likes to follow what we call antibody mediated rejection,” said Shah. “When the opportunity arose them through the years. “I think what I like she said. “It was very difficult to watch.” to recruit her to VCU Health, we thought it the most about it is, you know them the Seeking answers, she was involved in was a perfect match with her expertise and whole way through their journey—the good pivotal studies exploring a new drug. “We our intent on having a world-class advanced and the bad,” she said. “It’s longitudinal care.” LEFT: FLIGHT NURSE BEVERLY HARRIS IS ADMINISTERING BLOOD PRODUCTS TO A PATIENT. RIGHT: VCU HEALTH’S AIRBUS H145 IN FLIGHT. Air Transport Provides Critical Care

The fleet includes the new Airbus H145 ears from the thundering sound of blades. and an Airbus H135. “They’re very similar, but “Safety is really paramount to everything the 145 is a larger aircraft. It will fly a little bit that we do,” said Lovelady. Once it gets dark, further, it carries more weight,” he said. crew members wear night goggles so that The 145’s larger size allows for transports they can better identify power lines and other of heavier patients or an additional person— dangers as they fly over the state. such as the parent of an injured child. Cardiac patients make up about one- Specialty transports, such as ECMO patients, third of our patients; trauma and pediatric who require a heart perfusionist and cases comprise the remaining two-thirds. additional equipment, are now possible. The on-board medical equipment includes When lives are on the line, VCU Health’s Airbus H145 is based at Dinwiddie County a specialized cardiac monitor, a pacemaker helicopters are a welcome sight. Airport and often serves cities in southern defibrillator, a ventilator, a video laryngoscope Virginia, such as South Hill, Emporia and for intubating patients and various ICU “We have two helicopters and a 35-member Farmville. West Point is the hub for Airbus medications. team that responds to about 1,200 to 1,300 H135, reaching patients in Williamsburg, “Every week, we pick up patients having calls each year,” said Jay Lovelady, R.N., Northern Neck, the Peninsula and Tidewater. STEMIs or other heart attacks. We will fly to operations manager of the critical care The team also supports the Virginia State a remote part of the state to pick up a patient transport program and flight nurse. Often, Police’s MedFlight program with flight nurses who’s having chest pain, and we’ll start their VCU Health crews transport patients from and staffs a ground critical care transport treatment. At that point, we become the eyes, smaller hospitals, car wrecks and other ambulance based at VCU Medical Center. ears and hands of Pauley until we can get emergency scenes around the state to VCU Lovelady, who has worked as a flight here and transfer care.” Medical Center, the only Level I trauma nurse for 13 years, previously served as a Such patients often have faster recoveries center in the region. firefighter, paramedic, and ER and ICU nurse. than some trauma patients, who may take Each aircraft is staffed by three people. “The critical care transport setting is really a months to recover. “That’s why I think taking “They’re on duty 24/7, 365. There’s one pilot, blend of a lot of that,” he said. “I always enjoy care of cardiac patients is one of the more one flight nurse and one flight paramedic the fact that no two days are alike.” rewarding things that we do,” he said. “Often, available at all times.” The crew is supported Air Medical Transport crew members in the short time that we’re with them, we by medical director Dr. Harinda Dhindsa, and wear specialized gear, including helmets with get to see some improvements.” clinical manager Katie Rodman. integrated communications to protect their

