Nov. 18, 2014
Andy C. Kiser, M.D., chief of the UNC Division of Cardiothoracic Surgery, spoke at the recent meeting of the European Association for Cardio-Thoracic Surgery (EACTS) on a suprasternal direct approach TAVR procedure that he developed. TAVR is transcatheter aortic valve replacement, a less invasive procedure for valve replacement that is aimed at people who are too frail to undergo traditional aortic valve surgery.
The EACTS meeting was Oct. 11-15, 2014, in Milan, Italy.
The Suprasternal Aortic Access System (SuprAA System, Aegis Surgical Ltd, Dublin, Ireland) is a new minimally invasive approach for replacing the aortic valves of high-risk patients with aortic stenosis. The SuprAA device described at EACTS allows direct access to the aorta and innominate artery without sternal or thoracotomy incisions. It allows direct and precise deployment into the aorta of a transcatheter aortic valve and allows use of large sheaths for delivery of the valve.
Watch an EACTS interview with Dr. Kiser and co-investigator Michael Reardon, M.D., chief of cardiac surgery at Houston Methodist Hospital and professor of surgery at Baylor University. (If the video is not showing on the linked page, go to http://www.eacts.org/annual-meeting/video-highlights-28th-annual-meeting/ and look under Video Highlights for "Acquired cardiac disease" and "Late breaker: Suprasternal approach TAVR FIM.")
UNC's ventricular assist device (VAD) program had tremendous growth in 2013-2014. Ventricular assist devices (VAD) are mechanical devices implanted in open heart surgery to provide increased blood flow for heart failure patients, greatly improving their quality of life and survival. The devices may be used as a bridge to heart transplant, or as a destination therapy for patients who are not medically eligible for heart transplant.
The number of VAD devices implanted into UNC patients grew by 206% during the 2013-2014 fiscal year. Of the 72 mechanical circulatory support devices implanted, 40 were for durable (home) support, including destination therapy and as a bridge to heart transplant. Thirty-two of the mechanical circulatory support devices were for temporary in-hospital support, with 24 patients receiving extracorporeal membrane oxygenation (ECMO) as well.
Read more here, in an article by Laura Melega of the UNC Center for Heart and Vascular Care,
UNC has begun a program to offer transcatheter aortic valve replacement (TAVR) to patients who are too frail or ill to undergo open heart surgery. With TAVR, a new technology, physicians replace the aortic valve via minimally-invasive approaches, including percutaneous procedures (intervention without an incision), which provide outcomes that are as good, or sometimes better than, surgical valve replacement.
The TAVR procedure is well-suited for an academic medical center with a collaborative approach to patient care. The UNC Center for Heart & Vascular Care is a team of specialists from cardiac surgery, cardiology, interventional radiology and vascular surgery, provides comprehensive and well-coordinated patient care.
Thomas Caranasos, MD, of the UNC Division of Cardiothoracic Surgery, is one of the TAVR program’s medical directors. “We are going to be at the forefront of not just using the technology but developing and advancing the technology,” he said.
Read more here, in an article by Laura Melega of the UNC Center for Heart and Vascular Care.
Jason Long, M.D., M.P.H., assistant professor of surgery in UNC’s Division of Cardiothoracic Surgery, will be the guest on the "Your Health" radio program - he will discuss "Heart and Lung Surgery: Past, Present and Future."
We welcome Thomas G. Caranasos M.D., who joined the UNC Division of Cardiothoracic Surgery in July 2014 as assistant professor of surgery.
Dr. Caranasos, a heart and lung surgeon who specializes in adult cardiac surgery, has a special interest in aortic surgery, including the ascending aorta, arch pathology, thoracic aorta and aortic root; transcatheter aortic valve surgery; mitral and aortic valvular surgery; minimally invasive approaches to cardiac surgery; and video assisted thoracic surgery.
“I am passionate about the field of cardiac surgery because it allows me to offer treatment options to patients who often have a debilitating disease and treatment allows them to get back to enjoying life,” Dr. Caranasos said. “I also get to make a wonderful connection to the patient and family as they recover.”
