Download Outcomes 2014 - Inova Heart and Vascular Institute

Outcomes
2014
Inova Heart and Vascular Institute
(Based on 2013 Data)
“Over the last 10 years, Inova Heart and Vascular Institute has made a critical difference to a great many people. The statistics are
only part of the achievement: 118 TAVR patients, 157 heart transplant patients, 200 lung transplant patients, 15,500 PCI patients of
whom 3,800 presented as a STEMI, 1,900 Afib ablation patients, 4,200 heart valve surgery patients and 5,200 CABG patients.
Every physician, nurse and caregiver who touches our patients shares responsibility for the patient experience and takes pride in
our collective success.”
Harvey Sherber, MD, FACC
Medical Director, Inova Heart and Vascular Institute
Table of Contents
1Welcome
Welcome
We are pleased to present the 2014 Inova Heart and Vascular Institute (IHVI)
Outcomes Report, based on 2013 data. This report not only documents our recent
history, but also charts our trajectory and demonstrates why IHVI continues to be
nationally recognized as a heart and vascular center.
2
Regional Resource
3
Award-Winning Care
5Innovation
6
Cardiac Catheterization
7
Acute Myocardial Infarction
8Door-to-Balloon
Ten years ago, IHVI opened its doors as Northern Virginia’s first freestanding,
comprehensive cardiac care facility. Today, we remain the only such cardiac
program in the area, offering the most advanced diagnostics, care protocols and specialized
services delivered in a patient-centric environment by a caring staff focused on service
excellence. Our unique blend of expertise, technology, convenience and accessibility means your
patients can stay in Virginia for all their heart and vascular needs with the peace of mind that the
most innovative, effective therapies are right here close to home.
9
Percutaneous Coronary
Intervention
In this report, you will find program and research highlights, as well as volumes and outcomes
data. You will read about IHVI patients and learn their personal stories. These cases represent
not only our advanced clinical expertise, but also our service promise to meet the unique needs
of each person we are privileged to serve – every time, every touch.
Patrick Christiansen
All of us at Inova Heart and Vascular Institute are proud to share our success with you.
Together, we can improve the quality of life for heart patients and their families in our community.
Sincerely,
Patrick Christiansen, PhD
EVP, CEO, Inova Fairfax Medical Campus
10 Tackling the Final Frontier
11
Chronic Total Occlusion
12
Cardiac Rhythm Disorders
14
A Well-Oiled Machine
15
Atrial Fibrillation
16
Cardiac Surgery
17
Coronary Artery
Bypass Grafting
18
A Lifesaving Solution
19 Valve Disease
20
Aneurysm of Great Vessels
21 Vascular Disease/Surgery
22 Thoracic Surgery
24
Lung Transplantation
25
Advanced Heart Failure
26
Heart Transplantation
27
Reaching New Heights
28 Pediatric Congenital
Heart Program
30 Adult Congenital Heart Program
31 Cardiac Rehabilitation
32 Research/Publications
35 Our Physicians
inova.org/heart 1
“A heart institute is more than a building – it’s the passion and expertise of the people inside
that building. From our phenomenal nurses, anesthesiologists, physician assistants and cath
lab technicians, to our surgeons and cardiologists, to our dedicated researchers,
everyone is focused on just one thing: excellent outcomes for our patients.”
Alan Speir, MD
Medical Director, Cardiac Surgical Services
A Renowned Regional Resource
Inova Heart and Vascular Institute is the largest cardiac program in the Northern Virginia region. For more than 25 years, our team of
world-renowned surgeons, cardiologists, highly skilled nurses, and support staff has worked together to deliver comprehensive cardiac care.
Our patient-centered care is delivered in a facility designed to provide a healing environment.
Our convenient network of hospitals across Northern Virginia makes it easy for patients and families to seek the care they need.
See the inside back cover for a listing of facilities.
2 Outcomes 2014
Award-Winning Care
Inova Heart and Vascular Institute is consistently
recognized as one of the top cardiac programs
in the country. Our awards for services,
treatment and results include:
• Inova Fairfax Hospital was
ranked a top performing
regional hospital in
cardiology and heart
surgery by U.S. News.
• Inova Fairfax Hospital
received the Women’s Choice Award as one
of America’s Best Hospitals for Heart Care
in 2014. The award recognizes hospitals that
perform well on heart care measures and
have a high recommendation rate among
women. Only 290 hospitals out of 4,500
facilities nationwide made the list.
• Inova Heart and Vascular Institute received
the Cardiac Surgery Excellence Award
and a 5-star rating for 30-day mortality for
heart failure patients from HealthGrades,
the leading online resource that helps
consumers search, evaluate and compare
physicians and hospitals.
• The Joint Commission awarded its Gold Seal
of Approval® to Inova Heart and Vascular
Institute for treatment of
acute myocardial infarction
(heart attack) and left
ventricular assist device
(LVAD) patients.
• The Joint Commission named Inova Fair
Oaks Hospital a Top Performer on Key
Quality Measures® for heart attack and
heart failure.
• Inova Heart and Vascular Institute received
the Platinum Performance Achievement
Award from the National Cardiovascular
Data Registry (part of the American College
of Cardiology Foundation) for a higher
standard of care for heart attack patients.
• Inova Fairfax Hospital earned the Mission:
Lifeline® Silver Plus Award from
the American Heart Association
for its efforts to improve the
quality of care for heart attack
patients.
• Inova Heart and Vascular Institute received
a three-star designation – the highest
category of quality for cardiac surgery –
from the Society of Thoracic Surgeons.
inova.org/heart 3
Transcatheter aortic valve
replacement (TAVR) procedure:
Edwards Sapien® Valve
4 Outcomes 2014
Innovation
Inova Heart and Vascular Institute leads the way in innovative, technologically advanced
cardiovascular care in the Washington metro area. We offer some of the most exciting
advancements in heart care, including:
• Early ambulation for thoracic surgery patients, which promotes faster healing, less pain,
shorter length of stay, and fewer cases of deep vein thrombosis. Findings were presented at
the 15th World Conference in Australia in 2013.
• New Philips X-ray equipment in our cardiac and vascular laboratories that reduces radiation
exposure to patients and staff by up to 75 percent. We were the first hospital in the
Washington, DC, metropolitan area to install this state-of-the-art technology, which
provides a higher level of safety especially during long and
complex procedures.
• The Perceval S Sutureless Heart Valve clinical trial. Inova Heart
and Vascular Institute is the only heart center participating in
this non-randomized trial, which aims to demonstrate the safety
and efficacy of sutureless technology for surgical aortic valve
replacement. The Perceval S is manufactured by Sorin Group,
constructed of bovine pericardium and attached to a nitinol stent.
The stent sits above the annulus and anchors the valve in place,
eliminating the need for sutures.
Perceval™ S sutureless aortic valve
Sorin Group
• The leadless pacemaker. This is the pacemaker of the future, placed via the femoral vein,
delivered to the right ventricle and attached to the right ventricular apex with a screw.
The investigational device is available for VVIR pacing. Inova is the only institution in the
Mid-Atlantic to use it.
Nanostim™ leadless pacemaker
Nanostim™ leadless pacemaker
St. Jude Medical
inova.org/heart 5
Marjaneh Akbari, MD
Cardiac Catheterization
Inova Heart and Vascular Institute’s innovative outpatient cardiac
catheterization program blends convenient care with multidisciplinary
expertise. A coordinated approach, state-of-the-art catheterization
labs, and a dedicated interventional cardiology admission and
recovery suite staff all contribute to complication rates below the
national average.
6 Outcomes 2014
Diagnostic Cardiac
Catheterizations 2013
Facility
Any Adverse Event 2013
Total
IFH
3487
IAH
690
ILH
307
IHVI Combined
1.8%
4,484
IFH - Inova Fairfax Hospital
IAH - Inova Alexandria Hospital
ILH - Inova Loudoun Hospital
IHVI - Inova Heart and Vascular Institute
IHVI
Composite
2%
0.0
0.5
1.0
1.5
NCDR
Like Hospitals
2.0
Acute
Myocardial Infarction
Medicare.gov/hospitalcompare
(AMI)
30-Day Mortality
Q2, 2012 - Q3, 2013
20
Q2, 2012 - Q3, 2013
National
National
20
Inova
Inova
14.9%
15
14.6%
13.5%
Acute Myocardial Infarction
30-Day Readmission
17.2%
15
14.3%
17.7%
17.8%
17.0%
10
10
5
5
0
N=
IFH
678
IAH
252
ILH
176
0
N=
IFH
819
IAH
268
ILH
182
STEMI Volume Combined
Non Transfer
Patients
Transfer
Patients
Volume
284*
91*
Percentage of Total
75.7%
24.3%
Inova Heart and Vascular Institute is the largest acute heart attack
care provider in Northern Virginia. Our ST-elevation myocardial
infarction teams handle the most critical cases, including transfers
from other hospital emergency departments throughout the region.
Mortality rates for acute myocardial infarction patients are among
the country’s lowest, with 30-day mortality rates below the national
benchmark.
We are one of the few centers in the country to use optimized
X-ray equipment in our cardiac catheterization labs. This advanced
technology reduces radiation exposure to patients and staff by 75
percent during complex cardiovascular procedures without sacrificing
image quality.