Pauley Hosts 2nd Annual Heart Walk

On Oct. 7, crowds gathered for the “All patients and family members were invited Hearts and Air Medical Transport. American Heart Association Richmond to participate. Cumulatively, we had 2,786 This year’s participants raised $5,140 for Heart Walk at West Creek Parkway. laps, which totaled 253 miles. One patient the AHA. Including both walks, VCU Health That same day, a group of heart and did 62 laps throughout the day,” said Kimberly teams brought in $54,000 for the organization. stroke patients and their supporters Nelson, doctor of nursing practice, clinical Channel 6 was on hand. The opening strolled through hospital hallways nurse specialist. Last year, she and transplant ceremony featured speeches by Nelson as as part of Pauley’s second annual patient Craig Trowbridge launched Pauley’s well as Deborah Davis, CEO of VCU Hospitals “internal” heart walk. The event took first internal heart walk. and Clinics, Melinda Hancock, chief financial place in VCU Medical Center’s Main New this year, were vendors such as Zoll officer of VCU Health System; and a patient. Hospital, and the cardiovascular Medical Corporation, which demonstrated “We encouraged everyone to participate in thoracic surgical step-down unit, its LifeVest defibrillator and sponsored the fighting heart disease and stroke by being where stroke patients reside. lunch, as well as Hands Only CPR, Mended active,” said Nelson. Mended Hearts: Fellow Patients Share Lessons in Recovery

Joe Shocket knows a lot about that I might have missed.” Another volunteer, appreciated the visit,” he said. “You know, recovering from heart surgery. For Sharon Feldman, comes by on Fridays. you can feel kind of down after heart one thing, patients’ feet tend to swell. His routine begins with a knock on the surgery.” He attended his fi rst Mended That’s why he recommends they patient’s door. He asks for permission to Hearts meeting that December. bring sandals, slippers or other loose- come in, then introduces himself. “I tell “I think that when a person’s sick, the fi tting shoes to change into when them, ‘I’m a former heart patient. I was in a ability to talk to other people with heart they leave the hospital. bed like you are about eight years ago, and I disease makes a huge impact on their health know how it feels.’” and recovery,” said Dr. Kenneth Ellenbogen. Shocket, who underwent a quadruple In August 2009, Shocket went in for The visitors help patients understand heart bypass in 2009, “imparts tidbits of a pre-employment health screening at what to expect before, during and after information” like this to patients of Pauley. Chippenham Hospital. “Everything was surgery, and discuss the importance of good He’s the visiting chairman of Richmond fi ne, and then I went on a treadmill to take nutrition and cardiac rehabilitation. They also Chapter 28 of Mended Hearts, which runs a stress test. I was able to complete it, but leave behind the Mended Hearts HeartGuide a hospital visitor’s program and presents there were obvious issues for my heart.” with information on heart disease. speakers at its monthly meetings. Mended He went in for an angiogram and Sometimes patients just enjoy having Hearts has approximately 200 chapters in discovered he had 95% blockage. someone to talk with. Shocket recalled one the U.S., with over 20,000 members. Surgery followed at the hospital. patient from the Northern Neck who loved “It’s the largest peer-to-peer support to talk about fi shing and seafood. group in the country for heart patients and “I think that when a person’s sick, the “We might start talking about their family members,” he said. ability to talk to other people with heart heart failure, but it would always Locally, there are 14 active accredited disease makes a huge impact on their end up, `how was that oyster visitors who have gone through the health and recovery.” — Dr. Kenneth roast you went to the other organization’s training program. In 2016, Ellenbogen night?’ Or: ‘This is the way you those visitors met with 1,879 individual make oyster stuffi ng.’ patients at fi ve hospitals—the majority at “Open-heart surgery knocks you for a “Part of visiting is to engage the patient VCU Medical Center because of the size loop,” he said. “You’re really stiff, really sore.” and get them to a positive, happy place.” of the program. In terms of cardiac care, “I He remembers standing, then gradually Mended Hearts Chapter 28 meets the don’t think you could fi nd a better place than beginning to walk down the halls of the fi rst Tuesday of each month and usually here,” he said. hospital. “It’s like scaling a mountain. You features a speaker in the cardiac fi eld. To Wearing a red vest accented by a heart begin in very small increments. Each time learn more about the organization, visit symbol, Shocket is a familiar face around you walk, you try to go a little further.” MendedHeartsRichmondVa.org and the hospital on Mondays. He usually stops While he was in the hospital, someone MendedHearts.org. back on Wednesday “to catch any patients from Mended Hearts stopped by. “I really