Dr. Caranasos also serves as a director of the new Transcatheter Aortic Valve Replacement (TAVR) Program at UNC. John Vavalle, M.D. and Michael Yeung, M.D. of the UNC Division of Cardiology are also working on the program.
TAVR is a new technology that provides a treatment option for many patients who are too frail to undergo open heart surgery for aortic valve stenosis. With TAVR, physicians provide aortic valve replacement via minimally-invasive approaches, including percutaneous procedures (intervention without an incision), which provide outcomes that are as good as surgical valve replacement.
The TAVR Program is ideally suited for UNC, an academic medical center with a collaborative approach to patient care. The UNC Center for Heart & Vascular Care joins physicians from cardiac surgery, cardiology, interventional radiology, and vascular surgery who collaborate on patients’ care.
“I am excited to be a part of the transcatheter valve program at UNC. It is great to be able to offer patients in the region a cutting-edge technology that will treat their disease if they are too high-risk to undergo surgery,” said Dr. Caranasos. “I am also excited to be a part of this multidisciplinary team approach to treatment and having UNC be a leader in developing new technologies for treatment.”
Dr. Caranasos, a native of Gainesville, FL, completed a cardiothoracic surgery fellowship at the University of Florida in June 2014. He completed his general surgery residency at West Virginia University. He also earned M.D. and B.A. degrees from West Virginia University.
For appointments with Dr. Caranasos, call 919-966-3382 or 919-843-4614.
- Laura Melega, UNC Center for Heart and Vascular Care
The cardiac surgery and cardiology specialties at UNC Hospitals were recently ranked as "high performing" by U.S. News & World Report in its annual "America's Best Hospitals" issue. That means they are among the top 25 percent of hospitals in their specialty nationally in data compiled by U.S. News & World Report. Read more here in a story from the UNC Health Care newsroom.
Cardiac intensive care unit at UNC Hospitals celebrates five straight years of no ventilator-associated pneumonia
The Cardiac Intensive Care Unit (CICU) at UNC Hospitals recently celebrated its fifth straight year of having no cases of ventilator-associated pneumonia (VAP).
Widespread use of mechanical ventilation puts the CICU's critically ill patients at a particularly high risk for developing VAP. In 2008, the CICU began new practices to help reduce cases of VAP and keep their patients safe. CICU staff knew that cases of VAP would be reduced through the changes they implemented. But last year the CICU celebrated four consecutive years without a VAP -- an accomplishment unheard of among CICUs nationwide -- and this year the CICU reached its fifth year of being VAP-free.
Read more here in a story from the UNC Health Care newsroom.
Read the division's April 2014 newsletter(PDF).
Rex Healthcare plans to start construction of its new heart tower this fall. The 115-bed hospital, owned by UNC Health Care, will be home to North Carolina Heart & Vascular. Read more here
About five years ago, Craig Wilkins was feeling tired and breathless and decided to see his family doctor in Cary, N.C., before going on a trip.
Craig was otherwise healthy and had no history of heart disease, but his doctor discovered he had atrial fibrillation, a condition that can cause the heart to race, sometimes beating hundreds of times in one minute. For some, atrial fibrillation is annoying but not life-threatening. For Craig, the condition had gone undetected for so long that he had developed congestive heart failure.
After several attempts to regulate the heartbeat with cardioversion and with anti-arrhythmia medication, Craig's heart was still falling out of rhythm. His cardiologist referred him to Paul Mounsey, MD, director of electrophysiology at UNC Hospitals. Dr. Mounsey performed a cardiac ablation on Craig’s heart. In an ablation, doctors use radiofrequency to destroy the damaged heart tissue causing the atrial fibrillation. Ablations are often successful, but in Craig’s case, they were not. Dr. Mounsey then collaborated with Andy Kiser, M.D., chief of the UNC Division of Cardiothoracic Surgery, to perform the Convergent Procedure.
