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Heart Failure Program
Helping Hearts
Saving Lives
In Collaboration with
Vanderbilt Transplant Center
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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
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
• •
Johnson City
To make a patient referral, coordinate a hospital transfer,
or speak with a Vanderbilt Cardiovascular Physician:
(615) 936-3500
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.
To make an outpatient appointment
for consultation, simply call
Toll Free: 866-748-1494, ext. 6-3500
Monday through Friday from 8 am until 5 pm, CST.
For urgent physician needs
or for a patient transfer, please call:
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.
1215 21st Avenue South
MCE, 5th floor, South Tower, Suite 5209
Nashville, Tennessee 37232-8802
808 Oxford House
Nashville, Tennessee 37232-4745
Vanderbilt University is committed to principles of
equal opportunity and affirmative action.