Celebrating Heart Month

February is American Heart Month. A myriad of speakers appeared at Dr. Mark Levy, presented “Peripheral To raise awareness about the Third Annual Women’s Heart Health Artery Disease—Know Your Risk and cardiovascular health and disease, Symposium. The event took place Feb. 3 at Your Options,” on Feb. 8; then on Feb. 22, Pauley participated in numerous the Virginia Historical Society. (See p. 5 for cardiologist Dr. Phoebe Ashley presented events throughout the community. more details.) “Are you doing your part to maintain a VCU Health also presented three healthy heart?” The seminars were held at On Feb. 2, our staff took free blood seminars at Lewis Ginter Botanical Garden. Lewis Ginter’s Kelly Education Center, 1800 pressure readings and calculated body On Feb. 1, Dr. Vigneshwar Kasirajan, Dr. Lakeside Avenue in Richmond. All seminars mass indexes (BMIs) in the lobby of the Keyur Shah, and Dr. Daniel Tang, presented were free and open to the public. To learn VCU Medical Center’s Gateway Building. “The Future of Heart Replacement more about upcoming seminars visit: Last year, we provided this service to more Therapies.” Interventional cardiologist vcuhealth.org/events. than 800 individuals. Dr. Luis Guzman and vascular surgeon VCU Health CMH Opens New Hospital

In November, VCU Health Community On Nov. 11, 28 patients were moved Memorial Hospital (CMH) opened its from the old hospital to the new one, with new, state-of-the-art, 167,000-square- the support of several rescue squads. Did you know... foot facility in South Hill. The new facility “We ushered in a new era of health offers 70 acute care beds, along with a care today with this patient move. It’s a The Virginia Medical Group in cardiac catheterization lab, an emergency culmination of years of hard work by the Colonial Heights joined Pauley in department, three operating rooms, an CMH board, our partners with VCU Health June 2016. The outpatient cardiology obstetrics suite and other facilities. The new and, of course, our staff and volunteers,” and neurology practice, now known building is the fi rst medical facility erected said Scott Burnette, CEO of VCU Health as VCU Health at Colonial Square, in South Hill since 1954. VCU Health has CMH on the day of the move. “There were is located at 2905 Boulevard, Colonial committed at least $75 million in funding more than a few misty eyes when we Heights, VA. 23834. Phone: (804) to the hospital. VCU Health CMH provides announced at 10:42 that the old CMH was 526-0682. health services for the south-central region offi cially closed. A lot of fantastic work of Virginia and portions of northern North was done over the past 63 years inside Carolina. those walls.”

Cardiac Arrest In Memoriam vs. Heart Attack?

