Better Care, through Better Technology | 2015 HEART AND VASCULAR REPORT HEART AND VASCULAR INSTITUTE 2015 HEART AND VASCULAR REPORT Better Care, through Better Technology 2 The Heart and Vascular Institute 4 21 Facts and Figures Techniques and Devices 6 24 Pittsburgh Heart, Lung, Blood, and Trials and Tactics Vascular Medicine Institute 27 14 Top-Ranked Education and Training Future and Past 28 18 UPMC Hospitals and New Approaches Community Locations 2015 HEART AND VASCULAR INSTITUTE REPORT INSTITUTE AND VASCULAR HEART 2015 3 | UPMC The Heart and 4 | Vascular Institute: The Vanguard of Research and Technology Since the release of our inaugural report, the Heart and Vascular Institute (HVI) of UPMC has continued to lead the way in the provision of comprehensive cardiovascular care. This year and every year, our world-class cardiologists, cardiac and vascular surgeons, engineers, and allied practitioners have focused first on the wellbeing of our patients. And this year, we share with you our other passions: research and technology. Research is what allows our organization to break through In 2014, Andrew Voigt, MD, became the first physician the boundary of what is considered possible. What we learn in the state of Pennsylvania to implant a wireless in the lab inspires us to develop fresh approaches to patient pacemaker. The catheter-delivered, leadless device care. New technologies allow us to take on challenges that is extremely small, allowing it to be implanted directly into once seemed insurmountable. By embracing new tools and the right ventricle. UPMC is one of only six health care novel techniques, we contribute to the advancement of the systems in the nation selected to participate in the art and science of cardiovascular medicine. Our partner international trial of this device. organization, the Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute (VMI), makes this marriage of research These stories are only a few of the many that illustrate and clinical practice particularly strong. Through a variety of the ingenuity of the Heart and Vascular Institute of UPMC. research initiatives, affiliations, and educational opportunities, With our ongoing commitment to research and technology we’re extending our knowledge and sharing it with and the development of novel approaches to cardiovascular physicians far and wide. care, we are well positioned to build upon our successes in the years to come. Since 2014, Catalin Toma, MD, and Conrad Smith, MD, have applied advanced techniques and technologies to treat more than 100 patients in the Chronic Coronary Total Occlusion Program — one of only a few dozen such programs in the nation and the most experienced in our region. Our dedicated interventional cardiology facility is fully equipped for the application of this high-tech, hybrid approach to angioplasty. Stephen Chan, MD, PhD, recently joined the Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute (VMI) as the director of the Center for Pulmonary Vascular Biology and Medicine. His groundbreaking investigations into the molecular mechanisms of pulmonary vascular disease and pulmonary hypertension, combining network-based bioinformatics with unique experimental reagents, have placed him among the first scientists to identify the importance of microRNAs in processes critical to pulmonary hypertension progression. Joon Sup Lee, MD Michel Makaroun, MD Victor Morell, MD Our Star HVI Cardiology Director HVI Vascular Surgery Director HVI Cardiac Surgery Director Ratings UPMC PASSAVANT The multidisciplinary team at UPMC Passavant is an integral part of the HVI, offering a full spectrum of options for every type of heart or vascular disorder — including coronary artery bypass grafting, for which the hospital earned The Society of Thoracic a three-star rating from the STS. The STS also recognized Surgeons (STS) awarded UPMC Passavant for heart attack and heart failure UPMC Passavant and mortality and readmission outcomes that were better than UPMC Shadyside its the national average. REPORT INSTITUTE AND VASCULAR HEART 2015 highest rating — three 5 | stars — for heart surgery. The ratings, based upon data from 2014, place UPMC SHADYSIDE For 2014, the STS recognized UPMC Shadyside in the exceptionally favorable outcomes at UPMC Shadyside for heart top 9.9 percent of hospitals attack and heart failure mortality and readmission. The HVI nationally for aortic valve professionals who practice replacement procedures at UPMC Shadyside are also recognized experts in the and UPMC Passavant treatment of diseases involving the aorta. Our three-star ranking in the top 8.8 percent reflects our commitment to delivering optimal care with of hospitals nationally outcomes that exceed the national average. for