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Heart Failure Program Helping Hearts Saving Lives In Collaboration with Vanderbilt Transplant Center VanderbiltHeart.com VANDERBILT H EART : A L EADER IN H EART FAILURE T REATMENT AND T RANSPLANT The Vanderbilt Heart and Vascular Institute has extensive experience in treating patients with heart failure, as well as those with advanced cardiomyopathies. Our experienced, multidisciplinary team includes cardiac and transplant surgeons, specially trained and certified cardiologists, nurse practitioners, social workers, dieticians, psychologists, pharmacists, and, when needed, specially trained infectious disease physicians, to offer patients the latest in medical management of heart failure. Numerous studies have shown that this multidisciplinary disease management approach has resulted in better patient outcomes and improved quality of life for our patients. In addition to providing surgical therapies for heart failure patients, the transplant surgeons at Vanderbilt Medical Center have performed more than 500 heart transplants. Our rehabilitation services are among the best in the country for transplant patients – from recovery to long-term health. D IAGNOSING H EART FAILURE Heart failure is the leading cause of hospital admissions, and subsequent death, in the United States today. It occurs when the heart cannot pump enough blood to the body’s organs. Also known as congestive heart failure (CHF), this is a chronic condition that over time deprives the body of needed oxygen and nutrients. A variety of underlying heart conditions that damage or weaken the heart and its vessels can lead to heart failure. The most common causes of heart failure include: Coronary Artery Disease. This common form of heart disease results from atherosclerosis, or “hardening of the arteries.” The heart’s arteries become blocked with fatty deposits and cholesterol, causing less blood to reach the heart muscle. This prevents oxygen-rich blood from reaching the heart and damages the heart muscle. The heart’s inability to pump normally can lead to heart failure. Complex Valvular Heart Disease. Abnormalities of the aortic and mitral heart valves can result in heart failure. Cardiac valve defects may be congenital or acquired. When faulty heart valves do not open or close correctly, they can restrict blood flow, increase the heart’s workload or cause the heart’s chambers to stretch and enlarge. Cardiomyopathy. This serious heart muscle disease is the most common reason cardiac patients require heart transplantation. A progressive disease, cardiomyopathy means the heart is enlarged, thickened and/or stiffened, and, therefore, its ability to fill easily and pump blood is weakened. Myocardial Infarction. Coronary artery disease often leads to myocardial infarction. A heart attack, or myocardial infarction, occurs when the blood supply to the heart muscle is suddenly stopped or severely reduced. A portion of the heart muscle is injured or dies, replaced by scar tissue. Blood flow must be quickly restored to prevent severe damage or death. C ARDIAC I MAGING VHVI’s Cardiac Imaging program provides high-quality, detailed operating room images of cardiac and vascular anatomy, flow and function – typically in one patient visit. The diagnostic tests can characterize and define inflammatory myopathic processes, congenital anatomy, cardiac masses, and pericardial diseases. Some of our more traditional diagnostic studies include echocardiogram, electrocardiogram (EKG or ECG) exercise testing or stress testing, and nuclear cardiac imaging (MUGA, MPI). Some of our more advanced imaging technology include the following: Dedicated Cardiac MRI. The recent growth in the expanded cardiac MRI program provides patients with “one-stop shopping” – cardiac imaging, characterization of myocardial tissue viability, structure, and function and severity of valvular heart disease. Combined SPECT-CT Scanning. VHVI’s commitment to excellence in cardiac imaging extends to PET scanning, the “gold standard” in myocardial perfusion assessment in conjunction with state-of-the-art cardiac CT imaging. Enhanced Rubidium Nuclear Scanning for Increased Sensitivity. In non-invasive imaging, cardiac Rubidum PET imaging has the highest sensitivity and accuracy in identifying significant coronary atherosclerotic disease. Rubidium PET can be extremely helpful in evaluating patients for significant CAD, especially in those where body morphology (e.g. obese, chest deformity) leads to a difficulty in image interpretation. H EART FAILURE T REATMENT Vanderbilt Heart Failure Program provides a comprehensive