Process of Care Indicators
Overall AMI Performance Composite Score 2013
100
95.6
92.5
93.6
94.6
94.5
IFH
IAH
ILH
IHVI Combined
Comb. Like Hospitals
80
60
40
20
0
NCDR ACTION Registry-GWTG
Overall AMI Performance
Composite measures include:
aspirin at arrival, evaluation of
LV systolic function, reperfusion
therapy (STEMI only), time to
fibrinolytics (STEMI only), time
to primary PCI (STEMI only),
aspirin at discharge, beta
blocker at discharge, ACE-I or
ARB for LVSD at discharge,
statin at discharge, adult
smoking cessation advice,
and cardiac rehab referral.
7
Door-to-Balloon Times
Inova consistently surpasses national 90-minute
door-to-balloon time goals.
Primary PCI Received Within 90 Minutes
of
Hospital Arrival - 2013
Door-To-Balloon Median Time (minutes)
Non-Transfer Patients - 2008-2013
NCDR Cath PCI
94.8%
8 Outcomes 2014
IHVI Combined
93.3%
NCDR Like Volume
Hospitals
Inova Heart and Vascular Institute
NCDR Like Vol.
Hospitals
2008
69
69
2009
61
62
2010
65
66
2011
60
61
2012
56
60
2013
60
59
Percutaneous Coronary Intervention
All sources are NCDR Cath PCI
PCI Volume - IHVI Combined
Pharmacogenomics: The Right
Drug at the Right Time for the
Right Patient
Any Adverse Events
(PCI Without STEMI)
2
0
1
2
1867
IHVI
4.9%
2
0
1
3
1577
NCDR
Like Volume
Hospitals
5.8%
0
500
1000
1500
2000
0
PCI Success
99.1%
98.9%
1
2
3
4
5
6
Any Adverse Events
(PCI With STEMI)
99%
IHVI
14.8%
NCDR
Like Volume
Hospitals
15.5%
IHVI
%
NCDR Like Volume
Hospitals
0
5
Our proportion of outpatient PCI
continues to exceed the
10
15
90
20
%
Pharmacogenomics – a combination of
pharmacology and genomics – allows
physicians to personalize care by
tailoring medications to each individual’s
genetic makeup. The Inova Laboratory
for Genomic Medicine deployed its first
pharmacogenomic test in 2014, evaluating
the reaction of cardiac catheterization
patients to the anticoagulant drug Plavix®
(clopidogrel). Some people do not
process Plavix effectively, raising their
risk of the medicine not working and their
heart stent getting blocked. Based on
the pilot, between 20 and 30 percent of
patients – more than double the national
average – were prescribed an alternative
medication, and thus, received the right
drug at the right time based on their
unique genetic thumbprint.
th
percentile.
inova.org/heart 9
“... I’m walking one and a half miles every day with no problems.
I’d definitely recommend this procedure to others.”
- Jafar Omidvar
Tackling the Final Frontier
When Jafar Omidvar first felt pressure in his chest, he thought it
was due to exhaustion after a long flight from Dubai. The feeling
persisted and spread to his left arm. “I feared it might be my
heart, so I called 911,” says the 75-year-old from McLean, VA.
Paramedics diagnosed an obstructed artery and rushed him to
the Inova Fairfax Hospital Emergency Room where a medical
team was standing by to perform an angioplasty. But Jafar’s
artery was completely blocked – a condition known as chronic total occlusion
(CTO) – making a standard interventional procedure impossible. Instead, he was
sent home with medications to manage his condition.
Jafar did not want to spend the rest of his life on drugs. Nor did he want a
complicated bypass procedure, which is often the only solution available to CTO
patients. A friend recommended a heart and vascular practice in Vienna, where
he found Shahram Yazdani, MD, an interventional cardiologist who specializes in
pioneering CTO treatment.
Dr. Yazdani uses dual catheters to map the closed artery and then steers
specialized wires and devices into the vessel wall and re-enters the artery on the
other side of the occlusion. Occasionally, he is able to go through small collateral
arteries and open the blocked artery in a reverse fashion.
Jafar’s procedure took just 40 minutes. He was up and walking the next morning
and back home two days later. “Everything went well and I’ve gradually resumed
all my activities,” he says. “The pressure in my arm is gone and I’m walking
one and a half miles every day with no problems. I’d definitely recommend this
procedure to others.”
10
Chronic Total Occlusion
Inova Heart and Vascular Institute’s advanced treatment for chronic total occlusion (CTO) is the final frontier in interventional cardiology.
CTO refers to arteries completely blocked for more than 30 days. It is one of the most common cardiovascular conditions, but historically
difficult to treat with interventional techniques. In the past, patients faced open heart surgery or a lifetime of medications and debilitating
symptoms. Now, minimally invasive methods offer new hope. IHVI is at the forefront of this innovative technology and features one of the
largest CTO programs in the Mid-Atlantic region.
inova.org/heart 11
Ted Friehling, MD
Cardiac Rhythm Disorders
Inova Heart and Vascular Institute is a national leader in electrophysiology, offering a variety of novel imaging modalities, ablation
strategies and devices to manage simple and complex heart rhythm disorders. We perform the most ventricular ablation procedures in the
region, including the innovative epicardial ablation technique to eliminate arrhythmias on the outside of the heart. In addition, we are an
FDA test site for the world’s first leadless pacemaker, which requires no surgical pocket.
12
12 Outcomes
2014
Electrophysiology Lab Volume - 2013
Inova
Fairfax
Hospital
Inova
Alexandria
Hospital
Inova
Loudoun
Hospital
IHVI
Combined
Electrophysiology Studies
771
27
53
851
Ablation Procedures
791
22
56
869
243
3
0
246
AVN
61
8
37
106
VT
61
0
0
61
SVT
368
11
15
394
34
0
0
34
Inova
Fairfax
Hospital
Inova
Alexandria
Hospital
Inova
Loudoun
Hospital
IHVI
Combined
Pacemakers
622
104
129
855
ICD’s
487
58
63
608
Biventricular
204
12
35
251
Dual Chamber and
Single Chamber
285
37
28
350
41
3
6
50
Afib (including
Radiofrequency and Cryo)
Laser Device Lead
Extraction Procedures
Device Implants Volume - 2013
Loop Reorder
inova.org/heart 13
“The doctors are all A-1 and I strongly recommend this new ablation
procedure. I’m so grateful to everyone at Inova Heart and Vascular Institute
for taking such good care of me.”
- Anthony Crupie
A Well-Oiled Machine
The first shock came in the middle of the night. Anthony Crupie’s rapid, irregular heartbeat
had overwhelmed his pacemaker and his defibrillator had shocked him back to life. When
a second shock occurred three hours later, the 76-year-old from Springfield called 911.
After treatment in the Inova Fairfax Hospital Emergency Room, Anthony met Ganesh
Venkataraman, MD, an IHVI electrophysiologist, known to all as “Dr. V.”
He recommended cardiac ablation to treat Anthony’s arrhythmia at the source.
Initially, Dr. V performed a standard ablation procedure to remove scar tissue from
the endocardium, the inside of Anthony’s heart. But because Anthony had scar
tissue on the outside of his heart, too, Dr. V suggested a second, novel approach:
epicardial ablation.
In this pioneering technique, the surgeon inserts a catheter under the breast bone
and into the epicardium, the heart’s outer muscle, to remove exterior scar tissue.
The treatment is highly effective for patients such as Anthony, whose arrhythmia originates
on the heart’s surface. Dr. V is one of a handful of surgeons in the country specially trained
in this groundbreaking and technically demanding procedure.
When Anthony woke up, his heartbeat felt steady and strong. He returned home
to recuperate and is now back to his active life, including a 30-minute walk every
day. “I’m so grateful to Dr. V and everyone at Inova Heart and Vascular Institute for taking
such good care of me,” he says. “The doctors are all A-1 and I strongly recommend this
new ablation procedure. For the first time in a long time, my heart is a well-oiled machine.”
14
Niv Ad, MD
Atrial Fibrillation
Our surgical program for atrial fibrillation (Afib) remains one of the largest and
most effective in the country. We offer patients both traditional open surgery,
which is frequently performed with other cardiac procedures, and a more
advanced minimally invasive version, which allows a much faster recovery.
We were first in the Washington, DC, metropolitan area to use the Arctic Front®
cryoballoon ablation system, and we remain among the top one percent of
heart centers in the country to offer this technology. Cryoablation uses cold
energy, rather than heat, to isolate lesions that cause arrhythmias.
Trends in Minimally Invasive Stand-Alone
Cox Maze III Procedure
Surgery for Atrial Fibrillation 2012-2013
2
0
1
2
%
71
100
11
80
10
2
0
1
3
92
91
80
80
60
62
57
16
40
9
20
0
10
20
30
40
50
60
Concomitant Cox Maze Procedure
Stand-Alone Cox Maze Procedure
Concomitant Left Atrial Ablation
70
80
0
2009 2010 2011
2012
2013
Research Study:
Anti-Arrhythmic Medication (Amiodarone)
Post-Surgical Ablation for Atrial Fibrillation:
Is it Necessary?
Primary objective: Assess if the drug Amiodarone
is necessary as a treatment during the first three
months after surgical ablation. Being off antiarrhythmic medication is important as these drugs
carry significant side-effect profiles.
Principal Investigator: Niv Ad, MD
Current Status: Enrolling
15
Paul Massimiano, MD
“I truly felt as if there must not be any people in the hospital because
I was treated like I was the only one in the building. This is our first
experience with Inova Fairfax Hospital’s cardiac surgery. With the
exception of an emergency situation, I cannot see myself going to any
other hospital for scheduled services.”
