A PUBLICATION OF VCU HEALTH The Beat PAULEY HEART CENTER

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Partners in Life

ARCTIC Medical Director Dr. Mary Ann Peberdy and her husband, Dr. Joseph Ornato, have created one of the world’s most renowned cardiac resuscitation programs.

The pair have been at the forefront of clinical care and research in cardiac arrest for decades.

Continued JOSEPH ORNATO, M.D., AND MARY ANN PEBERDY, M.D., WORKING TOGETHER ON THE ARCTIC PROGRAM, WHICH CARES FOR ABOUT 90 PATIENTS EACH YEAR.

With the recent arrival of the Weil Advanced Resuscitation, Cooling Therapeutics, else in somewhat of a calm manner, despite Institute, VCU is poised to also and Intensive Care (ARCTIC) program for post- the precariousness of the situation,” said become a basic and translational cardiac arrest care. Peberdy and her husband, Hershberger. research powerhouse in this field. Joseph Ornato, M.D., chairman of the VCU Peberdy, the C. Kenneth Wright Professor Emergency Department, began cooling of of Cardiology, created the ARCTIC program, “That day is a total blank in my memory. patients at VCU in 2004, shortly after “new one of the first of its kind in the country, What I’ve been told is that I had been on an data became available that demonstrated that in 2004. The program is multi-tiered, with elliptical machine, and I left that and went to if you lower the body temperature you can components including a continuum of a stationary bicycle. At that point, I blacked improve survival and neurological outcomes clinical care, research, community training in out and fell off the bicycle,” recalled Bob in patients that have had cardiac arrest,” CPR, and coordination with a highly trained Hershberger, 70, a U.S. Air Force veteran said Peberdy. network of EMS’s and partner hospitals. and retired executive vice-president of the Following successful heart resuscitation “She is a master physician and truly Williamsburg Chamber and Tourism Alliance. after cardiac arrest, the patient often remains devoted to advancing the science for the in a coma from lack care of our patients,” said Vigneshwar “The work Dr. Peberdy and Dr. Ornato did with the of blood flow to Kasirajan, M.D., cardiothoracic surgeon and ARCTIC Program was pioneering. They did this the brain during the chair of the department of surgery. at a time when no one was really thinking about cardiac arrest. The In 1974, on the first day of his cardiology cardiac arrest and post-sequalae to the brain. body undergoes a fellowship at New York Hospital—Cornell Much of the work was done quietly and without rapidly escalating Medical Center, Ornato was assigned much fanfare. Now, this is the cutting edge of inflammatory to oversee and hone the training of the cardiovascular medicine.” response that can paramedics. “At that time, it was the only — Vigneshwar Kasirajan, M.D. further jeopardize 24/7 paramedic program in all of New York survival and City,” he recalled. Hershberger has pieced together neurological outcomes. To prevent and Although he knew little about the work, some of the details from April 7 when he reverse this damage, ARCTIC patients he began joining the paramedics on calls suffered a cardiac arrest—an often-fatal like Hershberger undergo therapeutic during slow times in cardiology. “Within condition when the heart suddenly stops temperature management with an a couple of months, we actually had our beating effectively—while working out intravascular cooling device, which chills first survival from cardiac arrest…which in at a local health club. Attendants at the their body temperature to 92 degrees for 1974 was virtually unheard of. If your heart club rushed to his aid and called a rescue 24 hours, then gradually returns the body stopped out of hospital, you were going squad. Paramedics shocked his heart with temperature to normal. to die,” he recalled. A few days after she a defibrillator and brought him to Sentara For Hershberger’s wife, Margaret, and awakened in the coronary care unit, his Williamsburg Regional Medical Center, other family members who gathered at VCU elderly patient—who was looking forward to where he was stabilized and then loaded to wait and worry, it was a lot to process: the birth of her first grandchild—expressed onto a critical care helicopter for transport. The death of a loved one, resuscitation, then her gratitude to Ornato with a kiss on his At VCU Medical Center, he was placed a coma. But Peberdy helped them through it. cheek. “I remember thinking, `I’ve been under the care of Mary Ann Peberdy, M.D., a “They were impressed by her. She was kissed by a dead person’. That moment cardiologist and the medical director of the very calm, which helped to keep everybody changed my career.” Today, through his work as a cardiologist the AHA got Congress to pass the Cardiac About the Doctors: and Emergency Medicine specialist, Ornato Arrest Survival Act of 2006,” said Ornato. still works closely with early responders, Soon after the study was published and who play a key part in the “chain of survival” the Act was passed, all federal buildings in the Mary Ann Peberdy, M.D., and necessary for cardiac arrest patients to country were required by law to have AEDs in Joseph Ornato, M.D., have survive. In addition to his work at VCU, he public places, and all airlines and airports now devoted a significant part of is the medical director of the Richmond have AEDs and personnel trained to use them. their careers to cardiac arrest Ambulance Authority, Richmond Fire & The ARCTIC program underwent several patients. Triple board-certified in EMS, and Henrico County Division of Fire. big changes in 2008. The first was that Cardiology, Internal Medicine, and He ensures all are kept up-to-date on VCU’s VCU began serving as a regional hub to Emergency Medicine, Ornato has ARCTIC program and cutting-edge science in other hospitals for its advanced post-arrest published over 400 papers in the resuscitation. therapies. The second was that the program’s field and recently was awarded attending physicians the prestigious American Heart Peberdy, the C. Kenneth Wright Professor of shifted their focus from Association National Clinical Cardiology, created the ARCTIC program, one cooling patients from the Research Award for his work. of the first of its kind in the country, in 2004. “outside in”—using cooling Peberdy is also triple boarded in blankets, ice bags and gel Internal Medicine, Cardiology, He and Peberdy also oversee the pads—to the “inside out.” The latter involves and Advanced Heart Failure and training of ARCTIC attending physicians, a endovascular cooling, which involves the use Transplant and has published component of the program that separates of a closed-circuit catheter that controls body over 200 