and aggressive approach to treating patients with heart failure. Patients referred to our program first undergo a complete evaluation to help determine the cause of heart failure, find out how far the disease has progressed and identify the best treatment regimen possible. Optimal treatment options for advanced-stage heart failure include: Using State-of-the-Art Drug Therapies: While medications do not cure heart failure, the right combination can improve heart function, slow the progress of the disease as well as relieve the patient’s symptoms and help to prevent hospitalization or premature death. Implanting Specialized Pacemakers and Defibrillators: Battery-operated pacemakers implanted by our expert physicians can stimulate the heart so that it beats with a regular rhythm and works more efficiently. Implanted cardioverter defibrillators act as internal “shock paddles” that respond automatically to a patient’s heart arrhythmias, delivering an electronic shock to return the heartbeat to a regular rhythm. Assigning Dedicated Electrophysiology Cardiologists for Device Management: Vanderbilt also ensures that implanted devices are closely managed by electrophysiologists – cardiologists trained especially to diagnose and treat abnormal heart rhythms. These electrophysiology cardiologists will collaborate with our patients’ other doctors to assure complete and quality care. Cardiac Resynchronization. With an integrated, multidisciplinary approach linking heart failure clinicians, electrophysiologists, echocardiographers and cardiac surgeons, VHVI provides a multi-modality approach to optimization of cardiac resynchronization therapy in patients with severe, advanced heart failure. Left Ventricular Assist Device (LVAD) Bridging to Transplantation. Vanderbilt is one of the first hospitals in the region to offer a potentially life-saving treatment option for severe heart failure patients too sick to undergo surgical interventions. The left ventricular assist device is inserted surgically. The device serves as a temporary bridge so that a patient can recover some life-sustaining degree of heart function prior to transplantation. Tandem Heart Program. VHVI is the first center in Tennessee to implant the Tandem Heart device, a percutaneous left ventricular assist device, as a bridge to cardiac transplantation. This potentially life-saving device can provide temporary support for critically ill patients while awaiting a transplant. Arrhythmia Advanced ICD Programming to Reduce ICD Shocks. One of the major causes of morbidity in ICD patients is shock following device implantation. Shocks can be reduced by improved standardized programming parameters that prevent inappropriate supraventricular tachycardia (SVT) detection and by the use of antitachycardia pacing (ATP) to painlessly terminate monomorphic ventricular tachycardias (VT) as determined by an electrophysiologist. The delivery of ICD therapy requires complex algorithmic programming of over 100 settings due to the device feature and capability enhancements. These algorithms provide high sensitivity and improved arrhythmia detection that allow our electrophysiologists to deliver optimal ICD therapeutic efficacy while minimizing unnecessary defibrillator discharges. Genetics of Atrial Fibrillation One of VHVI’s Electrophysiology Programs, the Atrial Fibrillation Center, provides comprehensive diagnostic and therapeutic services including genetic screening along with catheter-based and surgical approaches to ablation of atrial fibrillation. S URGICAL T REATMENT Surgical procedures may be required to treat heart failure patients who are experiencing symptoms as a result of damaged coronary arteries or heart valves. The Vanderbilt Heart Program offers comprehensive pre-operative screening, cardiac surgery and post-operative care for these patients. Procedures our surgeons perform include: High-risk Coronary Revascularization – blocked or damaged arteries are repaired or replaced through surgery, such as coronary artery bypass grafting (CABG), so that blood flow to the heart is restored; Complex Valvular Reconstruction – procedures to reconstruct heart valves (e.g., separating fused leaflets or repositioning valve chords) so that valves open or close better; and Ventricular Remodeling Surgery – can help some patients avoid the necessity for a heart transplant by restoring the heart to normal size, shape and function following injury to the left ventricle by a previous heart attack. T HE PATIENT ’ S C ARE T EAM The Vanderbilt Heart Program also gives patients access to a multi-disciplinary team who assists with