- a grateful patient
Cardiac Surgery
Inova Heart and Vascular Institute is home to one of the most experienced,
collaborative cardiovascular surgery programs in the nation. We offer tertiary
level care in all aspects of cardiac surgery – from myocardial revascularization,
percutaneous valvular intervention and large vessel surgery to heart and lung
transplant and pediatric surgery. We are one of the few programs in the country
to administer adult, pediatric, thoracic and vascular surgery from within the same
group. A robust cardiac surgical research agenda differentiates our program and
defines us as an institute.
Our patient-centered care delivery model focuses on the patient and family from
the moment they enter our hospital to discharge and beyond. HCAHPS scores
for our cardiac and thoracic surgery unit continue to rise, elevating us to the 86th
percentile for patients likely to recommend the hospital and the 93rd percentile
for overall hospital rating. In addition, patients give our clinicians high marks for
skill. Physicians are rated in the 99th percentile and nurses in the 89th percentile.
16 Outcomes 2014
Coronary Artery Bypass Grafting
Inova Heart and Vascular Institute’s team of highly skilled cardiac surgeons performs stateof-the-art coronary artery bypass grafting (CABG) procedures for patients with blockages,
angina, coronary artery disease and other conditions. CABG is an integral component
of our balanced patient treatment modalities, along with valve repair and replacement,
ventricular assist devices, heart and lung transplant, and catheter-based interventions.
Mortality and 30-day readmission rates for bypass patients remain well below the national
average. Major complications from isolated CABG are half the national benchmark set by
the Society of Thoracic Surgeons (STS).
Pure CABG Mortality
2.0
1.7
1.6
1.5
1.2
1.0
1.0
.97
CABG and CABG Combined Volume
437
0.5
2
50
0 2
1
23
2
2009
2010
Inova Mortality
2011
2012
2013
STS Benchmark*
10
412
2
0
1
3
CABG Post-Operative Length of Stay
59
5
24
13
0
100
Pure CABG
200
300
CABG+Aortic
Valve Replacement
CABG+Mitral
Valve Replacement
400
500
CABG+Mitral
Valve Repair
Year
IHVI
STS Benchmark*
2011
5 days
6 days
2012
4 days
6 days
2013
4 days
6 days
CABG+Carotid
Post-Op Blood Products Used
Intra-Op Blood Products Used
Pure CABG Readmission Within 30 Days
Year
IHVI
STS Benchmark*
Year
IHVI
STS Benchmark*
Year
IHVI
STS Benchmark*
2011
13.86%
40.30%
2011
11.65%
34.8%
2011
10.4%
10.10%
2012
12.59%
37.8%
2012
10.76%
32.8%
2012
7.55%
10.00%
2013
12.62%
34.4%
2013
6.07%
30.9%
2013
7.77%
9.50%
* All sources are National Adult Cardiac Surgery Database.
inova.org/heart 17
“Before my surgery, I had a message for my doctors....I told them
to do a good job because I plan on living to be 100.”
- Gloria Kesner
A Lifesaving Solution
Two years ago, Gloria Kesner faced a dire prognosis. Severe
aortic stenosis had weakened her heart and left her barely
able to function. The 86-year-old from Keyser, West Virginia
needed surgery to replace her faulty aortic valve. But age
and other risk factors made a traditional valve replacement
procedure impossible. Her family feared the worst.
Gloria’s cardiologist recommended another option: transcatheter aortic valve
replacement (TAVR) at Inova Heart and Vascular Institute. This new, minimally invasive
procedure is much easier on the patient because the surgeon does not have to
cut through the breast bone. The replacement valve is delivered on a catheter and
implanted by balloon inflation. IHVI was one of the first heart centers in the country to
offer this lifesaving solution.
Inova’s cardiac surgeons and cardiologists worked together to perform Gloria’s
TAVR procedure. When her family visited her in the recovery room, the change was
profound. “Right away we noticed she was a completely different color. She’d gone
from gray to pink,” says her daughter, Karen. Equally impressive was her newfound
energy and mobility. Unable to climb even a step or two before surgery, she soon
was making several trips a day. “Grandma was flying up and down those stairs,” her
granddaughter says.
After a routine recovery at her daughter’s Lorton home, Gloria returned to West
Virginia and all the activities she loves, including church, crossword puzzles and
crochet. Now she’s busy making afghans for four great-grandchildren scheduled to
arrive over the next few months.
Her family is profoundly grateful for Inova’s groundbreaking technology, skilled
surgeons and exceptional care. But nobody is happier than Gloria herself. “Before
my surgery, I had a message for my doctors,” she says. “I told them to do a good job
because I plan on living to be 100.”
18
Bryan Raybuck, MD, right
Alan Speir, MD, left
Valve Disease/Surgery
Inova’s comprehensive destination valve center performs the most valve repairs
and replacements in Virginia. Recent innovations include the minimally invasive
transcatheter aortic valve replacement (TAVR) procedure – a promising option
for high-risk patients with aortic stenosis. The surgeon uses a catheter to implant
a bioprosthetic valve within the original aortic valve. The new valve is then
expanded, pushing the old valve leaflets out of the way. Because the chest is not
cut open, patients experience less pain and a faster recovery. Inova Heart and
Vascular Institute is the only heart center in Northern Virginia to offer TAVR.
Valve Volume
Isolated* Valve Surgery Mortality**
Valve Surgeries
475
2
0
1
2
Mortalities ***
109
25
2
0
1
2
69
5
203
505
2
0
1
3
101
14
74
0
100
200
300
400
500
600
2
0
1
3
3
189
Total
Isolated Aortic Valve Replacement
Isolated Mitral Valve Replacement
Isolated Mitral Repair
0
50
100
150
200
250
* AVR, MV Repair, MV Replacement
** Excludes TAVR
*** IHVI Cardiac Outcomes
Catheter-Based Aortic Valve Treatments
2012
2013
TAVR
12
22
Balloon Aortic
Valvuloplasty
20
24
inova.org/heart 19
Right to left: Alan Speir, MD, Bryan Raybuck, MD, and Niv Ad, MD
Aneurysm of Great Vessels
As a tertiary and quaternary care referral center, Inova Heart and Vascular Institute specializes in complex surgery for conditions involving
the aorta, the main artery that feeds blood to the body. We routinely handle high numbers of patients with thoracic aortic aneurysms and
aortic dissections – two life-threatening conditions that often require emergency surgical intervention. Our highly skilled team, which
includes a dedicated thoracic aortic aneurysm surgeon, performs open chest repair as well as endovascular stent graft procedures.
20
20 Outcomes
2014
Vascular Disease
Inova Heart and Vascular Institute takes a pioneering approach to the treatment of peripheral
arterial disease uniting vascular surgeons, interventional radiologists, and interventional
cardiologists in one comprehensive program. At every Inova hospital, patients have access to
the full range of experts without the added stress of having to coordinate multiple specialist
referrals and appointments. Our vascular team collaboratively evaluates emerging technologies,
medications and procedures to create the most effective treatment plan for each patient.
Inova Heart and Vascular Institute is a tertiary and quaternary care center for complex aortic
surgery with outcomes that match those of the nation’s leading vascular centers. Our highly
specialized team treated more than 150 patients requiring abdominal aneurysm repair at Inova
hospitals in 2013, with an average length of stay just under two days; one of the shortest in the
region. Our team treats all types of aortic aneurysm disease utilizing techniques from endovascular
repair to open surgical repair. We specialize in the following treatments and procedures:
Dipankar Mukherjee, MD
Maseer Bade, MD
• Traditional endograft repair, which places a stent graft into the aorta to repair
the aneurysm via small incisions in the groin
• Open surgical aneurysm repair
• Entirely percutaneous endograft repair
• Ruptured abdominal aortic aneurysm repair
• Fenestrated stent graft repair
• Dissecting thoracic aneurysm repair: Type A and Type B
Keith Sterling, MD, right
James Cooper, MD, left
• Penetrating aortic ulcer repair
• Repair of intramural hematomas of the aorta
• Complex adjunct aneurysm repair procedures such as “snorkels,” “periscopes”
and “sandwiches”
Allen Joseph, MD
inova.org/heart 21
Sandeep Khandhar, MD
Thoracic Surgery
Inova Heart and Vascular Institute’s thoracic surgery program provides
care to the largest number of patients with lung and esophageal disease
in the region. A multidisciplinary treatment team performs lung resections,
esophageal resections, diaphragmatic hernia repairs, biopsies, surgery for
reflux disease and more. Minimally invasive techniques, including robotics,
are used whenever possible.
The program was one of the first in the country to develop a pathway to
have patients up and walking within an hour of complex thoracic surgery.
2013 Procedures
Case Type
Volume
Lung
380
Esophagus
53
Other
185
2013 Overall Mortality
0.03%
Thoracic Surgery Volumes
“We believe optimal patient outcomes and
a phenomenal patient experience are only
possible through the close collaboration of
super sub-specialists, experienced and highly
educated healthcare practitioners and a
committed administration. Inova’s thoracic
program has made this a reality and is pushing
boundaries technologically and with systems
of care. Our commitment to aggressive perioperative ambulation is a fine demonstration of
the success of this collaboration.” Sandeep Khandhar, MD
Medical Director, Thoracic Surgery
22 Outcomes 2014
800
700
694
600
721
675
618
600
500
400
300
200
100
0
2009
2010
2011
2012
2013
Amit Mahajan, MD
Thoracic Surgery and Interventional Pulmonology
Inova Heart and Vascular Institute’s thoracic surgery team is one of the few nationwide to include a dedicated interventional pulmonologist.
