VCU Medical Center » » » » » » » » » » 2006 ANNUAL REPORT 03 Virginia Commonwealth University Remarkable energy and vision » » » » » » » » » » That’s what fuels our success as one of the nation’s leading academic health centers. Strategic invest- ments to grow our facilities, strengthen our expertise and advance our research programs in 2006 propel us on a path of unequaled excellence and ensure we deliver the highest quality of patient care. CONTENTS o4 » Heart 24 » Workforce development o8 » Total artifi cial heart 28 » Access to care 10 » Transplant 32 » Kudos 12 » Cancer 34 » Research 16 » Nursing 38 » Facilities 20 » Dental 40 » Financials In January 2006, the VCU Heart Center became the VCU Pauley Heart Center, in recognition of a $5 million gift from the Pauley Family Foundation. The designation places the heart center among only a few named major heart centers across the country. “This generous gift in the development of congestive heart failure. Cardiologists at from the Pauley the VCU Pauley Heart Center are performing two new procedures Family Foundation that may revolutionize the treatment of atrial fi brillation: modi- means so much to fi ed Mini-Maze and cryoablation. the research and educational pro- An amazing technique. During the modifi ed Mini-Maze, sur- grams in cardio- geons insert instruments into the chest through several key- vascular disease,” hole-size incisions between the ribs. With the aid of a tiny Stanley F. Pauley and George W. Vetrovec, remarked Sheldon video camera, a specially designed instrument is placed around M.D., VCU Pauley Heart Center M. Retchin, M.D., the top of one of the atria and energy is delivered to destroy M.S.P.H., CEO of the VCU Health System and Vice President the tissue near the origin of the irregular impulses. The dam- for Health Sciences at VCU. aged tissue disrupts the abnormal signaling pathways, stopping Dorothy A. and Stanley F. Pauley lead the Pauley Family the irregular impulses. Foundation. Mr. Pauley, CEO of Carpenter Co., is a long-time Vigneshwar Kasirajan, M.D., chairman of cardiothoracic sur- supporter of VCU. He said he was impressed with the staff’s gery at the VCU Pauley Heart Center, performed the fi rst Mini- dedication and care and wanted to give something back that Maze procedure in June 2006. 05 would benefi t not only VCU but also all Virginians. “This is a signifi cant advance in the management of atrial “They are doing a great job in making a difference in peo- fi brillation,” he said. “We’ve known for some time this could ples’ lives,” Pauley said. “Their technical prowess is exceptional be an effective strategy for treating the abnormal rhythm, but and the intention of the gift is to extend their capabilities by until now we haven’t had the tools to do it effi ciently.” expanding the staff and providing suffi cient assets to keep up Heart with rapidly changing technology needed to treat heart dis- A cool approach. VCU Medical Center is one of fewer than eases.” A national leader in developing and implementing car- » » » » » » » » » JUMP-STARTING ADVANCEMENTS IN CARDIAC CARE 20 in the country with access to balloon cryoablation, an diovascular procedures, the center includes subspecialty areas investigational treatment for atrial fi brillation. in acute chest pain management, general and invasive cardiol- Cryoablation permanently disables heart arrhythmias by ogy, heart failure and transplantation, electrophysiology and using an extremely cold temperature to destroy very small cardiac surgery. and carefully selected parts of the heart. “The additional funding will advance our mission of excel- “This is the latest advancement and could potentially prove lence in patient care, innovative research and comprehensive to be a major change in how we treat atrial fi brillation,” said education, as well as help us attract exceptional cardiology Kenneth Ellenbogen, M.D., director of the Pauley Heart Center’s trainees and faculty,” said George W. Vetrovec, M.D., chairman cardiac electrophysiology lab. “We’ve found catheter cryoablation of cardiology at the VCU School of Medicine. “For all of this we to be successful and preliminary results from balloon cryoabla- are exceedingly grateful and proud.” tion suggest a success rate up to 85 percent in some patients.” During the treatment, cardiologists insert a small cath- SETTING THE PACE IN RHYTHM MANAGEMENT eter through a blood vessel into the heart. Doctors use According to the American Heart Association, more than 2 mil- another catheter tipped with an electrode to reproduce the lion people in the U.S. suffer from atrial fi brillation — a com- arrhythmia, then test it by cooling the catheter tip. The cold mon rhythm abnormality in the heart’s upper chambers — and temporarily stops the arrhythmia, which allows doctors to 300,000 new cases are diagnosed each year. In addition to an pinpoint the problem area without damaging surrounding increased risk for stroke, atrial fi brillation is a major contributor normal areas. VCU Medical Center » 2006 ANNUAL REPORT Once the exact location of the