coronary artery bypass grafting procedures. CHILDREN’S HOSPITAL OF PITTSBURGH OF UPMC The Society of Thoracic Surgeons noted that the Cardiothoracic Surgery Program at Children’s Hospital of Pittsburgh of UPMC is tied with another institution for the lowest surgical mortality among high-volume programs in the country, based on a 2015 survey of programs performing congenital heart disease surgery. Victor Morell, MD Our Star HVI Cardiac Surgery Director Ratings3 UPMC 8 | Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute (VMI) Inventing the Future of Medicine Through Research As a vital part of a world-renowned health care system, the Heart and Vascular Institute is necessarily concerned with the care of patients. This is our primary function. But as global leaders in academics and research, we are more than clinicians — we are also pioneers at the very edge of scientific discovery. Our partnership with the Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute has led to significant advancements that inspire other scientists to build bridges from new discoveries in basic science to applications in the clinic. Synergy brings practical application to cutting-edge investigation and illustrates how original thinking makes the leap from bench to bedside. 2015 HEART AND VASCULAR INSTITUTE REPORT INSTITUTE AND VASCULAR HEART 2015 9 | Under the leadership of Mark T. Gladwin, MD, who was recently named chairman, Department of Medicine, University of Pittsburgh School of Medicine, the Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute (VMI) brings together internationally known experts in cardiovascular biology, hemostasis, metabolism, and transfusion medicine to explore how molecular processes can affect blood flow to vital organs. Their translational and basic research have led to novel therapies that directly benefit patients. Our interdisciplinary teams of researchers, physicians, graduate students, and medical students work together every day to create the future of cardiovascular medicine. Over the past several years, our scientists have secured significant grants that have led to groundbreaking research, detailed in the world’s leading scientific publications: Thomas Gleason, MD, and his team are conducting a multiyear study funded by the National Institutes of Health (NIH) to test the hypothesis that accumulation of reactive oxygen species in aortic smooth muscle cells mediates the aortopathy in patients with bicuspid aortic valve syndrome. Dennis McNamara, MD, is leading a team in another multiyear, NIH-sponsored study that examines whether a specific haploid genotype associated with hypertension is a marker of enhanced therapeutic response to a combination of isosorbide dinitrate and hydralazine in African Americans with heart failure and reduced ejection fraction. Edith Tzeng, MD, is leading an effort funded by a multiyear Veterans Administration Merit Award to define alternative pathways of nitric oxide formation in diabetic wounds and other impaired wound-healing pathologies. These pathways support the development of a topical therapy that uses the wound environment to enhance healing. Liza Villanueva, MD, and her group are developing methods for delivering short interfering RNAs and microRNAs to cells in the heart and cancer cells using the interactions that occur between ultrasound and novel microbubble formulations carrying the nucleic acids; this research may pave the way toward the use of targeted gene silencing for the treatment of a spectrum of diseases. The NIH funds this ongoing study. These scientists and many others represent the synergy between the Heart and Vascular Institute and the Vascular Medicine Institute — a synergy that brings practical application to cutting-edge investigation and illustrates how original thinking makes the leap from bench to bedside. UPMC 10 | Welcome to the HVI’s home of research. As partner institutions, the HVI and the Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute (VMI) have always shared the goal of delivering the best and most innovative therapies and treatments to our patients. Only by working together can we ensure that no promising thought goes unexplored. The strength of our multidisciplinary relationships lies in their flexibility: often, no clear distinction exists between researcher and clinician. In recent years, the VMI has grown. We’ve added ten new investigators into the HVI and VMI, representing some of the best minds in the field of cardiovascular research, and we’ve secured significant funding to allow us to study and develop more and more of our ideas. By continuing to ask questions together, our organizations are poised to bring innovative solutions into play for many years to come. Mark T. Gladwin, MD Director,