Amit Mahajan, MD, is fellowship-trained in advanced diagnostic and therapeutic techniques that offer patients less invasive options than
traditional surgical approaches. Because it is synergistic, this unique program provides expedited, comprehensive assessment and state-ofthe-art treatment within days rather than months.
inova.org/heart 23
Lung Transplantation
Inova is home to the Washington, DC, region’s first and only lung and heartlung transplant program. Since we pioneered the area’s first lung transplant
more than 20 years ago, our team of highly experienced surgeons has
performed more than 325 such procedures. Our survival statistics continue
to match or exceed the national average, with a one-year lung transplant
survival rate of 92 percent compared to the national average of 88 percent
as reported by the Scientific Registry for Transplant Recipients.
1-Year Post-Transplant Outcomes
(07/01/2011-12/31/2013)
Observed
Expected
Adult graft survival (based on
60 transplants) (%)
91.89
88.04
Adult patient survival (based
on 57 transplants) (%)
91.54
89.06
Program-Specific Reports. Scientific Registry of Transplant Recipients.
http://srtr.org/csr/current/Centers/centerdetail.aspx?facility=VAFHTX1LU
Accessed February 4, 2015.
24 Outcomes 2014
Shashank Desai, MD, left
Lori Edwards, MSN, RN, right
Advanced Heart Failure
Our flagship program offers consummate care for patients with every stage
of heart failure, including those with advanced disease. We are a leader in
the development and use of ventricular assist devices (VADs), earning The
Joint Commission’s Gold Seal of Approval® for quality care and service.
Year
Volume
2008
41
2009
50
2010
38
2011
53
2012
38
2013
63
Reprinted with the permission of Thoratec Corporation
Total VAD Volume
“The Inova Advanced Heart Failure Program is a national leader in developing a network that supports patients with severe
heart failure – no matter where they live – by providing a hub-and-spoke model of care with physicians and hospitals
throughout the region. Our belief is that access to the full spectrum of heart failure care should be available to patients
locally. With this approach we see patients earlier and provide a superior quality of care to the community.”
Shashank Desai, MD
Medical Director, Heart Failure/Transplant
25
Heart Transplantation
In the past 10 years, Inova’s Heart Transplant Program has grown to
one of the largest and most highly respected in the Mid-Atlantic.
The number of patients receiving ventricular assist devices and heart
transplants at Inova Fairfax Hospital is at an all-time high and continues
to grow rapidly. Growth is due to the success of these treatments for
heart failure and Inova’s commitment to programs that provide this
advanced level of care.
Inova’s Heart Transplant Program is one of the few CMS-certified
programs in the Washington, DC, region.
1-Year Post-Transplant Outcomes
(07/01/2011-12/31/2013)
Observed
Expected
Adult graft survival (based on
53 transplants) (%)
92.45
89.94
Adult patient survival (based
on 50 transplants) (%)
96
91.82
Program-Specific Reports. Scientific Registry of Transplant Recipients.
http://srtr.org/csr/current/Centers/centerdetail.aspx?facility=VAFHTX1HR
Accessed February 4, 2015.
Linda Bogar, MD
"LVADs represent a promising option as a destination therapy for advanced-stage heart failure patients who do not respond to
conventional therapy and are not good candidates for heart transplantation. The device can support a patient’s heart function
and improve quality of life."
Anthony Rongione, MD
Medical
Director, Heart and Lung Transplantation
26 Outcomes
2014
“My recovery has been amazing. I feel so fortunate to have
such a great team at Inova. They’ve given me my life back.”
- Brian Stevens
Reaching New Heights
As a personal trainer, Brian Stevens sets the pace for
his clients. So when he suddenly had trouble breathing during a
routine walk, he knew something was wrong.
“At first, I thought it was allergies,” says the 45-year-old
from Bowie, Maryland, “but pretty soon taking just a few steps felt
like climbing a mountain.” His local hospital diagnosed congestive
heart failure and sent him to a cardiologist in Virginia where
doctors discovered he had sarcoidosis, an inflammatory disease affecting the heart.
Even with the help of a pacemaker, Brian’s condition deteriorated. He was referred
to Shashank Desai, MD, at Inova Heart and Vascular Institute who delivered some
grim news: Brian not only needed a heart transplant, but his heart was too weak
to keep him alive until a donor was found. Immediate surgery was necessary to
implant a ventricular assist device (VAD) to provide mechanical circulatory support
to his heart. Most patients need a VAD in either the left or right ventricle – Brian’s
heart was so damaged, he needed the technology in both. Inova Heart and
Vascular Institute is one of the only centers in the country to offer this extremely
rare procedure, known as bivad surgery.
Brian was scared but knew he was in good hands. “Everybody had such confidence
and experience. I took my strength from that,” he says. Following his successful
bivad procedure, he was able to return to work and daily activities. He had a heart
transplant 11 months later.
Now, two years post transplant, he’s more fit and stronger than ever. He’s already
met a personal goal to hike 26 miles on the Mount Vernon trail. His clients are
inspired and his coworkers call him “Superman”.
25 27
Lucas Collazo, MD
Pediatric Congenital Heart Program
The Congenital Heart Program at Inova
Children’s Hospital has been caring for the
hearts of our region’s children for more
than 25 years. Our pediatric cardiologists,
electrophysiologists, anesthesiologists,
radiologists, perinatologists and cardiac
surgeons have dedicated their practice to
helping children overcome complex congenital
heart abnormalities. Our specialized programs
include the Inova Fetal Care Center, focused
on the prenatal diagnoses and management
of congenital heart disorders; the Single
Ventricle Clinic, providing multi-disciplinary
care for Hypoplastic Left Heart Syndrome
and other single ventricle anomalies; and a
Neurodevelopmental Follow-on Clinic; among
others. Part of Inova Heart and Vascular
Institute, the Congenital Heart Program is able
to provide a lifetime of care, starting before birth
through childhood and throughout adult life in
the Adult Congenital Program.
Inova Children’s Hospital Mortality Rate
as Compared to National Benchmarks
Expected STAT (STS/EACTS Congenital
Heart Surgeons Society Mortality)
Actual Inova Children’s
Heart Surgeries
Expected Congenital Heart
Surgeons Society Mortality
Risk Adjustment for
Congenital Heart Surgery
5
4.1
4
3.3
3
2
3
2.8
2.5
2.6
2.1
2.2
2.6
2.7
2.9
2.6
2.4
2.1
1.4
1
3.9
3.5
2
1.1
0.4
0
2009
2010
2011
2012
2013
In 2013, our pediatric cardiovascular program
had a surgical survival rate of
99.6%
.
"What makes our program unique is a complete scope of services that spans a lifetime. We specialize in the diagnosis and management
of all forms of congenital heart disease in people of all ages - from the tiniest patients still in utero to adults who require ongoing care.
Our patients have the advantage of seamless access to the collective expertise of our highly skilled pediatric and adult specialists in a
single location, which improves outcomes and enhances quality of life.”
Lucas Collazo, MD
28 Outcomes
2014
Medical
Director, Pediatric and Congenital Cardiac Surgery
Pediatric Interventional Catheterizations by Type: 2009-2013
PDA
Coil
ASD
Septostomy
2
0
0
9
Balloon Dilation
Hybrid
62
4
Melody
Pediatric Electrophysiology Procedures by Type: 2009-2013
(Dilations = PV, AoV, Coarct, Branch
PAs, Conduits and Stents)
ICD
11 0
48
48
0
2
0
1
0
48
7
20
13 7 5
2
2
0
1
1
39
1
34
38
11 5
0
2
0
1
2
28
8
28
53
44
01
2
0
1
3
36
7
0
23
59
50
3
100
Ablation
EP
2
0
0
9
12
69
2
0
1
0
15
56
2
0
1
1
18
49
10
2
0
1
2
17
52
7 5
2
0
1
3
11
58
5
0
150
Pacers
20
40
7
13
60
14
5
7
1
80
100
120
200
Volume and Survival by Surgical Procedure: 2010 - 2013
Surgical Procedure
2010
Volume
2010
Survival
Ventricular Septal Defect (VSD)
27
100%
14
Tetralogy of Fallot (TOF)
10
100%
11
Atrial Septal Defect (ASD)
4
100%
6
Arterial Switch for TGA
2012
Volume
2012
Survival
2013
volume
2013
Survival
4-year
Total
Volume
4-year
Total
Survival
19
100%
20
100%
80
100%
91%
6
100%
5
100%
32
97%
100%
13
100%
8
100%
31
100%
2011
2011
Volume Survival
100%
9
78%
6
100%
5
100%
7
100%
27
93%
20
100%
13
100%
27
96%
26
100%
86
100%
Atrioventricular Canal Repair (AVC)
6
100%
7
100%
7
86%
3
100%
23
96%
Total Anomalous Pulmonary Venous Return (TAPVR)
2
100%
3
100%
4
100%
3
100%
12
100%
Partial Anomalous Pulmonary Venous Return (PAPVR)
5
100%
2
100%
3
100%
4
100%
14
100%
Valves/Conduits
Caval Pulmonary Connections (Glenns and Fontans)
7
100%
17
100%
12
100%
16
100%
52
100%
Coarctation of the Aorta
9
100%
10
100%
14
100%
10
100%
43
100%
Systemic-Pulmonary Shunt
10
80%
9
100%
3
66%
4
100%
26
86%
Pacemakers and ICDs (primary and replacements)
20
100%
13
100%
8
100%
9
100%
50
100%
Norwood/ Damus-Kaye-Stansel/Hybrids
10
80%
15
93%
2
50%
8
100%
35
87%
ECMO Support
12
58%
12
58%
4
50%
5
80%
33
61%
Transplant
0
n/a
0
n/a
0
n/a
1
100%
1
100%
inova.org/heart 29
Adult Congenital Heart Program
As techniques in the treatment of pediatric congenital heart disease continue to advance, the need for adult congenital heart care
becomes increasingly apparent. A 20-year member of the Adult Congenital Heart Association, the Inova Adult Congenital Heart
Program has been a trailblazer in meeting the unique healthcare needs of this patient population. The clinic includes pediatric and
adult specialists, as well as double boarded physicians. As an integral part of Inova Heart and Vascular Institute, the program is able to
offer patients all non-surgical and surgical care options, including mechanical circulatory support and transplant, when needed.