articles. it from others in the small club of top-tier temperature internally. Both physicians have served cooling programs. The newer process allows for “targeted on the AHA national committees “We have five attending physicians who temperature management,” which includes for resuscitation science and are on call, 24/7, to help with the decision- an induction phase, in which the body is have been authors in the AHA making for the therapy,” he said. “We really cooled; a maintenance phase, in which the Guidelines for resuscitation tried to have a small enough number so lowered temperature is maintained for about continuously since the 1980s. that we could ensure that every one of us 24 hours; and a rewarming phase, in which They are also founding is absolutely up-to-date on what the latest the body is returned gradually to its normal physicians of the AHA Get with science is showing as to the proper use and temperature. the Guidelines-Resuscitation selection of patients for this kind of cooling The process of caring for ARCTIC Program, which is the world’s therapy.” patients in the Coronary ICU is dynamic. largest repository of performance The volunteer group includes Ornato “Care is minute-to-minute and hour-to-hour. improvement and research data and Peberdy; Antonio Abbate, M.D., Ph.D., It’s constant evaluation and re-evaluation,” for in-hospital cardiac arrest. James Roberts Professor of Cardiology said Michelle Gossip, BSN, ARCTIC care and vice-chair of the Division of Cardiology; coordinator. Stephen Miller, D.O., assistant professor of Nurses play a key role, she said. “It is Learn more… Emergency Medicine; and Harinder Dhindsa, the nurse who sees subtle changes in our M.D., chair of the Division of EMS. patient population and, working with our “Dr. Ornato is one of the leading physician staff, provides ongoing emotional View the VCU ARCTIC Program on international experts in cardiac resuscitation. support for patients and families.” a PBS NOVA program that aired He is not satisfied with the current state of Unlike many other programs, continuous on January 26, 2011. To view it, the art, and he and his research and clinical brain wave monitoring is performed and visit PBS.org/wgbh/nova/body/ partner, Dr. Mimi Peberdy, are developing there is a strong focus on ventilation, can-we-live-forever.html (the new tools for treating and preventing cardiac hemodynamic, and metabolic parameters segment starts around the 47-minute arrest,” said Kenneth Ellenbogen, M.D., chair to improve outcomes. The ARCTIC program mark). of the Division of Cardiology. was also the first in the country to perform One of Ornato’s most important detailed neuro-cognitive testing in survivors contributions was serving as principal to identify more subtle, persistent areas of Hear the story of 16-year-old investigator of the Public-Access Defibrillation brain injury and begin early rehabilitation ARCTIC survivor Ellie Whelan at study, which was funded by the NIH, the AHA, treatment in these patients. Treatment plans vcuhealth.org/success and industry. Peberdy served as the PI for require multidisciplinary teams, made up of VCU/Richmond. The 18-month study trained heart doctors as well as nurses, neurologists, 19,000 people and placed 1,500 AEDs in 24 pulmonologists, technicians, social workers, For updates on the Weil Institute U.S. and Canadian cities in how to perform nutritionists, rehabilitation experts, and research, presentations and CPR and how to recognize a cardiac arrest physical, occupational, and speech therapists. awards go to: www.weil.vcu.edu and call 911. In half of the study sites, lay Hershberger, who exercised regularly volunteers were also trained and equipped to and had no history of heart disease, was use an AED on the victims before EMS arrival. found to have blockages in the arteries The study’s findings were published in supplying blood to his heart, which led to SAVE THE DATE: the New England Journal of Medicine in his arrhythmia and ultimately cardiac arrest. Pauley Heart Center Consortium 2004. “We were able to show that lay persons Once he completed the comprehensive Event on Thursday, May 17, 2018 performing CPR and using an AED doubled the post-arrest care and awoke from his coma, at Rhythm Hall on the first floor chances of survival from cardiac arrest out of he underwent a successful double bypass of Dorothy Pauley Square in the hospital compared to having the lay person just surgery at VCU. Upon discharge, he started Dominion Arts Center. perform CPR. And based on the study—which a 12-week, medically supervised cardiac got a lot of national and international press— rehabilitation program near his home. Partners in Life continued That all changed in 2016, when, after working very closely with them so that the “We want to arm our patients with all a year-long search, the Weil Institute of projects they do can be easily translated the tools they need to be successful when Critical Care Medicine chose to move its to the bedside if there are promising they’re discharged,” said Gossip, who world-renowned, basic science laboratory outcomes found in the laboratory.” coordinates the care for this complex patient from Rancho Mirage, California, to VCU Wanchun Tang, M.D., who was population and runs a support group for Medical Center. The institute, founded in trained by Weil and ran the Institute after cardiac arrest survivors. She also teaches 1961, was named after the late Max Harry Weil passed away in 2011, joined VCU Hands Only CPR and, with Peberdy, provides Weil, M.D., Ph.D.—a mentor and friend of as professor of Emergency Medicine training to partner hospitals. Peberdy’s and Ornato’s for over 25 years— and continues as the Institute’s director. “Michelle is the glue [that holds this who is considered the father of critical Peberdy and Ornato were named co-deputy program together],” said Ornato. “I just can’t care medicine. Most of the institute’s work directors of the Weil Institute of Emergency say enough good things about her.” involves cardiac arrest and emergency care. and Critical Care Research at VCU, which Despite the great success of the “Weil’s board of directors made the held its grand opening in October 2016. ARCTIC program, “the one thing we were decision to come to VCU because they “We are learning more and more about lacking was the ability to go back and wanted the ability to have their basic how to better care for these patients,” said forth between the bench and the bedside science work translate into clinical work Peberdy. “And it’s our hope that we can to further increase our knowledge and and they chose us, in part, because of further our research and continue to get improve outcomes,” said Peberdy. the ARCTIC program,” she said. “We are better at what we do.”