Traditionally, surgeons such as Dr. Kiser have created scar patterns to disrupt the circuitry that causes atrial fibrillation arrhythmia, while electrophysiologists such as Dr. Mounsey have performed ablations. In the Convergent Procedure, developed by Dr. Kiser, an electrophysiologist and surgeon work together using miniature cameras, small catheters and electrodes to map out an individualized pattern that will work to reestablish normal rhythms in each patient.
Drs. Kiser and Mounsey have completed procedures on more than 100 patients since 2011. They have an 80 percent success rate, very high for complex arrhythmias.
Five years after Craig’s initial atrial fibrillation diagnosis and a year and a half after having the Convergent Procedure, he says his health is excellent. “I can’t believe how bad I used to feel,” says Craig. “I have energy and a desire to do things now.”
Read more here, in a story by Stephanie Soucheray-Grell from UNC Health Care's magazine, Well.
Residents and medical students at UNC are invited to submit abstracts for the annual meeting of the Nathan A. Womack Surgical Society, to be held at the University of North Carolina at Chapel Hill from May 1 to 3, 2014. Abstract submissions will be accepted until Friday, April 4, 2014, at 11 p.m. EDT. Four submitted abstracts will be selected for presentation at the annual meeting on Friday, May 2. The George F. Sheldon Research Competition Award will be given for the most outstanding presentation. Abstracts may be on any medical research topic but are often related to surgery.
Please follow these instructions to submit an abstract:
Abstract Limit: There are no restrictions on the number of abstracts you may submit.
Character Limit: There is a limit of 250 words for the text of your abstract submission. Title, authors, institutions, tables, and images are not counted in the 250-word limit.
Tables and Images: You may add 1 table and 1 image to your submission.
Abstract Structure: All abstracts must be structured with the following headings and content:
- Objectives – A brief statement on the objectives of the study and the current state of research in the field. What limitation or problem does this study address?
- Methods – The methods of study or experimental approach must be defined briefly.
- Results – A summary of the study results, including sufficient details to support those conclusions. A brief table or image may be used.
- Conclusions – A statement concerning the significance of the work and its implications for further research or clinical practice.
George F. Sheldon Research Competition Award
The award is named after the late George F. Sheldon, M.D., Zach D. Owens Distinguished Professor of Surgery. Dr. Sheldon chaired the UNC Department of Surgery from 1984 to 2001 and served as president of the American College of Surgeons from 1998 to 1999. This award will be awarded to the medical student or resident in training with the most outstanding presentation. Selection will be based upon the quality of abstract as well as the oral presentation, as judged by a panel of visitors and UNC faculty. The award includes $500 cash and recognition at the annual Womack Society reception on Friday evening, May 2.
Submission: All abstracts must be submitted electronically to Andy Kiser, M.D., email@example.com , by 11 p.m. EDT on April 4, 2014. Questions may be directed to Dr. Kiser or to Debbie Alberti, firstname.lastname@example.org , at (919) 966-3391.
Read about the Nathan A. Womack Surgical Society here.
Dr. Feins joins with Dr. Alterovitz on project to develop robotic tentacle device that reaches far into lungs or head
Ron Alterovitz, PhD, assistant professor of computer science and head of the Computational Robotics Research Group in the UNC Department of Computer Science, has been investigating new algorithms that can enable robotic tentacles to achieve depth and precision inside the human body.
He has focused on a new surgical device – a robotic set of concentric nested tubes made of nickel titanium. The device can be deployed from the tip of a bronchoscope, allowing physicians to reach farther than ever into the lungs to diagnose abnormal growths. It can also be deployed via the nose to surgically access tumors in the brain or nearby structures in the head. The robotic device has the potential to move through the body so precisely that it can avoid anatomical obstacles and reach its target within a millimeter. Richard H. Feins, MD, of the UNC Division of Cardiothoracic Surgery, has been working with Dr. Alterovitz on the project. Brent Senior, MD, Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology, is interested in Dr. Alterovitz's research for its potential to reach tiny areas of the head.
Read more about their collaboration here, in an article by Zach Read of the UNC Health Care News Team.