social, nutritional, exercise and financial needs. This team includes physicians, nurses, a nurse practitioner, exercise specialists, a social worker and a nutritionist. In delivering optimum care, we seek to rapidly return patient telephone calls, see patients promptly and coordinate treatment with each patient’s primary care physician. All patients are extensively educated about heart failure and supported in becoming more involved in their own care. Particular emphasis is placed on: Patient self-monitoring – Tracking daily weight gain, for example, can help detect fluid retention. Elevation of the head during sleep if shortness of breath occurs can help regulate heartbeat. Reducing stress in life and learning relaxation techniques can also be effective in treating heart failure. Exercise – Moderate physical activity that keeps the patient in better overall physical condition will reduce demands on the heart muscle. Vanderbilt will outline a tailored physical fitness program where appropriate as part of individualized treatment, particularly in patient rehabilitation following transplantation. Nutrition – Working with patients on improving nutrition can slow progression of the disease and ease symptoms. Areas include restricting sodium, lowering fats and cholesterol in the diet and limiting use of alcohol and fluids. Stopping smoking, of course, is essential. H EART T RANSPLANTATION A patient who does not respond to traditional therapies or has more advanced-stage heart failure may require a heart transplant. Patients diagnosed with end-stage heart failure but who are otherwise considered healthy may become candidates for heart transplantation. In this surgical procedure, a healthy donor heart replaces the person’s damaged or diseased heart. In other advanced-stage heart failure patients, a left ventricular assist device can be implanted to aid the weakened part of the heart. This device can provide short-term or long-term support to gain time until a suitable donor heart is available for a patient who is a candidate for heart transplantation. H EART T RANSPLANT P ROGRAM The Vanderbilt Heart Transplant Program is a Medicaredesignated program for heart transplantation. Such designation is awarded after extensive evaluation of outcomes, experience, expertise and institutional commitment by a panel of experts in immunology, cardiology, cardiac surgery and transplantation biology. Vanderbilt’s first heart transplant was performed in April of 1985. Vanderbilt performed Tennessee’s first pediatric transplant, first heart-lung transplant, and first single lung transplant. Vanderbilt was also the first program in Tennessee to perform heart transplants in infants with hypoplastic left heart syndrome. Vanderbilt was the seventh center in the nation and first in the Southeast to successfully implant the second generation electrical left ventricular assist device (Novacor LVAD) as a “bridge” to transplantation. The use of this device, and other similar devices, has now become standard for “bridge to transplantation” in severely unstable patients who are awaiting suitable organs. Vanderbilt’s Heart Transplant Program is supported by a broad-based congenital and adult cardiovascular program which has treated over 50,000 patients. Vanderbilt’s Heart Transplant Program continues to progress both on a regional and national scale. Sophisticated technology and state-of-the-art equipment include a Magnetic Resonance Imaging Center and PET scanner supported by an FDA-approved pharmaceutical laboratory, as well as a sophisticated echocardiography laboratory for detailed, noninvasive images of blood flow patterns and cardiac anatomy. The Vanderbilt Heart Transplant Program’s mission includes research, education, and teaching, as well as a primary mission of providing excellence in clinical care for patients with end-stage organ failure. Many components contribute to the overall success of the Vanderbilt Heart Transplant Program. Smoking cessation, nutritional counseling and cardiopulmonary rehabilitation for pre- and post-transplant patients are offered by the Kim Dayani Center for Cardiac Rehabilitation. Vanderbilt’s unique Transplant Return-To-Work Program provides vocational rehabilitation services and plays a vital role in improving quality of life by returning transplant patients to gainful employment. Adult Transplantation. When Vanderbilt Heart experts determine that heart transplantation is required, a team from cardiology and cardio-thoracic surgery, pulmonology, nephrology, infectious diseases, nursing, pathology, pharmacy, social work, nutrition, ethics, psychiatry, and rehabilitative medicine