According to the American Heart Association, more than 350,000 out-of-hospital cardiac arrests occur in the U.S. each year, and overall survival is 10%. Chances of survival can double or triple with timely CPR and early defibrillation with an AED.

Walk of Fame: Patient Leads ‘Virtual Heart Walk’

When the American Heart Association Richmond Heart Walk took place in September 2016, Craig Trowbridge was in the VCU Health Pauley Heart Center, awaiting a donor heart. But he was determined to take part in the walk.

“I’ve always been an active person—running, biking, hockey, golf—and when I heard about the Heart Walk, I told [Clinical Nurse Specialist] Kim Nelson that I was going to participate by walking the 3.1 miles that day on the 10th floor, having my own virtual Heart Walk. Kim took that idea and set up the Heart HEART PATIENT CRAIG TROWBRIDGE AND THE HELPFUL STAFF AT VCU. Walk for the floor,” recalled Trowbridge, 58. He had received a total artificial heart in former patients now home with left them became second family to us as we March 2016; by the time of the walk, he was ventricular assist devices (LVADs) also took talked about vacations, kids, weddings, still tethered to the large console that drove part in the walk. A total artificial heart patient engagements, and new births.” the heart, known as “Big Blue.” However, at with a theatre background sang the national He has moved back home to Ithaca, that time, he was actively engaged in cardiac anthem for the opening ceremonies. New York, and returned to work at Cornell rehab and walking two miles a day. When Trowbridge completed the laps, University, where he directs an applied “I was very elated, as it was the research unit. “I can’t give enough gratitude and praise longest walk that I had completed He has many special memories of the to the physicians, nurses, cardiac rehab while living with Big Blue,” he said. Heart Walk: “The opening ceremony and staff, and others for the care and support Through his walk, he raised about presentations, walking the 10th floor and that I and my family received at VCU.” $2,000 for the AHA. having other patients in the doorway to their Eight months after Daniel Tang, room cheering us on, seeing LVAD and other “I was confident that I would complete M.D., performed his total artificial heart surgery, patients participating in the walk. Having the walk, but I was more worried about Trowbridge underwent a successful transplant, family and friends participate with me was finding people to pull the 400-pound Big led by Mo Quader, M.D. “Both are excellent special, and the overall atmosphere was just Blue machine for 36 laps. But as was true surgeons, personable and very compassionate warm and supportive.” of the staff at VCU, they enthusiastically about their patients,” said Trowbridge, who was “For several months after the walk, I would supported my walk both by pulling Big discharged from VCU on December 7, 2016. see people on the 10th floor that would say `I Blue and cheering me on,” he said. Also Although he lived at the hospital for know you, you did the Heart Walk.’” lending support was his wife, Maureen, many months, he recalls the time fondly. “I Craig Trowbridge’s tradition will continue, three daughters (with one participating by can’t give enough gratitude and praise to as the patients on the 10th floor CVT Facetime from Colorado), and friends. the physicians, nurses, cardiac rehab staff, Progressive Care Unit will take part in the Several patients from the Cardiothoracic and others for the care and support that 2nd annual virtual AHA Richmond Heart Walk Surgery Progressive Care Unit and some my family and I received at VCU. Many of on October 7. Leadless Pacemaker Provides New Option for Patients

A tiny pacemaker is making huge be implanted directly into the heart’s right This would necessitate major interventions waves in the electrophysiology ventricle by a deflectable catheter—entering and occasionally might require surgical community. the body through a vein in the groin. This removal. provides a new option for patients who The device is available to patients The one-inch Micra Transcatheter Pacing were previously not candidates for surgery, who require a single-chamber ventricular System is currently the world’s smallest including some with a history of infections pacemaker to control arrhythmias, such as pacemaker and is also the first one without or who have had prior surgery on the chest, atrial fibrillation or bradycardia-tachycardia wires, known as leads. VCU Pauley Heart such as a mastectomy. syndrome. While it can vary by patient, the Center is the first health system in central estimated battery life is 12 years. Virginia to implant the pacemaker, which “It’s a new procedure, you can’t “At this moment, it is a niche device, was approved by the FDA in April 2016. get it done at any other hospital helping patients who need pacing in “This is a brand-new technology—the in central Virginia. We’re excited only one chamber, but the future of this future of pacing,” said Kenneth Ellenbogen, to be offering this procedure and technology is truly promising. The current M.D., chair of the Division of Cardiology and have been successful with it.” leadless pacemaker is a spectacular device director of Clinical Cardiac Electrophysiology —Kenneth Ellenbogen, M.D. with an outstanding safety profile,” said and Pacing. “It’s a new procedure, you can’t Jayanthi Koneru, M.D., who with fellow get it done at any other hospital in central Micra also differs from standard electrophysiologist Gautham Kalahasty, Virginia. We’re excited to be offering this pacemakers because it is self-contained M.D., received special training in the device procedure and have been successful with it.” and does not contain leads—the wires and began implanting it in Dec. 2016. Pacemakers generate electrical impulses that connect the device to the heart. Over Koneru predicted that “leadless pacing to treat irregular heartbeats and are time, leads can sometimes get scarred into will truly be a game changer.” traditionally placed through an incision in the nearby tissue or be secondarily infected chest. Because of its small size, Micra can when a patient has a bloodstream infection. ABOVE: JAY KONERU, M.D., HOLDING PACEMAKER