Courtney, a 17-year-old cardiac patient, has been cared for by UNC doctors since she was a baby. She has been treated medically and surgically for her heart problems. Most recently, Michael R. Mill, M.D., repaired her mitral valve in June 2013 and Jennifer S. Nelson, M.D., implanted a left ventricular assist device (LVAD) when Courtney's heart was failing in August 2013. The LVAD, which is not often implanted in pediatric patients, will support her heart until she can receive a heart transplant.
Courtney's courage has impressed her doctors.
“The evening of her [LVAD] surgery, she woke up calmly, her breathing tube in place, and asked for a pen and paper,” Dr. Nelson said. “On that paper, the first thing she wrote was, 'Thank you. Courtney'. I still have a picture of that note. Every time I look at it, I am blown away by her bravery.”
Michael R. Mill, M.D., a professor of surgery in the UNC Division of Cardiothoracic Surgery, has been appointed professor of pediatrics in the Department of Pediatrics at UNC, effective Dec. 20, 2013. Under the joint appointment, Dr. Mill will teach and do research with the Department of Pediatrics, focusing on congenital cardiac surgery.
Dr. Mill, director of pediatric cardiac surgery at UNC, joined the UNC Division of Cardiothoracic Surgery in 1988 and served as chief of the division for 12 years. He started the heart transplant program at UNC and performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as director of the UNC Comprehensive Transplant Center and as program director of the UNC Cardiothoracic Surgery Residency Program, and has been active in national organizations relating to cardiothoracic surgery and residency training. He recently served as co-investigator on a study funded by the Agency for Healthcare Research and Quality, Improving patient safety in a pediatric service line (grant 05-R18 H5019636-01-02). His clinical interests include neonatal and pediatric heart surgery, pediatric and adult heart and heart-lung transplantation, complex valve repairs, mechanical cardiac assist devices, and surgery for end-stage heart failure. He is listed in the U.S. News and World Report's "Top Doctors" database and in the "Best Doctors in America" database.
Congratulations to Drs. Thomas M. Egan and Michael R. Mill, who are both listed in the 2014 "Best Doctors in America" database. "Best Doctors" lists outstanding physicians who have been nominated for inclusion by their peers. Dr. Egan and Dr. Mill, both professors of surgery in the UNC Division of Cardiothoracic Surgery, are among 251 doctors at UNC.
Dr. Egan, a thoracic surgeon, is internationally known for his research on lung transplantation. He joined the UNC faculty in 1989 and began its lung transplant program. He is principal investigator of a large, NIH-funded clinical trial to study assessment and transplantation of lungs from victims of sudden death (More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors, grant 1 UM1 HL113115-01A1). Dr. Egan has shown that lungs are still viable after circulation stops because lung cells obtain oxygen after death from air in the air sacs and airways (other organs require blood circulation to obtain oxygen). If successful, his project could greatly increase the number of lungs available for transplant. He led the group that developed a 2005 change in U.S. allocation policy for lung transplants that allocates donor lungs based primarily on estimates of survival probability; this change has been credited with saving lives and improving efficiency. He no longer performs surgery due to a physical disability but is available for second opinions or consultation.
Dr. Mill, a congenital cardiac surgeon, is director of pediatric cardiac surgery at UNC and started the heart transplant program at UNC after his arrival in 1988. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as chief of the Division of Cardiothoracic Surgery at UNC, director of the UNC Comprehensive Transplant Center, and program director of the UNC Cardiothoracic Surgery Residency Program, which trains future surgeons. He has studied clinical outcomes of transplantation and also pulmonary blood flow physiology in congenital heart disease. He has recently been co-investigator on a study funded by the Agency for Healthcare Research and Quality, Improving patient safety in a pediatric service line (grant 05-R18 H5019636-01-02). His clinical interests include neonatal and pediatric heart surgery, pediatric and adult heart and heart-lung transplantation, complex valve repairs, mechanical cardiac assist devices, and surgery for end-stage heart failure.
- Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, email@example.com
A clinical trial underway at the University of North Carolina is testing the idea that lungs can be recovered for transplant from people who die suddenly, away from the hospital. Lungs for transplant normally come from people who have suffered brain death and have been on a ventilator in a hospital, but many lungs from these donors are not usable because of infection or inflammation resulting from brain injury. Many people with end-stage lung disease are unable to get lung transplants because of the serious shortage of suitable lungs.
Thomas M. Egan, M.D., is principal investigator of the UNC study, which is funded by the National Institutes of Health/National Heart, Lung, and Blood Institute (NHLBI grant 1 UM1 HL113115-01A1). UNC co-investigators include Benjamin Haithcock, M.D., and Jason Long, M.D., of the UNC Division of Cardiothoracic Surgery; Peadar Noone, M.D., of the UNC Division of Pulmonary Diseases and Critical Care Medicine; of the UNC Department of Biostatistics and , Ph.D.,Katherine Birchard, M.D., of the UNC Department of Radiology.
The Associated Press reported on the study in a story on Nov. 17, 2013. Read the AP article here and watch an AP video about the study .
Dr. Egan pioneered the idea that lungs could be suitable for transplant for hours after circulation stops because lung cells obtain oxygen after death from air sacs and airways (other organs require blood circulation to obtain oxygen). He believes that the lungs from people who have died suddenly may not only be plentiful; they may be superior to lungs transplanted from brain-dead donors.
The study uses lungs from people in Wake County, NC, who have indicated that they wish to be organ donors and who have died of sudden cardiac arrest, usually at home. If emergency crews fail to resuscitate the person, organ donation officials talk to family members to request use of the lungs for possible transplant. If the family agrees, the body is transported to UNC Hospitals, where the lungs are recovered and assessed for transplant using ex-vivo (outside the body) perfusion. Lungs that are found acceptable will be transplanted to patients who have consented to use of the lungs under protocols approved by the Food and Drug Administration (FDA) and the UNC Institutional Review Board (IRB). Outcomes will be compared to patients who have received transplanted lungs from conventional donors. No other research team in the United States has FDA approval to test transplants of lungs from sudden-death donors.
Wake County Emergency Medical Services, law enforcement, the North Carolina medical examiner's office, and other government offices are cooperating in the project.
Contact: Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, firstname.lastname@example.org
Jennifer S. Nelson, M.D., joined the UNC Division of Cardiothoracic Surgery in August as a pediatric cardiac surgeon. She serves as an assistant professor of surgery in the UNC School of Medicine and as director of the Congenital ECMO Program at the North Carolina Children’s Hospital.
Dr. Nelson earned B.S. (with Distinction) and M.D. degrees from the University of North Carolina at Chapel Hill and finished a General Surgery residency at UNC in 2010. She completed a Thoracic Surgery residency at the University of Michigan in 2012 and was an ACGME Fellow in congenital cardiac surgery at Michigan in 2012-13.
Her clinical interests include pediatric heart surgery, heart surgery in newborns and low birth weight infants, adult congenital heart surgery, and ECMO (extracorporeal membrane oxygenation).
Her research interests include the Ross procedure in children, post-cardiotomy ECMO, and pediatric cardiac assist devices.
To make an appointment with Dr. Nelson, call 919-966-3382.
Dr. Long earned a B.S. from the University of North Carolina at Chapel Hill, an M.P.H. from Harvard University, and an M.D. from Wake Forest University. He completed a General Surgery residency at the University of Chicago and completed a Cardiothoracic Surgery residency at the University of Michigan in June.
Dr. Long’s clinical interests include thoracic oncology (including cancer of the lung and esophagus), lung transplantation, ECMO, minimally invasive thoracic surgery including robotic surgery, and other lung and esophageal surgery.
His research interests include ex-vivo lung perfusion, use of lungs from non-heart-beating donors for transplantation, and international health. He recently became a co-investigator on a large NIH clinical trial grant at UNC, “More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors” (NHLBI grant 1 UM1 HL113115-01A1; Thomas Egan, principal investigator).
To make an appointment with Dr. Long, call (919) 966-3381.