Pauley has lost a few beloved friends an incredible impact,” said Dr. Kenneth Many people confuse heart attacks of the Consortium. Ellenbogen. with cardiac arrests, but they are At VCU Health, Jeanette and her late very different. Robert Huntington Cropp, of Williamsburg husband, Eric, established several endowed passed away on Sunday, Aug. 27, 2017, at the faculty positions, including the Eric Lipman A heart attack is a circulatory problem age of 79. He enjoyed a 35-year career with Research Professorship in Cardiology, the that results when blood fl ow to the heart the IBM Corporation, which took him from Hermes A. Kontos, M.D. Professorship in is suddenly stopped due to a blocked San Francisco to Honolulu, Sacramento, Cardiology, the George W. Vetrovec Chair, artery, usually causing symptoms like chest Calif., White Plains, N.Y., Los Angeles and and the Jeanette and Eric Lipman Chair in discomfort, sweating, and shortness of Washington, D.C. He was active in many Oncology. The family also created several breath. A cardiac arrest arises when an organizations, including the Kiwanis Club research funds, including the Aubrey Sage electrical malfunction in the heart leads of the Colonial Capital, the Boy Scouts of MacFarlane Lung Injury Research Fund and to an arrhythmia that causes the heart to America and the American Bible Society. the Carol Jean Lipman MacFarlane and Ann suddenly stop beating. With his wife, Gloria, Bob was a devoted Debra Lipman Cancer Research Fund. While a heart attack victim may member of the Consortium, who gave H. Merrill Plaisted, III, died on Nov. 30, experience immediate discomfort, generally generously to support the work of the Pauley 2016, at the age of 81. “Although H. Merrill their symptoms will worsen over hours and Heart Center. Plaisted, III, was born in Maine to a family the vast majority of these people do not “Bob Cropp was a great family man, a of governors, we were fortunate to call him die. A victim of cardiac arrest will become business leader and an inspiration to so many a dedicated Richmonder since 1960,” said unresponsive within seconds and die within others. He will be missed by all,” said Charles Ellenbogen. minutes if they do not receive treatment. Crone, MCV Foundation board member. A prominent member of the real estate A very small percentage of heart attack Jeanette Lipman passed away Jan. industry, “Mr. Plaisted was committed to victims—10-20%--may secondarily go into 10, 2017, at the age of 102. “She was an many community organizations, serving as cardiac arrest. For either situation, call 911 extremely caring, generous woman and president of Big Brothers and Big Sisters of right away. devoted Richmond philanthropist. She made Richmond and giving generously to Pauley.” First Class Mail U.S. Postage First Class Mail 1200 EAST BROAD STREET PAID U.S. Postage P.O. BOX 980036 Permit No. 869 PAID RICHMOND, VIRGINIA 23298–0036 Richmond, VA Permit No. 869 Return Service Requested Box 980036 Richmond, VA Richmond, Virginia 23298-0036

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Friends and Supporters,

Welcome to the winter edition of The Beat. We recently celebrated American Heart Month, a special time when we work to raise A publication of awareness in the community on VCU Health Pauley Heart Center the prevention and treatment of cardiovascular disease. In this Design issue, you can learn about the Bergman Group special events that took place Photography during American Heart Month, and VCU Creative Services some of the research and programs we are undertaking to improve the General Information lives of our patients. (804) 628-4327 Our cover story is especially fitting, as Cardiology it provides a glimpse of our long and storied history in heart transplantation—from the (804) 828-8885 days of Dr. Richard Lower to the outstanding physicians and scientists who are carrying Cardiothoracic Surgery on his pioneering legacy today. Heart transplantation is an incredible gift of life for many (804) 828-2775 patients, truly one of the miracles in medicine. Pediatric Cardiology One of my favorite stories is the trip to India made by Dr. Jay Koneru and nurse (804) 828-9143 practitioner Cha Roberts. These two concerned providers worked long hours caring Heart Failure and Transplant for the needs of some very ill patients with complex cardiac conditions. At the same (804) 828-4571 time, they provided training to local doctors and nurses to ensure their impact would be Heart Valve lasting. (804) 628-4327 Sarcoidosis and amyloidosis are two rare but often life-threatening diseases that are often underreported by healthcare providers. In this issue, you’ll learn how Dr. Address Jordana Kron and Dr. Keyur Shah are working to help identify these patients earlier Box 980036 and connect them with some very impressive treatments and therapies through their Richmond, Virginia 23298-0036 comprehensive, multidisciplinary clinics. Finally, I want to thank the incredible members of our Pauley Heart Center Copyright 2018. All rights reserved. community. The gifts made to support innovative research through the new Pauley Heart Pilot Research Grants and the Christine B. and David E. Cottrell Surgical Innovation Laboratory are truly transformative. Thank you for allowing us to stay at the HOW TO MAKE A GIFT. forefront in the fight against heart disease. Gifts to VCU Health Pauley Heart Center allow us to invest resources in Sincerely, transforming patient care, education and research. For more Dr. Kenneth A. Ellenbogen information on how to honor a loved Chair, Division of Cardiology one or a caregiver, please contact Carrie Mills at (804) 828-0453 or [email protected]