Cardiology Fellows Give Back to Heart Center

Nirmal Shah, M.D., has pleasant who is now affiliated with Cardiovascular in the cardiovascular field. memories of the years he spent Specialists of Frederick, Maryland,—has Chair of Cardiology Kenneth Ellenbogen at VCU Medical Center, where made several donations to the VCU Pauley appreciates Shah and other alumni fellows he completed his internship and Heart Center. His contributions have helped who wish to honor their years at VCU residency in Internal Medicine, then support a fellowship fund and a cardiology through a donation. “Giving back is certainly his fellowship in Cardiology in 2001. scholarship. a lovely way of saying, thank you,” he “I wanted to express my gratitude to the said. “Gifts like these help us to support At the time known as MCV, VCU “has place which trained me so well and is the so many more academic activities that the best clinically oriented program and reason for my success in life,” he said. further enhance the clinical and educational the best teachers,” said Shah. “I fondly Another former cardiology fellow opportunities for our fellows.” remember my many mentors.” He counts recently provided support to the newly If you would like to honor a mentor or among them Drs. Walter Paulsen, Ian Nixon, established Vetrovec Symposium. Named a loved one, or learn about other giving Michael Kontos, Bob Jesse, Andrea Hestillo, after George Vetrovec, M.D., longtime opportunities at the Pauley Heart Center, Michael Hess, Kenneth Ellenbogen, Mark director of the VCU Cardiac Catheterization please contact Carrie Mills, Senior Major Wood, George Vetrovec, and Anthony Minisi. Lab, the symposium will bring national Gift Officer, at (804) 828-0453 or cmills@ In appreciation, Shah—a cardiologist speakers to Richmond to discuss advances vcuhealth.org. FROM LEFT TO RIGHT: FARIN BALA, PA; CASSAUNDRA MINTER, NP; VICKI GREEN, NP (BACK ROW); LINDA TONEY, NP ; MARY KAY JARRETT, NP (BACK ROW); KRISTIN COX, NP; JENNIFER CARLIN, NP (BACK ROW); MICHELLE KENNEDY, NP; AMY RUSNAK, NP (BACK ROW); KRISTYN RUDISILL, PA; LISA CAPPS, NP, AND ERIN SWITZER, PA Increase in Patient Load, New Responsibilities Lead to Rise of APPs

Mary Kay Jarrett, FNP-BC, is part of Their numbers have grown due to During the critical inpatient time, a growing trend. “I was drawn to a rapidly growing patient population, working with others—from surgeons and advancing my nursing education reduction in barriers to practice, and a nurses to fellows, residents and anesthesia when I met Judy Collins, a longtime reduction in the number of allowable hours and perfusion teams, as well as many other Women’s Health Care nurse for residents at the hospital. specialists—is key. “Our APPs work hard practitioner here at VCU many years “An APP can help the surgeon manage to collaborate care with other healthcare ago. I witnessed her outstanding their ever-growing patient load without professionals to provide the highest level of clinical skills as well as her excellent endlessly overbooking their clinics. This patient care,” said Physician Assistant Erin care of the entire patient. I knew leads to reduced wait times for clinic Switzer, one of 18 APPs in Cardiac Surgery. right then that I wanted to pursue appointments, reduced use of emergency These advanced clinicians also help that kind of role,” said Jarrett, lead rooms, higher patient satisfaction, and less patients prepare for discharge by providing nurse practitioner for Cardiology. burnout for the physician,” said Morgan them with education about their condition, Messner, one of two nurse practitioners in filling out the forms required by their Recent years have seen an increase in Vascular Surgery. employers, setting up any needed therapies, the number of highly trained clinicians like In the hospital, their duties can range and arranging home health equipment and Jarrett who are known as Advanced Practice from assisting in the operating room to follow-up appointments. Once the patient Providers, or APPs. Made up of nurse is home, they may see them in practitioners (NPs) and physician assistants “Our APPs work hard to collaborate care outpatient clinics, refill medications, (PAs), these individuals provide care to with other healthcare professionals to and respond to their questions. patients while supporting doctors in caring provide the highest level of patient care,” “Our APPs are often more for the multi-dimensional needs of patients. said Physician Assistant Erin Switzer. accessible to patients than our “APPs often have more time to spend surgeons, who are frequently in the with the patients and assist patients as they providing bedside care to patients in ICUs, OR,” said Switzer. “Patients can reach our transition from the hospital to the home. progressive care units, and outpatient APPs via phone, the call center, or the portal.” They’re just wonderful care providers and procedure rooms. “The APPs are excellent clinicians are so expert in their field,” said Kenneth “Each patient is important and cared and work both independently and in Ellenbogen, M.D., chair of the Division of for by these advanced practice providers collaboration with our physician colleagues. Cardiology, which has 20 APPs. with attention to detail in their medical They take time to listen to patients, ask NPs and PAs require specialized management, compassion for their questions and provide education and training, including at least a master’s emotional needs, and care for the whole information,” said Jarrett. “The combination degree, and must pass national exams. Both patient,” said Jarrett, who has been a nurse of these skills helps patients feel confident occupations require continuing education and practitioner for 26 of her 30 years as a in their medical care as well as making recertification after a certain number of years. registered nurse. them feel as if they are being heard.” A Long, Storied History: Dr. Michael Hess Recalls Early Days of Transplant Program