Inova Children’s Hospital Congenital Heart Surgery Volume
Congenital Cardiac Catheterizations Volume: 2009-2013
■ Pediatric Interventional ■ Pediatric Diagnostic ■ Adult Interventional and Diagnostic
2
0
0
9
163
79
80
2
0
1
0
110
2
0
1
1
88
77
2
0
1
3
82
0
30 Outcomes 2014
50
104
186
26
141
135
2
0
1
1
130
43
130
2
0
1
2
122
94
132
118
38
128
2
0
1
3
103
100
117
2
0
1
0
120
88
2
0
1
2
■ Pediatric Open ■ Pediatric Closed ■ Adult Congenital
150
200
116
51
0
50
100
150
200
Cardiac Rehabilitation
Inova Heart and Vascular Institute’s comprehensive cardiac rehabilitation program begins
in the hospital and continues on an outpatient basis. Patients recovering from any heart
condition or procedure – including heart attack, valve surgery, transplant or angioplasty –
may participate. New congestive heart failure guidelines from CMS open the benefits of
cardiac rehab to a broader array of patients.
We are the only program in the area certified for more than 15 years by the American
Association of Cardiovascular and Pulmonary Rehabilitation for adherence to rigorous
national standards and guidelines.
With locations across Northern Virginia, patients have access to a complete, personalized
heart-disease management program close to home and work. Inpatient and outpatient
cardiac rehabilitation services are available at the following Inova hospitals:
Inova Alexandria Hospital
4320 Seminary Road
Alexandria, VA 22304
703.504.3398
Inova Loudoun Hospital
44035 Riverside Parkway, Suite 500B
Leesburg, VA 20176
703.858.6674
Inova Fairfax Hospital
3300 Gallows Road
Falls Church, VA 22042
703.776.3635
Inova Mount Vernon Hospital
2501 Parker’s Lane
Alexandria, VA 22306
703.664.8034
Patient
Visits
Phase I
inpatient
Phase II
Phase III/IV
2012
1,343
10,318
790
2013
1,110
11,396
294*
*Program ended 6/2013
To learn more about cardiac rehabilitation
from the patient’s perspective,
visit www.inova.org/video/patricia
“We have an amazing staff, wonderful facilities and we meet strict accreditation criteria. Above all, our program helps
patients improve their quality of life and reintegrate back to daily activities following a cardiac event.”
Robert Shor, MD
Medical Director, Cardiac Rehabilitation
inova.org/heart 31
Research/Publications
Journal Articles
Ad N, Holmes SD, Pritchard G, Shuman DJ. Association of
operative risk with the outcome of concomitant Cox Maze
procedure: A comparison of results across risk groups. J
Thorac Cardiovasc Surg 2014;148(6):3027–3033.
Mavroudis C, Stulak JM, Ad N, Siegel A, Giamberti A, Harris
L, Backer CL, Tsao S, Dearani JA, Weerasena N, Deal BJ.
Prophylactic atrial arrhythmia surgical procedures with
congenital heart operations: review and recommendations.
Ann Thorac Surg 2014 Nov 15. [Epub ahead of print]
Spiegelstein D, Holmes SD, Pritchard G, Halpin L, Ad N.
Preoperative hematocrit as a predictor of perioperative
morbidities following nonemergent coronary artery bypass
surgery. J Card Surg 2014 Oct 17. [Epub ahead of print]
Ad N, Holmes SD, Stone LE, Pritchard G, Henry L. Rhythm
course over 5 years following surgical ablation for atrial
fibrillation. Eur J Cardiothorac Surg 2014 Mar 17. [Epub
ahead of print]
Ad N, Holmes SD, Pritchard G, Shuman DJ. Association of
operative risk with the outcome of concomitant Cox maze
procedure: a comparison of results across risk groups. J
Thorac Cardiovasc Surg 2014;148(6):3027–3033.
Ad N, Henry L, Shuman DJ, Holmes SD. A more specific
anticoagulation protocol is required for patients
after the Cox maze procedure. Ann Thorac Surg
2014;98(4):13311338.
Ad N. The quest for a durable bioengineered tissue for the
treatment of valvular heart disease. J Thorac Cardiovasc
Surg 2014;148(6):3202–3203.
Ad N, Henry L, Hunt S, Holmes SD. Should surgical
ablation for atrial fibrillation be performed in patients with
significantly enlarged left atrium? J Thorac Cardiovasc Surg
2014;147(1):236–241.
Ad N, Holmes SD. Prediction of sinus rhythm in patients
undergoing concomitant Cox maze procedure through
a median sternotomy. J Thorac Cardiovasc Surg
2014;148(3):881–887.
Ad N, Tran HA, Halpin L, Speir AM, Rongione AJ, Pritchard
G, Holmes SD. Practice changes in blood glucose
management following open heart surgery: from a
prospective randomized study to everyday practice. Eur J
Cardiothorac Surg 2014 May 15. [Epub ahead of print]
32 Outcomes 2014
Henry L, Ad N. Performance of the Cox maze procedure―a
large surgical center’s experience. Ann Cardiothorac Surg
2014;3(1):62–69.
Pezzella AT, Holmes SD, Pritchard G, Speir AM, Ad N.
Impact of perioperative glycemic control strategy on
patient survival after coronary bypass surgery. Ann Thorac
Surg 2014;98(4):1281–1285.
Ad N, Henry L, Friehling T, Wish M, Holmes SD. Minimally
invasive stand-alone Cox maze procedure for patients
with nonparoxysmal atrial fibrillation. Ann Thorac Surg
2013;96(3):792–799; discussion 798–799.
Ad N, Henry L, Holmes SD, Stone LE, Hunt S. The
association between early atrial arrhythmia and long-term
return to sinus rhythm for patients following the Cox maze
procedure for atrial fibrillation. Eur J Cardiothorac Surg
2013;44(2):295-301.
Ad N, Henry L, Hunt S, Holmes S. Impact of clinical
presentation and surgeon experience on the decision to
perform concomitant surgical ablation for atrial fibrillation.
Ann Thorac Surg 2013;96(3):763–769.
Ad N, Henry L, Hunt S, Holmes SD, Halpin L. Results of
the Cox maze III/IV procedure in patients over 75 years
old who present for cardiac surgery with a history of atrial
fibrillation. J Cardiovasc Surg (Torino) 2013;54(2):281–288.
Ad N, Henry L, Massimiano P, Pritchard G, Holmes SD. The
state of surgical ablation for atrial fibrillation in patients with
mitral valve disease. Curr Opin Cardiol 2013;28(2):170–180.
Ad N, Holmes SD, Massimiano PS, Pritchard G, Stone
LE, Henry L. The effect of the Cox maze procedure for
atrial fibrillation concomitant to mitral and tricuspid valve
surgery. J Thorac Cardiovasc Surg 2013;146(6):1426–1434.
Cheema FH, Pervez MB, Mehmood M, Younus MJ, Munir
MB, Bisleri G, Barili F, Ayala IL, Ad N, Cox JL, Roberts HG Jr.
Does cryomaze injure the circumflex artery? A preliminary
search for occult postprocedure stenoses. Innovations
(Phila) 2013;8(1):56–66.
Halpin L, Henry L, Szelkowski L, Hunt S, Vourlekis J, Ad N.
Ventilator-associated pneumonia among cardiac surgery
patients: what can we do for prevention? J Nurs Care Qual
2013;28(4):345–351.
Henry L, Ad N. The surgical treatment for atrial fibrillation:
ablation technology and surgical approaches. Rambam
Maimonides Med J 2013;4(3):e0021.
Henry L, Hunt S, Holmes S, Martin L, Ad N. Are there
gender differences in outcomes after the Cox maze
procedure for atrial fibrillation? Innovations (Phila)
2013;8(3):190–198.
LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess
BD, Rich JB, Kasirajan V, Fonner E Jr, Kron IL, Speir AM;
Investigators for the Virginia Cardiac Surgery Quality
Initiative. Blood product conservation is associated with
improved outcomes and reduced costs after cardiac
surgery. Thorac Cardiovasc Surg 2013;145(3):796–803;
discussion 803–804.
Massimiano P, Yanagawa B, Henry L, Holmes SD,
Pritchard G, Ad N. Minimally invasive fibrillating heart
surgery: a safe and effective approach for mitral valve
and surgical ablation for atrial fibrillation. Ann Thorac Surg
2013;96(2):520–527.
