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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 G33686/2-15/8,500