VCU Health’s reputation as a leader in long-distance transport in May 1977. Retired cardiac transplantation has its roots in MCV surgeon Szabolcs Szentpetery, M.D., the 1960s, in the MCV West Hospital who was a fellow at the time, was sent laboratory of Richard Lower, M.D. to Indianapolis to retrieve the heart. The young doctor was nervous that “it wouldn’t “Dr. Lower was very low key, very soft work and we would lose everything,” says spoken and fanatically dedicated to cardiac Hess. “And it worked like a champ. That transplantation,” says cardiologist Michael revolutionized the fi eld.” Hess, M.D., who worked with Lower, Hess himself was a revolutionary. In 1981, beginning in the mid-1970s. claiming “I had no one to talk to,” he created Lower studied under pioneering the International Society of Heart and Lung transplant surgeon Norman Shumway, M.D., Transplantation at the annual meeting of the at Stanford. In 1959, during his residency American Medical Association. “I thought there, Lower transplanted part of a dog’s it was very important to start the project, heart to a second dog, which lived for eight number one, to have an exchange of ideas days—a record at the time. and good science and number two, it was He was recruited to MCV by David obvious the fi eld was going to grow and Hume, M.D., who with his mentee H.M. MICHAEL HESS, M.D. somebody had to take a leadership role and Lee, M.D., performed Virginia’s fi rst kidney maintain quality and standards,” says Hess, transplantation at the medical college in (Shumway, the fi rst in the U.S. at Stanford; who served as the fi rst president—even 1957. Lower arrived in Richmond in 1965 and Lower, the fi rst in Virginia at MCV). bringing in a Canadian colleague passing continued his work in animal transplantation. Hess later would tease Lower about this by the room to make the fi rst meeting truly In 1966, South African surgeon Christiaan tension. “I knew how to make him angry. international. Barnard, M.D., spent six months visiting You’d just say, `Chris Barnard.’” Today, the organization is the world’s Lower’s laboratory, studying his approach. He Hess says his work with Lower “started leading scientifi c society of transplant then studied with Shumway. out as a hallway conversation in West physicians and surgeons and operates the Hospital.” It was a Friday International Registry for Heart and Lung Today, the organization is the world’s leading when he introduced Transplantation, the only database of its kind scientifi c society of transplant physicians and himself to the surgeon in the world. surgeons and operates the International Registry and expressed interest “This was a landmark event,” says for Heart and Lung Transplantation, the only in caring for his post- Vigneshwar Kasirajan, M.D., cardiothoracic database of its kind in the world. transplant patients. “He surgeon and chair of Surgery. “Without the looked me square in ISHLT, thoracic organ transplant science As the possibility of human the eye and he said, `Well, I have two new and practice would have never been widely transplantation grew closer, many wondered patients coming in to the clinical research unit spread and benefi ted thousands of patients. if Barnard, Lower, and Shumway would be Monday morning. Go to work on them.’” Mike Hess deserves all the credit for this very the fi rst to perform the surgery. Their rivalry In the early days of transplantation, the remarkable endeavor.” was explored in “Every Second Counts: The brain-dead organ donors were at MCV, and The Pauley Heart Center wishes all the Race to Transplant the First Human Heart” by transplants were performed locally. “Lower best to Dr. Michael Hess, who retired in June. Donald McRae. made a very signifi cant contribution when He came out of retirement in 2013 to start In the end, Barnard performed the world’s he clearly showed in his lab that he could Virginia’s fi rst cardio-oncology program at VCU. fi rst successful human heart transplant in preserve a heart for four hours and it would Our faculty, staff, and supporters thank Dr. 1967, while the surgeons who had trained still work,” says Hess. Hess for his many years of inspiring work and him in their techniques followed in 1968. This led to MCV’s taking part in the fi rst dedication to his patients.

In the News First in Our Hearts

In December, the Journal of Heart and Lung 1968 – First heart transplant in Virginia (and 9th in the country,16th worldwide) takes place at Transplantation will publish an issue dedicated MCV; 557 completed to date to the 50th anniversary of the fi rst human 1972 – MCV wins landmark Tucker Trial involving a human heart transplant; for the fi rst time, heart transplant, performed by Christiaan death can be defi ned by “brain death” Barnard, M.D., in Cape Town, South Africa, on 1977 – First long-distance heart transplant in the world occurs at MCV Dec. 3, 1967. VCU cardiologist Michael Hess, 1981 – International Heart Lung Society created by MCV physician M.D., and Sharon Hunt, M.D., of Stanford 1986 – First heart-lung transplant in Virginia takes place at MCV University, are co-authoring the special issue’s 1994 – First LVAD implanted at MCV fi rst chapter, “Early Challenges in Cardiac 2006 – First total artifi cial heart implanted on the East Coast at VCU Transplantation.”

VCU Health has the longest-running cardiac transplantation program on the East Coast and the second oldest in the nation. Grateful Patient Recalls Cardiac Arrest Chain of Survival Saves Runner