contributes to the patient’s treatment – from pre-operative screening and surgical preparation to post-operative monitoring, rehabilitation and counseling. Half of the patients are transplanted within two months after being listed. Our team is experienced with high-risk cases and delivers quality care while patients are waiting for a matched donor heart. We are also committed to long-term follow-up care of transplant patients. Support for social needs by adult recipients and their families include support groups, a heart transplant website and a patient newsletter entitled Heart Happenings. Pediatric Heart Transplantation. When a child needs a heart transplant, multiple family members become affected and involved. It can be an especially frightening time for the patient’s parents and siblings. The pediatric cardiology and cardiac surgery program at Vanderbilt Children’s Hospital offers one of the highest levels of cardiac care for infants, children and young adults throughout the United States. A team of experienced cardiac surgeons, cardiac anesthesiologists, pediatric cardiologists and pediatric intensivists work closely together to care for infants, children and young adults undergoing cardiac surgery. In addition, nurses, respiratory therapists, child life specialists and social workers dedicated to the care of critically ill children attend to every need of the child undergoing heart surgery as well as the needs of the family. After heart surgery, infants and children make their initial recovery in the Pediatric Intensive Care Unit. Following the surgeon’s discharge of the patient, the child’s pediatric cardiologist, either at Vanderbilt or elsewhere, will continue to see the child in follow-up. Rehabilitation and Patient Counseling Services. The Vanderbilt Heart Transplant Program provides patient support and rehabilitation services from pre- to posttransplantation. In addition to individualized exercise programs and nutrition counseling, patients get support in smoking cessation and weight control. Our goal in working with the patient, physician and family is cardiac rehabilitation and reducing risk factors to prevent future cardiac complications. Our cardiopulmonary rehabilitation services for pre-transplant patients and following heart transplantation include prescribed physical activity; recommended lifestyle changes and education about how to lower risk factors. Our team also provides emotional and psychological support, and we build relationships with our patients for long-term recovery. Vanderbilt Transplant Return-to-Work Program. For heart transplant patients, resuming employment helps complete the recovery process and restores emotional and financial well being. Yet many patients are unable to return to the positions held prior to their illnesses because of functional limitations or medication side effects. The Vanderbilt Transplant Return-to-Work Program offers patients guidance and support with services ranging from career interest testing and counseling to job placement assistance. The program has been recognized as a model for nationwide implementation of similar programs throughout the transplant community. All Vanderbilt “return-to-work” services are offered to patients at no charge. Vanderbilt Transplant Ethics Program. Through this program, Vanderbilt provides consultative expertise to patients and to medical staff regarding the complex ethical issues surrounding the management of critically ill patients and the recipient selection process. The Vanderbilt Transplant Ethics Program participates in patient evaluations, engages in policy-oriented research and policy development, and reviews professional education focused on ethical concerns associated with transplantation. C LINICAL R ESEARCH O PPORTUNITIES The Vanderbilt Heart Failure Program participates in research trials to evaluate new strategies for the treatment of heart failure patients – from medications and exercise training to treatment devices and pulmonary artery catheterization. Interested, eligible patients may receive trial medication and research-related care without charge. Vanderbilt is also pioneering heart transplant infectious disease research and transplantation outcomes research focused on health-related quality of life prior to and following organ transplantation. H EART FAILURE AND T RANSPLANT T EAM Heart Failure John G. Byrne, M.D. William S. Stoney Professor of Cardiac Surgery Chairman, Department of Cardiac Surgery M.D. Degree: Boston University, 1987 Post-Graduate Training: University of Illinois Affiliated Hospitals, Chicago; Harvard Medical School, Boston; Brigham and