Speir A, Henry L, Hunt S, Holmes S, Ad N. Health-related
quality of life following isolated aortic valve surgery: is
earlier intervention better? J Heart Valve Dis 2013;
22:270–275.
Yanagawa B, Burton N, Collazo L, Ad N, Speir A. Combined
heart transplant and thoracic endovascular aortic repair for
heart failure secondary to tricuspid atresia palliated with
Potts shunt. Innovations (Phila) 2013;8(3):242–244.
Yanagawa B, Holmes SD, Henry L, Hunt S, Ad N. Outcome
of concomitant Cox maze III procedure using argon-based
cryosurgical system: a single center experience with 250
cases. Ann Thorac Surg 2013;95(5):1633–1639.
Abstracts
Holmes SD, Martin LM, Miller CE, Ad N. Impact of patient
expectations prior to cardiac surgery on postoperative
outcomes. Psychosom Med 2014;76(3):A-70.
Holmes SD, Weinstein AA, Lydick S, Miller C, Lamont D,
Martin LM, Ad N. Effect of the Cox maze procedure for
atrial fibrillation on mental stress reactivity: a pilot study.
Psychosom Med 2014;76(3):A-97.
Ad N, Holmes SD, Pritchard G, Rongione AJ, Halpin L,
Massimiano PS. Stand-alone mitral valve repair: what are
the predictors for minimally invasive approach? Innovations
(Phila.) 2013;8(2):142–143.
Holmes SD, Martin LM, Miller CE, Ad N. Development and
validation of the Cardiac Surgery Patient Expectations
Questionnaire (C-SPEQ). Psychosom Med 2013;
75(3):A-161–162.
Lydick SE, Weinstein AA, Holmes SD, Miller C, Ad N.
Cardiovascular reactivity to laboratory-induced mental
stress in patients undergoing surgery for atrial fibrillation.
Psychosom Med 2013;75(3):A-163.
Book Chapters
Ad N. Surgical ablation for AF: current procedures and
clinical outcomes: the cryo-maze procedure. In: Saksena
S, Marchlinski FE, Damiano R, Jr, Estes NA III (eds).
Interventional Cardiac Electrophysiology: A Multidisciplinary
Approach. Minneapolis, MN: Cardiotext Publishing; in press.
Papers Presented at Scientific Meetings
Ad N, Stone LE, Holmes SD. Results of the full Cox maze
procedure: EKG vs 24-hour Holter vs one-week longterm Holter monitoring. Annual Scientific Sessions of the
American Heart Association, Chicago, IL, November 2014.
Ad N, Henry L, Holmes SD. Is there a need for a more
specific anticoagulation management protocol for patients
following the Cox maze procedure for atrial fibrillation?
50th Annual Meeting of the Society of Thoracic Surgeons,
Orlando, FL, January 2014.
Ad N, Henry L, Halpin L, Pritchard G, Holmes SD. Predictors for failure of the Cox maze procedure at 12 months in
a large prospective cohort study: does surgeon experience
matter? 49th Annual Meeting of the Society of Thoracic
Surgeons, Los Angeles, CA, January 2013.
Ad N, Holmes SD, Stone LE, Pritchard G, Henry L. Rhythm
course over five years following surgical ablation for
atrial fibrillation. 27th Annual Meeting of the European
Association for Cardio-Thoracic Surgery, Vienna, Austria,
October 2013.
Henry L, Lamont D, Holmes SD, Pritchard G, Halpin L, Ad
N. Does PreDischarge Transthoracic Echocardiography
Post-Valve Surgery Add Value? 49th Annual Meeting of the
Society of Thoracic Surgeons, Los Angeles, CA, January
2013.
Ad N, Halpin L, Rongione AJ, Speir AM, Pritchard G, Holmes
SD. Practice changes in blood glucose management
following open heart surgery: from a prospective
randomized study to everyday practice. 27th Annual
Meeting of the European Association for Cardio-Thoracic
Surgery, Vienna, Austria, October 2013.
Massimiano P, Yanagawa B, Hunt S, Henry L, Ad N. The
safety and efficacy of minimally invasive mitral valve surgery and Cox maze procedure without aortic cross clamp
and cardioplegic arrest. 49th Annual Meeting of the Society
of Thoracic Surgeons, Los Angeles, CA, January 2013.
Martin LM, Holmes SD, Stone LE, Shuman DJ, Ad N.
Impact of psychosocial factors on survival after cardiac
surgery. Annual Scientific Sessions of the American Heart
Association, Chicago, IL, November 2014.
Fitzgerald D, Ad N, St. Onge JR, Ioanou C, Martin LM,
Holmes SD. SIRS and the fluid management of the cardiac
surgical patient: a pilot study. Annual Meeting of the
International Society for Minimally Invasive Cardiac Surgery,
Prague, Czech Republic, June 2013.
Yanagawa B, Massimiano P, Holmes SD, Henry L, Hunt S,
Ad N. The outcome of concomitant Cox maze III procedure
using argon-based cryosurgical platform: a single-center
experience with 250 consecutive cases. 49th Annual Meeting of the Society of Thoracic Surgeons, Los Angeles, CA,
January 2013.
Ad N, Sarin E, Speir A, Halpin L, Pritchard G, Henry L,
Holmes SD. Effect of patient age on blood product
transfusion following cardiac surgery. 40th Annual Meeting
of the Western Thoracic Surgical Association, Dana Point,
CA, June 2014.
Holmes SD, Martin LM, Miller CE, Ad N. Development and
Validation of the Cardiac Surgery Patient Expectations
Questionnaire (C-SPEQ). 71st Annual Scientific Meeting of
the American Psychosomatic Society, Miami, FL, March
2013.
Ad N, Henry L, Friehling T, Wish M, Holmes SD. Minimally
invasive stand-alone Cox maze procedure for patients with
nonparoxysmal atrial fibrillation. 49th Annual Meeting of the
Society of Thoracic Surgeons, Los Angeles, CA, January
2013.
Ad N, Holmes SD, Lamont D, Martin LM. Health-related
quality of life and symptom status by gender in heart valve
surgery patients. Sixth Annual Joint Scientific Session of
the Heart Valve Society of America and the Society for
Heart Valve Disease, New York, NY, May 2014.
Lydick SE, Weinstein AA, Holmes SD, Miller C, Ad
N. Cardiovascular Reactivity to Laboratory-Induced
Mental Stress in Patients Undergoing Surgery for Atrial
Fibrillation. 71st Annual Scientific Meeting of the American
Psychosomatic Society, Miami, FL, March 2013.
Presentations and Lectures
Ad N, Holmes SD, Pritchard G, Halpin L. Predictors of
length of stay and hospital readmissions following first-time
valve surgery. Sixth Annual Joint Scientific Session of the
Heart Valve Society of America and the Society for Heart
Valve Disease, New York, NY, May 2014.
Ad N, Henry L, Hunt S, Holmes SD. Should surgical
ablation for atrial fibrillation be performed in patients with
significantly enlarged left atrium? 39th Annual Meeting of
the Western Thoracic Surgical Association, Coeur d’Alene,
ID, June 2013.
Ad N, Holmes SD, Stone LE, Pritchard G. Sinus rhythm
prediction in concomitant Cox maze Patients. 94th Annual
Meeting of the American Association for Thoracic Surgery,
Toronto, ON, Canada, April 2014.
Ad N, Holmes SD, Pritchard G, Rongione AJ, Halpin L,
Massimiano PS. Stand-alone mitral valve repair: what are
the predictors for minimally invasive approach? Annual
Meeting of the International Society for Minimally Invasive
Cardiac Surgery, Prague, Czech Republic, June 2013.
Holmes SD, Martin LM, Miller CE, Ad N. Impact of patient
expectations prior to cardiac surgery on postoperative
outcomes. 72nd Annual Scientific Meeting of the American
Psychosomatic Society, San Francisco, CA, March 2014.
Holmes SD, Weinstein AA, Lydick S, Miller C, Lamont D,
Martin LM, Ad N. Effect of the Cox maze procedure for atrial
fibrillation on mental stress reactivity: a pilot study. 72nd
Annual Scientific Meeting of the American Psychosomatic
Society, San Francisco, CA, March 2014.
Ad N, Henry L, Massimiano PS, Pritchard G, Stone LE, Hunt
S, Holmes SD. The impact of the Cox maze procedure for
atrial fibrillation concomitant to mitral and tricuspid valve
surgery. Annual Meeting of the American Association for
Thoracic Surgery, Minneapolis, MN, May 2013.