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

Jeff Stover was steps away from the Stover underwent ARCTIC therapy “Every person that I come finish line of the Monument Avenue at VCU, then required surgery to fix the into contact with through the 10K this April when he collapsed. problem that had led to his cardiac arrest. ARCTIC program has either been “My issue was a bicuspid aortic valve. saved by CPR or potentially Stover, 48, has little memory of the race— It’s hereditary, but I didn’t know I had it,” saved by knowledge of CPR,” a family tradition that he undertakes each he said. Most people have three flaps on said Michelle Gossip. year with his eldest son. “I remember this valve, but Stover had only two. “So, starting, and then I remember at the very it already isn’t working as efficiently as it tone for how well they’re going to do end, I could see the finish line. I remember should. And then it tends to calcify more.” afterwards.” thinking to myself, `Should I pick up the Looking back, he realized that a doctor ARCTIC Program Nursing Coordinator pace a little bit—you know, finish strong?’ had detected a murmur during a high school Michelle Gossip, who assisted in And then I remember saying to myself, `No, physical—but no testing was ever done, coordinating Stover’s care in the hospital, I’m good.’” which would have revealed his condition. said VCU trained about 2,000 community He also remembers members in Hands Only CPR last year. “Every person in that chain is extremely that he got more out She is passionate about this outreach. important,” said ARCTIC Medical Director Mary of breath training for “Every person that I come into contact with Ann Peberdy, M.D. “The early care that those the 10K this year than through the ARCTIC program has either patients get really sets the tone for how well in the past. been saved by CPR or potentially saved by they’re going to do afterwards.” As to his care, knowledge of CPR,” she said. Stover benefited Stover, whose path ran smoothly from His 15-year-old son, Harrison, had from the perfect experience of what the immediate CPR all the way through to the already completed the race and was American Heart Association calls the out- care he received at VCU (“I can’t speak waiting for his dad at Monroe Park with of-hospital Chain of Survival for Cardiac highly enough of the folks at VCU”) knows friends when Stover went into cardiac Arrest. The five links in this chain are: he is fortunate. arrest and collapsed about 10 yards from • Recognition of cardiac arrest and “All the stars aligned—almost as the finish line. Fortunately, he had some activation of the emergency response perfectly as they could have.” helpful—and well-trained—strangers who system Note: According to cardiologist Joe jumped in to help. Running behind him was • Early cardiopulmonary resuscitation (CPR) Ornato, M.D., exercise is very beneficial to an emergency physician from University with an emphasis on chest compressions the heart. A very small percentage of cardiac of Virginia, who immediately began • Rapid defibrillation arrests occur during exercise, usually as the administering CPR. A paramedic bystander, • Basic and advanced emergency medical result of a previously unknown blockage or who was waiting for his wife to complete services other form of heart disease. Most cardiac the 10K, also rushed over to help. Nearby • Advanced life support and post-cardiac arrests—88 percent, according to the AHA— in a tent at the finish line were Richmond arrest care occur at home, but your chances of survival Ambulance Authority paramedics, who “Every person in that chain is extremely are much better if your arrest is witnessed, used a defibrillator to quickly regain a important,” said ARCTIC Medical Director in a public place, and bystanders call 911 heartbeat and then brought him to VCU for Mary Ann Peberdy, M.D. “The early care immediately, perform CPR, and apply an the ARCTIC program. that those patients get really sets the AED before EMS arrives. Raising Awareness of Women’s Heart Health

VCU Pauley Heart Center hosted physician assistants, and nurses. up-to-date information relating to women’s the second annual Heart Health in “One highlight of our program was Dr. cardiovascular health to continue to advance Women Symposium on Feb. 4 at Reavey-Cantwell’s discussion of stroke in heart health in our community.” the Virginia Museum of Fine Arts. women. He outlined the unique features Phoebe Ashley, M.D., and Jordana of stroke in women, the high incidence of ABOVE: DR. INNA TCHOUKINA, DR. DEBORAH Kron, M.D., co-chaired the event for stoke, particularly in young women, and KOEHN, DR. HEM BHARDWAJ, DR. PHOEBE the second year, and were among the unique risk factors in women. He was very ASHLEY, DR. JORDANA KRON, DR. JENNIFER many VCU cardiologists who spoke well-received,” said Ashley. SALLUZZO, DR. SUSAN WOLVER, AND DR. that day. Other topics included exercise and JOHN REAVEY-CANTWELL WERE AMONG THE cardiac rehab in women, pregnancy and SPEAKERS AT THE HEART HEALTH IN WOMEN “Our goal is to update and educate the heart, and a panel discussion on SYMPOSIUM. THE EVENT RAISED AWARENESS healthcare professionals so that women “Survivorship: The Heart of the Breast ABOUT THE UNIQUE FEATURES OF WOMEN’S receive state-of-the-art cardiovascular care Cancer Patient” that included specialists in HEART DISEASE, THE NO. 1 KILLER OF WOMEN throughout Virginia and the surrounding cardio-oncology and heart failure. AND THE CAUSE OF DEATH IN 1 OF 3 WOMEN. areas,” said Ashley. “The participants seemed to really enjoy The event, which began with breakfast the program with many being interested in Heart Health in Women’s Symposium and concluded at noon, drew 70 participants moving it to a full-day event,” said Ashley. on Saturday, February 3, at the who were physicians, nurse practitioners, “We plan to annually bring the most Virginia Historic Society Museum.

Hume-Lee Celebrates 60 Years and 5,000 Transplants

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

It’s a banner year for the VCU Health The center is named after pioneering MCV A 60th Anniversary Celebration for the Hume-Lee Transplant Center. The transplant physicians David Hume, M.D., VCU Health Hume-Lee Transplant Center transplant program at VCU—formerly and H.M. Lee, M.D. Accomplishments at will take place on Sat., Dec. 2 at 6 p.m., the Medical College of Virginia— the center also include Virginia’s first liver at the Virginia Museum of Fine Arts. To was once one of only three such transplant, one of the world’s first tissue- learn more, please visit First-in-Second- programs in the U.S. In 1957, it was typing labs, and Virginia’s first vascular- Chances.com. the site for Virginia’s first kidney access program. In May, the center transplant. completed its 5,000th transplant. Pauley Reveals Latest EP Lab; Interventional Cardiology Suite Now Complete