Women’s Hospital, Harvard Medical School, Boston Tarek S. Absi, M.D. Assistant Professor of Cardiac Surgery M.D. Degree: American University of Beirut, 1995 Post-Graduate Training: North Shore University Hospital, NYU School of Medicine, Manhasset; University School of Medicine, St Louis; Vanderbilt University Medical Center, Nashville; Brigham and Women's Hospital, Harvard Medical School, Boston Rashid M. Ahmad, M.D. Assistant Professor of Cardiac Surgery M.D. Degree: College of Physicians and Surgeons, Columbia University, 1992 Post-Graduate Training: The Cleveland Clinic, Cleveland; Harvard Medical School, Boston; The New York HospitalCornell Medical Center, New York Jorge M. Balaguer, M.D. Assistant Professor of Cardiac Surgery Chief of Cardiac Surgery, Department of Veterans Affairs Medical Center M.D. Degree: Universidad de Buenos Aires, 1985 Post-Graduate Training: Finochietto Hospital, Buenos Aires, Argentina; St. Vincent Hospital & University of Massachusetts Medical School, Worcester; Brigham & Women’s Hospital, Boston; Harvard Medical School, Boston Stephen K. Ball, M.D. Assistant Professor of Cardiac Surgery MD Degree: Mississippi School of Medicine, 1987 Post-Graduate Training: University of Mississippi Medical Center, Jackson; Rush University Medical Center, Chicago David P. Bichell, M.D. Chief, Division of Pediatric Cardiac Surgery Professor of Pediatric Cardiac Surgery M.D. Degree: Columbia University College of Physicians and Surgeons, 1987 Post-Graduate Training: Brigham & Women’s Hospital, Harvard Medical School, Boston; Children’s Hospital Boston, Harvard Medical School, Boston; Barnes-Jewish Hospital, Washington University, St. Louis; Columbia-Presbyterian Hospital, Columbia University, New York Karla G. Christian, M.D. Associate Professor of Pediatric Cardiac Surgery Associate Chief, Pediatric Cardiac Surgery M.D. Degree: University of Washington Medical Center, 1986 Postgraduate Training: University of Washington Medical Center, Seattle; Vanderbilt University Medical Center, Nashville, James P. Greelish, M.D. Assistant Professor of Cardiac Surgery M.D. Degree: Wake Forest University School of Medicine, 1992 Post-Graduate Training: Hospital of the University of Pennsylvania, Philadelphia; Institute for Human Gene Therapy, University of Pennsylvania, Philadelphia; Brigham and Women’s Hospital, Harvard Medical School, Boston Steven J. Hoff, M.D. Assistant Professor of Cardiac Surgery Surgical Director, Heart Transplant M.D. Degree: The Johns Hopkins University School of Medicine, 1986 Postgraduate Training: Vanderbilt University Medical Center, Nashville Betty S. Kim, M.D. Assistant Professor of Cardiac Surgery Chief, Cardiac and Thoracic Surgery Maury Regional Hospital M.D. Degree: Yale University School of Medicine, 1991 Postgraduate Training: Brooke Army Medical Center, San Antonio; Walter Reed Army Medical Center, Washington, D.C.; Brigham and Women’s Hospital, Harvard Medical School, Boston Michael R. Petracek, M.D. Professor of Clinical Cardiac Surgery M.D. Degree: The Johns Hopkins School of Medicine, 1971 Post-Graduate Training: Vanderbilt University Hospital, Nashville; Johns Hopkins Hospital, Baltimore Physician Assistants M. Craig Cilimberg, PA-C Edmund J. Donahue, PA-C Thomas M. Stahl, PA-C Nurse Practitioners Nora Cobb, ANP-BC Anna Fong, ACNP-BC Jayme Gibson, ACNP-BC Mary Anne Jorrisen, ACNP-BC April Kapu, ACNP-BC Shawn Lee, ANP-BC Lauren Nevels, ACNP-BC Megan Shifrin, ACNP-BC Sean Smithey, ACNP-BC Joshua Squiers, ACNP-BC Kristie Walker, ACNP-BC Brian Widmar, ACNP-BC Transplantation Thomas G. Di Salvo, M.D. Associate Professor of Medicine Medical Director, Vanderbilt Heart and Vascular Institute M.D. Degree: University of Cincinnati College of Medicine, 1987 Post-Graduate Training: Johns Hopkins Hospital, Baltimore; Massachusetts General Hospital, Boston; Harvard Medical School, Boston Debra Dodd, M.D. Medical Director, Heart Transplant (Pediatrics) Associate Professor of Pediatrics M.D. Degree: Johns Hopkins University, 1984 Post-Graduate Training: Vanderbilt University Medical Center, Nashville Allen J. Naftilan, M.D., Ph.D. Associate Professor of Medicine Director, Heart Failure Program M.D. Degree: University of Alabama School of Medicine, 1982 Post-Graduate Training: Brigham and Women’s Hospital, Harvard Medical School, Boston Henry L. Ooi, M.D. Assistant Professor of Medicine M.D. Degree: Trinity College Medical School, Dublin, Ireland, 1989 Post-Graduate Training: Boston University Medical Center, Boston; Mater Misericordiae, Ireland; St. Vincent’s Hospital, Ireland; Our Lady’s Hospital for Sick Children, Ireland Douglas