American Heart Association, Chicago, IL, November 2014:
•
Presenter, Ask the Experts―New Technologies and
Future Horizons in Cardiac Surgery: “Arrhythmia
Surgery: The Future”
•
Moderator, abstract oral session: “Surgical
Treatment of Arrhythmias and Heart Failure”
Third Heart Valve Summit of the Israel Heart Society, in
collaboration with the Israel Society of Cardiothoracic
Surgery, Tel Aviv, Israel, October 2014:
•
•
•
Co-chair, Session I: “General Concepts in Valvular
Disease”
Presenter, Session I: Surgical Treatment of Atrial
Fibrillation in Valvular Patients”
Presenter, Session II, “The Aortic Valve”: “Surgical
Treatment of Atrial Fibrillation in Valvular Patients”
inova.org/heart 33
European Association for Cardio-Thoracic Surgery, Milan,
Italy, October 2014:
•
•
•
Co-Chair, Panel Discussion: “Electrophysiologic
Findings and Long-Term Outcomes of Percutaneous
Ablation of Atrial Arrhythmias after Surgical Ablation
for Atrial Fibrillation”
Presentation: “Minimally Invasive Mitral Valve
Surgery Without Aortic Cross-Clamping and with
Femoral Cannulation Not Associated with Increased
Risk for Stroke Compared to Traditional Mitral Valve
Surgery: A Propensity Score–Matched Analysis”
Presentation: “Systematic Review Comparing
Endocardial Full Maze to Epicardial Ablation
and Hybrid Procedure on Safety and Efficacy of
Minimally Invasive Surgical Ablation for Lone Atrial
Fibrillation”
•
Research workshop: How to develop a CF surgery
research database
•
Workshop: What the Visionary Hospital
Administrator Should Know about Minimally
Invasive Cardiac Surgery and Postoperative Care
Invited Faculty, Cardiovascular Research and Technologies
2014, Washington, DC, February 2014: Valve and Structural
Heart Revolution for the Surgeon
•
Presentation: Update on Maze Technique and
Results
•
Moderator, Panel Discussion: Percutaneous Mitral
Valve Repair vs. Replacement: What Will Be the
Dominant Procedure?
•
Moderator, Mitral Valve Repair Panel Discussion
•
Presentation: Who Are the Inoperable Patients with
Direct Myocardial Revascularization and Functional
Mitral Regurgitation?
Japanese Rhythm Society and Japanese Society of
Electrocardiology, Tokyo, Japan, July 2014:
•
Presentation, Panel Discussion: “Minimally Invasive
AF Surgery with Cryo”
•
Invited Lecturer and co-chair: “Innovations in
Arrhythmia Surgery”
Invited Speaker, 17th Annual Meeting of the International
Society for Minimally Invasive Cardiothoracic Surgery
(ISMICS), Boston, MA, May 2014: “Patient Selection and
Perioperative Considerations”
Invited Faculty, Sixth Annual Joint Scientific Session of the
Heart Valve Society of America and the Society for Heart
Valve Disease, New York, NY, May 2014:
•
Co-chair (with James Gammie, MD): Plenary V: Atrial
Fibrillation, Strokes, and Anticoagulation
• “Minimally Invasive Atrial Fibrillation Ablation”
Visiting Professor, University of California Davis,
Sacramento, CA, April 2014: Perspectives in Clinical
Cardiology Grand Rounds Series: “The Surgical Treatment
of Atrial Fibrillation: Decision Making and Surgeon
Experience”
Visiting Professor, Long Beach Memorial Medical Center,
Long Beach, CA, March 2014
•
•
Presentation: Surgical Options in the Care of
Patients with Atrial Fibrillation
Roundtable workshops: Management of
Postoperative Atrial Fibrillation and Use of the
Surgical Maze Procedure
34 Outcomes 2014
50th Annual Meeting of the Society of Thoracic Surgeons,
Orlando, FL, January 2014:
•
Moderator, General Session
•
Moderator: “Ask the Experts: Controversies in Mitral
Valve and Atrial Fibrillation Surgery”
•
Table Instructor: STS University, “Mitral Valve”
Program Co-Director and Invited Faculty: AtriCure® CT
Surgery Symposium on Atrial Fibrillation: “Evolution of the
Cardiac Arrhythmia Surgeon,” Orlando, FL, January 2014:
•
“The Decision-Making Process in the Surgical
Treatment of AF”
•
“Surgical Ablation in Patients with Aortic Valve
Disease and Coronary Artery Disease”
•
Dry lab with heart models to practice lesion
placement Instructor: Mission Hospital, Asheville, NC, January 2014:
FDA-required training course on surgical ablation with the
Atricure platform
Moderator: American Heart Association, Dallas, TX,
November 2013: “Minimally Invasive Cardiac Surgery
Where Are We in 2013?”
Visiting Professor, Grand Rounds, The Cleveland Clinic,
Cleveland, OH, November 2013: “The Surgical Treatment
of Atrial Fibrillation: Decision Making and Surgeon
Experience”
16th Annual Scientific Meeting of the International Society
for Minimally Invasive Cardiothoracic Surgery, Prague,
Czech Republic, June 2013:
•
Lecture: “Surgical Ablation of Atrial Fibrillation”
•
Moderator: Ablation Live on Tape Session
Invited Moderator: Heart Valve Conference, Venice, Italy,
June 2013: “How Much Should the Maze Procedure Affect
Valve Replacement Choice?”
Visiting Professor: Cardiology Grand Rounds, George
Washington University, Washington, DC, April 2013:
“Surgical Ablation for Atrial Fibrillation: Past, Present,
Future”
Invited Faculty: Florida Hospital, Orlando, FL, May 2013:
“Arrhythmia Surgery in Patients with Congenital Heart
Disease”
Invited Panel Speaker: 2013 Cardiovascular Symposium,
Tysons Corner, VA, May 2013
Invited Faculty: American Association for Thoracic Surgery
Mitral Conclave 2013, New York, NY, May 2013: “Making the
Decision to Perform a Concomitant Maze Procedure”
Invited Faculty: 93rd Annual Meeting of the American
Association for Thoracic Surgery, Minneapolis, MN, May
2013: “Minimally Invasive Atrial Fibrillation Ablation”
Visiting Professor: Cardiology Ground Rounds, George
Washington University, Washington, DC, April 2013:
“Surgical Ablation for Atrial Fibrillation: Past, Present,
Future”
Invited Faculty: The Second Atrial Fibrillation Symposium,
Leviev Heart Center, Sheba Medical Center, Israel, February
2013:
•
“Surgical Treatment for Atrial Fibrillation: The
ISMICS Consensus Statement”
•
“Surgical Ablation for Atrial Fibrillation”
Invited Faculty: Cardiovascular Research and Technologies
2013, Washington, DC, February 2013:
•
Moderator for Surgeons’ Breakfast I: “Valve and
Structural Heart Revolution”
•
Speaker: “Update on Maze Technique and Results”
•
Moderator, Panel Discussion: “Mitral Valve Repair”
Invited Faculty: 49th Annual Society of Thoracic Surgeons
Annual Meeting, Los Angeles, CA, January 2013:
•
Filmed Roundtable Discussion: “Capture Short- and
Long-Term Atrial Fibrillation Follow-up Data in a
Web-Based Module”
•
Moderator: Adult Cardiac General Session
Our Physicians
Cardiac Surgeons
Niv Ad, MD
Linda J. Bogar, MD
Lucas Collazo, MD
Paul S. Massimiano, MD
Kathleen R. Petro, MD
Anthony Rongione, MD
Liam P. Ryan, MD
Ramesh Singh, MD
Alan M. Speir, MD
Hassan A. Tetteh, MD
Thoracic Surgeons
Sandeep J. Khandhar, MD
Paul D. Kiernan, MD
Interventional Pulmonology
Amit K. Mahajan, MD
Cardiology/Cardiovascular
Disease
Raushan K. Abdula, MD
Tarek Abou-Ghazala, MD
Khalid A. Abousy, MD
Marjaneh Akbari, MD
Muhammad Ali, MD
Walter L. Atiga, MD
Tariq A. Aziz, MD
Nicholas R. Balaji, MD
Michael R. Banihashemi, MD
Subash B. Bazaz, MD
George W. Bell, MD
Kambeez Berenji, MD
Rachel L. Berger, MD
Steven F. Berman, MD
George A. Besch, MD
Elizabeth S. Biegelsen, MD
Carl P. Bon Tempo, MD
Kenneth M. Brooks, MD
Christine D. Bussey, MD
Dean Carpousis, MD
Felix D. Castro, MD
Anthony C. Chang, MD
Tania Chao, MD
Asad E. Chaudhry, MD
Keith H. Chu, MD