After nearly seven years in the rooms less cluttered, cleaner, and safer for place at VCU this year. The labs will help making, the new VCU Health staff with no trip hazards,” said Williams. VCU meet growing patient demand, Pauley Heart Center interventional “Additionally, each room is equipped with including an increasing number of cardiology suite dazzles with eight CleanSuite ceiling technology developed complex, high-risk cases. bright, spacious rooms and state-of- by Huntair. This is a custom, laminar air “We are doing a lot more structural the-art technologies, including fully delivery system that continuously fi lters air heart procedures that close abnormal integrated GE imaging systems. in the procedure rooms, reducing airborne openings in the heart or correct valve contaminants.” problems. In EP, we are performing left atrial “We worked very hard to make the rooms Many of the components in the room, appendage closures. We were doing those as functional and effi cient as possible. such as the lighting, attach to the Huntair before the construction, but it’s much, much We’ve tried to include everything the ceiling grid. Large fl at-screen monitors easier in these new rooms,” said Williams. doctors and staff need to make the rooms angle wherever needed throughout the The process began in 2012 when work well,” said Ruth Williams, nurse room, with additional screens in the the Pauley Heart team closely reviewed manager of the Cardiac Catheterization and procedure room and control room to and meticulously tweaked the plans and Electrophysiology Labs and Cardiovascular optimize visualization for all team members. helped select the equipment. “I think the Progressive Care Unit. “EP has a lot of very complex biggest challenge has been the extreme equipment. We were able to number of details…When you’re trying to “These rooms have advanced technologies integrate all of that equipment conceptualize new construction, you really that all communicate with each other. All so that the staff can see any have to put yourself into that room in your rooms were equipped with booms that modality, at any place in the mind and think, `What do I need? What do I contain all cables to keep the rooms less room,” she said. “Everybody need where?’” cluttered, cleaner and safer for staff with no can see what everybody else A daily challenge was keeping the trip hazards,” said Williams. is doing and keep a closer eye departments up and running safely, on the patient.” Additionally, she said. “We have a very vulnerable Take EP2, the fi nal ,room in the suite, “radiation exposure to our patients, as well population, especially with our cardiac which was completed in July. An x-ray table as doctors and staff, has decreased.” transplant patients. Everything has to be in the middle of the room is surrounded The four rooms that make up the EP very tightly sealed in the construction areas, by the latest in technologies—from a surgical suite are connected by a hallway to so we were constantly working with our GE Innova 620, with a C-shaped arm for the four new cardiac catheterization labs, epidemiology colleagues and assuring all imaging, to the multiscreen fl at monitors which include a hybrid operating room. Near quality and safety metrics were being met. and the three Stryker booms that suspend the EP labs, a conference room that will All the hard work has paid off. The from the ceiling, containing outlets for connect audiovisually to the procedure rooms custom design and equipment wows medical gases, electrical outlets, and IT is under construction. It will support the visitors, including those from other integration for all equipment. increasing number of clinical staff who want hospitals. “These rooms have advanced to watch the many innovative procedures “I’ve even had people ask to see technologies that all communicate with taking place at the Pauley Heart Center. our blueprints,” Williams said with a each other. All rooms were equipped with An estimated 1,900 EP and 3,800 laugh. “I think everybody has been really booms that contain all cables to keep the Cardiac Cath Lab procedures will take impressed.” Cardiac Surgeons Explore New Heart Failure Devices

VCU Health Pauley Heart Center “Overall, outcomes were relatively instead of as a bridge-to-transplant. cardiothoracic surgeons Daniel Tang, similar, but the Heartmate III group did “The trial is ongoing, with very limited M.D., and Mohammed Quader, M.D., demonstrate superiority compared to the enrollment. We were the fi rst center to are taking part in several clinical Heartmate II in freedom from re-operation enroll a patient—who was, for a time, the trials involving new devices for for pump thrombosis [the creation of blood only patient,” said Tang. “It is a challenging patients with advanced heart failure. clots, which increases the risk of strokes],” trial due to a very narrow risk/benefi t said Tang. “While we wait for further and window. Nonetheless, it is an important trial “The fi eld of device therapy for advanced longer-term results, the trial is currently as the total artifi cial heart may be the only heart failure has certainly exploded,” said enrolling another 1,000 patients.” device option for certain patients who are Tang. “Yet despite the marked improvement not candidates for transplantation.” in outcomes with newer generation “VCU remains actively engaged in being Syncardia 50cc trial – Tang is devices, patients still face signifi cant at the forefront of advanced therapies for the PI for this Phase III trial, which potential for adverse events.” For that end-stage heart failure,” said Tang. is open for enrollment. “The current reason, “VCU remains actively engaged in 70cc device offered by Syncardia being at the forefront of advanced therapies Heartware HVAD Lateral – This non- is sized for large men. The smaller pump for end-stage heart failure.” randomized study, which was conducted to opens the total artifi cial heart to smaller- Here are some updates from some explore the feasibility of using a minimally sized patients—namely, women and recent trials: invasive approach to implant this continuous children,” he said. Momentum (Heartmate III) – Chair fl ow, centrifugal LVAD. The trial completed of Surgery Vigneshwar Kasirajan, M.D., its enrollment of 145 patients in 2016, with is the primary investigator (PI) for this preliminary six-month results reported at Phase III trial. Patients are implanted with the recent International Society for Heart Stony Point the Heartmate III left-ventricular assist and Lung Transplantation meeting in April. device (LVAD), which offers the use of a “The data is undergoing review and only Opening magnetically levitated rotor with wider very early results have been reported. It fl ow pathways than previous models, along appears promising as there was 92 percent Coming soon: The Pauley Heart Center with other innovations. The device is being survival rate at six months,” said Tang. will begin offering outpatient services at a evaluated for its safety and effectiveness, “Our experience and pretrial data suggests new VCU Health building located at 9000 and patients are compared to a control potential benefi ts of reduced blood loss and Stony Point Parkway, Richmond, VA. 23235. group using the Heartmate II. possible less right ventricular failure.” Cardiology, cardiothoracic, and vascular The trial began in Jan. 2015, and short- Syncardia DT trial – Tang is the PI for this services will be offered, using state-of- term results from the trial’s fi rst 1,000 Phase III trial, which explores the Syncardia the-art imaging. VCU cardiologist Phoebe enrolled patients were reported at the Nov. DT total artifi cial heart as destination Ashley, M.D., will serve as the facility’s 2016 AHA Scientifi c Sessions. therapy—that is, implanted permanently medical director. Stay tuned.