B. Sawyer, M.D., Ph.D. Chief, Division of Cardiovascular Medicicne Jack and Betty Bailey Professor of Cardiovascular Medicine Associate Professor of Medicine Director, Cardiovascular Medicine Fellowship Program MD Degree: Cornell University Medical College, 1991 Post-Graduate Training: Brigham and Women’s, Harvard Medical School, Boston Hospital, Boston Mark A. Wigger, M.D. Assistant Professor of Medicine Medical Director, Heart Transplant (Adults) Clinical Assistant Professor Internal Medicine, ETSU M.D. Degree: East Tennessee State University School of Medicine, 1987 Post-Graduate Training: Oregon Health Sciences University, Portland; Vanderbilt University Medical Center, Nashville; East Tennessee State University School of Medicine, Johnson City Nurse Practitioners Dawn Eck, ACNP-BC Patti Logan, ACNP-BC Caroline Mauldin, ACNP-BC H EART FAILURE AND T RANSPLANT C LINIC L OCATIONS Nashville • • Johnson City • • To make a patient referral, coordinate a hospital transfer, or speak with a Vanderbilt Cardiovascular Physician: (615) 936-3500 VANDERBILT T RANSPLANT C ENTER Located on the scenic campus of Vanderbilt University in Nashville, Tennessee, Vanderbilt University Medical Center is home to one of the most active academic transplant centers in the southeastern United States. Vanderbilt Transplant Center is a full-service, multidisciplinary center offering transplantation services for the heart, lung, kidney, pancreas, liver and bone marrow for adult and pediatric patients. On average, Vanderbilt performs 250 solid organ transplants and 200 bone marrow transplants annually. Vanderbilt’s focus is not just on one aspect of transplantation but the whole process from basic research to patient education. Unique transplant services are integrated into the patient care provide at Vanderbilt including transplant psychiatry, infectious disease, pharmacy, return to work, social work, quality of life outcomes and specialized transplant ethics consultations. Vanderbilt Transplant Center remains the leader in Quality of Life research for transplant patients of all types. Multiple research opportunities provide training for fellows, residents, medical students and nursing students. Established in 1985 Vanderbilt’s Heart Transplant Program has performed more than 550 total transplants since the program’s inception. In 1987 Vanderbilt performed Tennessee’s first pediatric heart transplant. Over the next twenty years, more than 150 pediatric patients have received heart transplants at Vanderbilt and Monroe Carell Jr. Children’s Hospital at Vanderbilt. Vanderbilt’s Heart Transplant Program remains the largest program of its kind in the state of Tennessee. Vanderbilt physicians use a wide range of mechanical support devices to maximize success rates of the program. The Heart Transplant Program is also augmented by a strong congestive heart failure program and developing programs in stem cell and bariatric surgery. Program Leadership: Steven Hoff, M.D., surgical director; Mark Wigger, M.D., medical director, adult heart transplantation; Debra Dodd, M.D., medical director, pediatric heart transplantation, David Bichell, M.D. surgical director, pediatric heart transplantation. A PPOINTMENTS AND S CHEDULING To make an outpatient appointment for consultation, simply call 615-936-3500 Toll Free: 866-748-1494, ext. 6-3500 Monday through Friday from 8 am until 5 pm, CST. E MERGENCY C ALLS For urgent physician needs or for a patient transfer, please call: 866-886-2478 or 615-343-9188 Fax: 615-343-6559 to reach the access coordinator. Our guarantee: We will answer the phone within two rings, 24 hours a day, 7 days a week. The Vanderbilt Heart Failure program is located in Medical Center East, South Tower. Parking is available in the East Garage located in the same building. Valet parking available. Remember to have your parking ticket stamped at the registration desk for complimentary parking. Red Coat Volunteers The Vanderbilt Heart Red Coats are volunteers from the community who welcome you as you arrive. They are stationed in Medical Center East at the second floor entrance. Many of our Red Coat volunteers have been patients here themselves, or have had loved ones cared for at Vanderbilt. They are happy to escort you and your family members to your clinic appointment. VA N D E R B I LT H E A RT FA I LU R E P R O G R A M 1215 21st Avenue South MCE, 5th floor, South Tower, Suite 5209 Nashville, Tennessee 37232-8802 VanderbiltHeart.com 808 Oxford House Nashville, Tennessee 37232-4745 vanderbilttransplantcenter.com Vanderbilt University is committed to principles of equal opportunity and affirmative action.