arrhythmia has been confi rmed, cardiologists use extreme cold to freeze and scar the problem- Discovering an unlikely protector » » » » » » » » » atic heart tissue, eliminating the arrhythmia altogether. Cryotherapy is already used to successfully treat certain types The discovery of Viagra as a treatment for male erectile dys- a potent chemotherapeutic agent frequently used in the of cancer, including prostate, and in Food and Drug Administra- function was accidental. Researchers had been developing treatment of breast cancer, leukemia and sarcomas. tion-monitored studies following its safety and effi cacy, cryo- the drug for the treatment of hypertension when they dis- “Our work in understanding the mechanisms of precon- ablation also shows promise as a therapy for atrial fi brillation. covered an interesting side effect — a change in erectile ditioning has led to the identifi cation of several novel “We believe that this procedure tends to be simpler and safer, function. But Rakesh C. Kukreja, Ph.D., VCU professor of compounds that will have enormous impact in protecting so more patients may soon be candidates for it,” Ellenbogen internal medicine and cardiology and NIH MERIT recipient, the heart muscle after a severe heart attack in patients said. “It’s an exciting new technology that appears to be quite has brought the research back to its initial focus and found a with coronary heart disease,” said Kukreja. “This landmark successful treating atrial fi brillation.” potentially important use for this drug — heart protection. discovery could give these compounds a lifesaving medical “Dr. Ellenbogen and his group are nationally recognized for Kukreja’s laboratory is one of the fi rst to explore the area role.” their pioneering leadership in arrhythmia management,” said of “preconditioning,” a way to protect the heart muscle from Kukreja said that the PDE-5 inhibitors — drugs that help Vetrovec. “New therapies such as cryoablation are available to serious damage in the future by subjecting it to very brief dilate the arteries — might be developed for future use to patients at the VCU Medical Center before many other hospitals periods of deprivation of blood fl ow and, therefore, oxygen. protect the brain, liver and other organs against ischemic can provide such services.” This preconditioning effect was modeled in his lab by injury — those injuries that are caused by lack of oxygen. pretreating mice with doses of Viagra, which also increases Kukreja’s laboratory has three studies currently funded BEATING THE BENCHMARK FOR RESPONSE TIME desirable levels of nitric oxide. A preconditioned or pre- by the National Institutes of Health, one by the American A new program at the VCU Pauley Heart Center is decreasing treated heart has an improved ability to produce nitric oxide Heart Association and two from the pharmaceutical industry the time it takes for heart attack patients to receive life-saving and directly improves a patient’s outcome following a heart providing a total of more than $6 million for his work in treatment. The Acute Myocardial Infarction Program provides attack. Generally, damage following a heart attack is related this area. patients with 24/7 access to the cardiac catheterization lab, to an inability to recover ensuring that a blockage is opened with percutaneous coro- from lack of oxygen. “Our work in understanding the mechanisms of preconditioning has nary intervention within 90 minutes after hospital arrival, In 2005, Kukreja and the goal identifi ed by the American College of Cardiology and his colleagues demon- led to the identifi cation of several novel compounds that will have the American Heart Association. The Joint Commission on strated that Viagra pre- enormous impact in protecting the heart muscle after a severe heart Accreditation of Healthcare Organizations and the Centers vented damage to the for Medicare and Medicaid Services report data nationally heart from doxorubicin, attack in patients with coronary heart disease.” » Rakesh C. Kukreja, Ph.D. for the previous 120-minute benchmark. Since the program’s implementation in early 2005, the Acute MI Program has exceeded this benchmark, and since early 2006, 100 percent of patients have received treatment within 120 minutes and 86 percent within 90 minutes of hospital arrival, faster than the average rate of hospitals both nation- (72 percent) and statewide (74 percent). TAKING A TEAM APPROACH TO AORTIC DISEASE Derek Brinster, M.D., joined the VCU Medical Center in 2006 as director of the Thoracic Aortic Surgery Program. Treating problems of the aorta in the chest, the abdomen and the vessels that feed blood to the brain and other organs, the program offers an experienced multidisciplinary team that excels in both medical management and surgical interven- tion of individuals with serious aortic conditions. Under the leadership of Brinster and Vigneshwar Kasirajan, M.D., chief of the Division of Cardiothoracic Surgery, the medical center now offers expertise covering all aspects of the treatment of cardiac and aortic disease.