Reaching Out, Saving Lives

Beyond their walls, VCU Health and and triumphs, “the value is it provides RichmondVaHeartWalk.org. the Pauley Heart Center participates everyone with a new sense of purpose in At the Heart Walk, VCU Pauley in many community events. Here are the community.” For more information, visit Heart Center staffers will take part in a few coming up: StrokeCamp.org. demonstrations of Hands-Only CPR. VCU Health is a sponsor for the American Promoting this simple rescue technique VCU Health is sponsoring the Retreat and Heart Association’s Life Is Why Richmond that does not require mouth-to-mouth Refresh Stroke Camp for stroke survivors Heart Walk, which will take place Saturday, resuscitation has been an important and and their loved ones. The camp will be held Oct. 7, at West Creek Parkway. The annual frequent outreach effort for Pauley. Sept. 8–10 at Airfi eld Conference Center 1- and 3.1-mile walk supports education and During CPR Awareness Week (June in Wakefi eld. Offered throughout the U.S., research for heart disease and stroke, with 1-7), Michelle Gossip, BSN, Advanced the nonprofi t camp was started by a stroke the Richmond chapter hoping to raise Resuscitation Cooling Therapeutics survivor and his loved one. This will be the $1.6 million this year. and Intensive Care (ARCTIC) Program fi rst time the camp is offered in Virginia Last year, the Pauley Heart Pumpers, Coordinator took part in one to two according to Kristina Gooch, a nurse with led by co-captains Lorraine Witzke, RN, and community events every day. At one the VCU Stroke Program who is helping to patient Greg Lowe, raised $11,830 and function, she helped train 700 City of coordinate the effort. were the number-one VCU fundraising team. Richmond employees in Hands-Only CPR. During camp, survivors and caregivers The team included transplant survivors “It does save lives,” said Gossip. “People will have the opportunity to meet and and several patients who took part in the are afraid of doing CPR and we need to interact with others in their situation. “There walk from inside the heart center (see debunk that fear.” will be activities to retreat and relax from article “Walk of Fame: Patient Leads ‘Virtual the daily struggles they face,” said Gooch. Heart Walk.’”). To sign up or support a VCU Read more online at vcuphc-thebeat.org. As participants talk about their problems Pauley Heart Center team, please visit First Class Mail U.S. Postage

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Friends and Supporters,

Welcome to the fall issue of The Beat. In this issue, you’ll visit some of our innovative programs and meet some of the talented physicians and teams who are making a difference in the lives of our patients. Our cover story will bring you up close and personal to a truly terrifying experience: cardiac arrest. In the story, you will meet two patients who lived to tell their tales and, like so many, are grateful to Pauley’s world- class ARCTIC program, led by Dr. Mimi Peberdy and Dr. Joe Ornato. In electrophysiology news, you can read about Dr. Jay Koneru and Dr. Gautham Kalahasty, the first physicians in central Virginia to implant the world’s tiniest, and first leadless, pacemaker. We have also completed the new EP suite, which provides an optimal setting for both exploration and patient care. DR. KENNETH A. ELLENBOGEN Longtime heart center innovator Dr. Michael Hess recently retired. But he leaves behind many important legacies—including his A PUBLICATION OF innovative work with cardiac transplant patients. I hope you will enjoy VCU HEALTH reading about his memories of working with pioneering transplant PAULEY HEART CENTER physician, Dr. Richard Lower, in the early days of the program. DESIGN: One of the things that’s fantastic about this place is the people Bergman Group that we’re surrounded by—including the many Advanced Practice PHOTOGRAPHY: Providers—nurse practitioners and physician assistants--who are so VCU Creative Services expert in cardiology and patient care. In this issue, you can read about ADDRESS: the many ways they are helping patients in the divisions of cardiology, 1200 East Broad Street cardiac surgery and vascular surgery. P.O. Box 980036 There are so many phenomenal things occurring on this campus, and Richmond, Virginia 23298-0036 some of the best are the result of our doctors, researchers, nurses, and PHONE: other team members working together to provide the best care possible 804.828.0067 to our patients. They, together with friends like you—who make so much Copyright 2017. All rights reserved. of our work possible—are truly what makes this place great.

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

HOW TO MAKE A GIFT. Gifts to the Pauley Heart Center allow us to invest resources in transforming patient care, education and research at VCU Health. For more information on how to honor a loved one or a caregiver, please contact Carrie Mills at (804) 828-0453 or [email protected]

VCU Health Pauley Heart Center Contacts Visit us online at vcuphc-thebeat.org

CARDIOLOGY CARDIOTHORACIC SURGERY PEDIATRIC CARDIOLOGY HEART VALVE CENTER HEART FAILURE

VCU Medical Center VCU Medical Center Adult Congenital Heart Disease VCU Medical Center AND TRANSPLANT P.O. Box 980036 P.O. Box 980068 VCU Medical Center 417 N. 11th Street VCU Medical Center Richmond, VA 23298 Richmond, VA 23298 P.O. Box 980543 Richmond, VA 23298 P.O. Box 980204 804.828.8885 804.828.2775 Richmond, VA 23298 804.628.4327 Richmond, VA 23298 804.828.9143 804.828.4571