Mariano D. Chutuape, MD
Nicholas A. Cossa, MD
Robert E. Cunnion, MD
Anna T. Czajka, MD
Stephen M. Day, MD
Shashank S. Desai, MD
Paul E. DiLorenzo, MD
Thien M. Do, MD
James Duc, MD
Sarfraz A.K. Durrani, MD
Zayd A. Eldadah, MD
Kelly C. Epps, MD
Michael G. Escano, MD
Aldo R. Esposito, MD
Timothy P. Farrell, MD
Adam S. Fein, MD
Cleveland Francis, MD
Ted D. Friehling, MD
Rajat Garg, MD
Nadim Geloo, MD
Merdod Ghafouri, DO
Brian N. Glick, MD
John S. Golden, MD
Michael H. Goldman, MD
Tariq M. Haddad, MD
Afsane Haddad-Mashad, MD
Richard J. Hart, MD
Edwin K. Huang, MD
Denise L. Hurst, MD
Leonard Ilkhanoff, MD
Jeffrey A. Jackman, MD
Ahsan Q. Jafir, DO
Laurance W. Kam, MD
Andrew J. Keller, MD
Fareeha I. Khan, MD
Charanjit S. Khurana, MD
Joseph M. Kiernan, MD
Albert H. Kim, MD
Bhanumathi Krishnan, MD
Sara Kulangara, MD
Amey R. Kulkarni, MD
Sung W. Lee, MD
Roy H. Leiboff, MD
Warren S. Levy, MD
Yaning Liu, MD
Jeffrey S. Luy, MD
Shahryar Mafi, MD
Alireza Maghsoudi, MD
Ara M. Maranian,MD
Carey M. Marder, MD
Christopher W. May, MD
Alexander Mayer, DO
Robert L. McSwain, MD
Stuart A. Meyers, MD
Lawrence A. Miller, MD
Azita Moalemi, MD
Jason M. Morda, MD
Mehrdad Mostaan, MD
Sunil Nachnani, MD
Pradeep Nayak, MD
Minh V. Ngo, MD
Michael P. Notarianni, MD
Seema E Nour, MD
John T. O'Brien, MD
Paul J. O'Brien, MD
Susan O'Donoghue, MD
Antonio R. Parente, MD
David J. Park, MD
Young D. Park, MD
Dhaval R. Patel, MD
Richard P. Perrin, MD
Paula E. Pinell-Salles, MD
Edward V. Platia, MD
Pio F. Poblete, MD
Dean M. Pollock, MD
Ashok J. Prasad, MD
Jun Anthony V. Quion, MD
Narian P. Rajan, MD
Gautam Ramakrishna, MD
Devanhalli Ramaswamy, MD
Haroon Rashid, MD
Jason M. Rashkin, MD
Bryan D. Raybuck, MD
Archana Reddy, MD
Kevin M. Rogan, MD
Arnold J. Rosenblatt, MD
Stephen P. Rosenfeld, MD
Lawrence R. Rubin, MD
Anne M. Safko, MD
Chirag M. Sandesara, MD
Palak Shah, MD
Manish H. Shah, MD
S. T. Shahab, MD
Robert E. Shapiro, MD
Rishabh Sharma, MD
Jennifer A. Shea, MD
Stuart E. Sheifer, MD
Mazhar Sheikh, MD
Harvey S. Sherber, MD
Robert A. Shor, MD
Padma Shukla, MD
Balbir S. Sidhu, MD
James N. Sipes, MD
Tseday E. Sirak, MD
Prachak T. Siriprakorn, MD
Tina L. Slottow, MD
Rahsaan C. Smith, MD
Michael A. Solomon, MD
S. A. Strickberger, MD
inova.org/heart 35
David A. Strouse, MD
Anne E. Summers, MD
Hassan Tabandeh, MD
Hamid Taheri, MD
Mark P. Tanenbaum, MD
Naghmeh Tebyanian, MD
Behnam N. Tehrani, MD
Henry A. Tran, MD
Ketan K. Trivedi, MD
Constantine J. Tziros, MD
Ganesh S. Venkataraman, MD
Kinda N. Venner-Jones, MD
Ajay Virmani, MD
Mark C. Vives, MD
Timothy S. Welch, MD
Marc H. Wish, MD
Jonathan E. Yager, MD
Shahram Yazdani, MD
Kambiz Yazdani-Najafabadi, MD
M. Rafiq Zaheer, MD
Qiong Zhao, MD
Interventional Cardiology
Tarek Abou-Ghazala, MD
Khalid A. Abousy, MD
Marjaneh Akbari, MD
Nicholas R. Balaji, MD
Kambeez Berenji, MD
Rachel L. Berger, MD
Steven F. Berman, MD
George A. Besch, MD
Elizabeth S. Biegelsen, MD
Kenneth M. Brooks, MD
Felix D. Castro, MD
Mariano D. Chutuape, MD
Nicholas A. Cossa, MD
Stephen M. Day, MD
Paul E. DiLorenzo, MD
Kelly C. Epps, MD
Aldo R. Esposito, MD
Rajat Garg, MD
Nadim Geloo, MD
John S. Golden, MD
Michael H. Goldman, MD
Ahsan Q. Jafir, DO
Andrew J. Keller, MD
Charanjit S. Khurana, MD
Joseph M. Kiernan, MD
Albert H. Kim, MD
Warren S. Levy, MD
Alexander Mayer, DO
Stuart A. Meyers, MD
Lawrence A. Miller, MD
Seema E. Nour, MD
John T. O'Brien, MD
Antonio R. Parente, MD
Richard P. Perrin, MD
Dean M. Pollock, MD
Ashok J. Prasad, MD
Jun Anthony V. Quion, MD
Narian P. Rajan, MD
Devanhalli Ramaswamy, MD
Bryan D. Raybuck, MD
Kevin M. Rogan, MD
Stephen P. Rosenfeld, MD
S. T. Shahab, MD
Rishabh Sharma, MD
Balbir S. Sidhu, MD
Prachak T. Siriprakorn, MD
Tina L. Slottow, MD
Rahsaan C. Smith, MD
Hamid Taheri, MD
Behnam N. Tehrani, MD
Ajay Virmani, MD
Shahram Yazdani, MD
M. Rafiq Zaheer, MD
Cardiac Electrophysiology
Walter L. Atiga, MD
Anthony C. Chang, MD
James Duc, MD
Sarfraz A. K. Durrani, MD
Zayd A. Eldadah, MD
Adam S. Fein, MD
Ted D. Friehling, MD
Denise L. Hurst, MD
Leonard Ilkhanoff, MD
Sung W. Lee, MD
Robert L. McSwain, MD
Susan O'Donoghue, MD
Edward V. Platia, MD
Haroon Rashid, MD
Jason M. Rashkin, MD
Chirag M. Sandesara, MD
Manish H. Shah, MD
S. A. Strickberger, MD
David A. Strouse, MD
Ganesh S. Venkataraman, MD
Marc H. Wish, MD
Cardiology/Peripheral
Vascular Interventions
Kelly C. Epps, MD
Charanjit Khurana, MD*
Albert Kim, MD*
Bryan Raybuck, MD*
Tariq Shahab, MD*
Rahsaan Smith, MD*
Hamid Taheri, MD*
Shahram Yazdani, MD
Interventional Radiology
Sandeep Bagla, MD*
Jim Cooper, MD*
Alain Drooz, MD*
Allen Joseph, MD*
Michael Karnaze, MD*
Hong Lim, MD*
Salman Mufti, MD*
Calvin Neithamer, MD*
Jim Papadouris, MD*
Ken Rholl, MD*
David Spinosa, MD*
Keith Sterling, MD*
Arina Van Breda, MD*
Jay Varma, MD*
Vascular Surgeons
Behdad Aryavand, MD*
Maseer A. Bade, MD*
John D. Edwards, MD*
Seyed M. Hashemi, MD*
Homayoun A. Hashemi, MD*
Dipankar Mukherjee, MD*
Richard Neville, MD*
Rodeen Rahbar, MD*
Pediatric Cardiac Surgery
Lucas Collazo, MD
Pediatric Cardiology/
Cardiovascular Disease
Hasan Abdallah, MD
Annette Ansong, MD
Robert Barlow, MD
Patrick Callahan, MD
Amir Dangol, MD
Ted D. Friehling, MD
Wali Gauvin, MD
Steven Herold, MD
Jared Kirby, MD
Jennifer Lindsey, MD
Mohamed Mardini, MD
Rahel Zubairi, MD
* Member of Vascular Program at Inova Heart and Vascular Institute
36 Outcomes 2014
Convenient Access
Inova Heart and Vascular Institute’s convenient network of hospitals across Northern Virginia makes it easy for patients and families to seek
the care they need. All Inova Heart and Vascular Institute locations are seamlessly connected to our modern, accessible flagship facility on the
Inova Fairfax Medical Campus.
Inova Alexandria Hospital
Inova Fair Oaks Hospital
Inova Heart and Vascular Institute
Inova Fairfax Medical Campus
Inova Loudoun Hospital
Inova Mount Vernon Hospital
Inova Heart and Vascular Institute
at Inova Alexandria Hospital
4320 Seminary Road
Alexandria, VA 22304
703.504.3000
Inova Heart and Vascular Institute
at Inova Loudoun Hospital
44055 Riverside Parkway
Leesburg, VA 20176
703.858.6000
Inova Fairfax Hospital Cardiac
Diagnostic Services at Telestar
2901 Telestar Court, Suite 525
Falls Church, VA 22042
703.852.7750
Inova Heart and Vascular Institute
at Inova Fair Oaks Hospital
3600 Joseph Siewick Drive
Fairfax, VA 22033
703.391.3600
Inova Heart and Vascular Institute at Inova
Mount Vernon Hospital
2501 Parker’s Lane
Alexandria, VA 22306
703.664.7000
Inova Loudoun Hospital Cardiac
Diagnostic Services
44035 Riverside Parkway, Suite 150
Leesburg, VA 20176
703.852.7770
Inova Vein and Vascular Center - Gainesville
13575 Heathcote Boulevard, Suite 210
Gainesville, VA 20155
703.468.2610
Inova Fair Oaks Hospital Cardiac
Diagnostic Services
3580 Joseph Siewick Drive, Suite 301
Fairfax, VA 22033
703.852.7760
Inova Heart and Vascular Institute
at Inova Fairfax Hospital
3300 Gallows Road
Falls Church, VA 22042
703.776.4001
Inova Heart and Vascular Institute
at Inova Children’s Hospital
3300 Gallows Road
Falls Church, VA 22042
703.776.4002
Inova Fairfax Hospital Cardiac
Diagnostic Services at Prosperity
8505 Arlington Boulevard, Suite 320
Fairfax, VA 22031
703.641.0500
Inova Alexandria Hospital Cardiac
Diagnostic Services
4660 Kenmore Ave, Suite 1203d
Alexandria, VA 22304
703.852.7740
inova.org/heart
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