A researcher at The University of North Carolina at Chapel Hill has received a $4 million, three-year grant from the National Institutes of Health to study assessment and transplantation of lungs from victims of sudden death. The National Heart, Lung, and Blood Institute awarded a $4,185,275 clinical trial grant to UNC for the study, which will begin Sept. 1 and will be led by Thomas M. Egan, M.D., M.Sc., principal investigator. Dr. Egan, a thoracic surgeon, is professor of surgery in the Division of Cardiothoracic Surgery, Department of Surgery at UNC.
Dr. Egan, who started the lung transplant program at UNC in 1989, is internationally known for his research on lung transplantation. His research has focused on use of lungs for transplant from patients who have died suddenly, outside the hospital, and have not been on mechanical ventilation. These are known as non-heart-beating donors (NHBDs). 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). His lab has perfused and ventilated human lungs outside the body (ex vivo) to determine if they are suitable for transplant; the lab also has worked to show the safety of transplanting these lungs.
If successful, Dr. Egan’s project could greatly increase the number of lungs available for transplant. Currently, solid organs for transplant come primarily from patients who have suffered brain death and have been on mechanical ventilation before controlled circulatory arrest. However, many lungs from these donors cannot be used for transplant because of inflammation or infection during a prolonged interval of brain death. Lungs retrieved from NHBDs may not only be much more plentiful; they may be superior to lungs currently being transplanted from brain-dead donors.
Duke University (R. Duane Davis, M.D., principal investigator for the subaward), Carolina Donor Services, the regional organ procurement organization, and Lung Banks of America, a non-profit oganization, will have subawards on the grant. Wake County Emergency Medical Services, law enforcement, the medical examiner’s office and other government entities have cooperated to ensure the project is successful.
Lungs from the non-heart-beating donors that are found acceptable after ex-vivo assessment will be transplanted at UNC and Duke to patients who have consented to use of the lungs under FDA- and IRB-approved protocols. Outcomes will be compared to patients contemporaneously transplanted with lungs from conventional organ donors. If the trial is successful, it could lead to a broader study at more institutions. The grant is “More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors” (NHLBI grant 1 UM1 HL113115-01A1).
- Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery
Maryam, an 8-year-old girl from Afghanistan, underwent heart surgery at UNC Hospitals on Tuesday, July 9, and came through it well, her surgeon, Michael R. Mill, M.D., said. (Update: Maryam went home from the hospital to her host family's home in Raeford on Tuesday, July 16.)
Dr. Mill corrected a narrowing of Maryam's aorta (a surgical procedure called resection of coarctation of the aorta) and closed a fetal blood vessel, the ductus arteriosus, that had not closed normally when Maryam was a newborn (that surgery is called division of a ). )
"The procedure went well and she is doing fine postop," Dr. Mill said.
The ductus arteriosus is a vessel that allows blood to go around a baby's lungs before birth; after birth, it usually closes. If it does not, blood flows abnormally from the aorta to the pulmonary artery. Elman Frantz, M.D., a pediatric cardiologist at UNC, had planned to close the PDA in a catheter procedure on July 3. Dr. Frantz suspected the narrowing of the aorta after seeing results of an echocardiogram; he confirmed it during the catheter procedure. Narrowing makes it difficult for blood to flow through the aorta, the main artery that leads out of the heart. Surgery was necessary to fix the coarctation and if Dr. Frantz had closed the PDA, it would have made the surgery more difficult. So, both problems were fixed during surgery, Dr. Mill said.
Children often have high blood pressure before the operation because of the narrowing of the aorta and they need medication for a few days to weeks after surgery until the body adjusts to not having the aortic obstruction, Dr. Mill said.
The usual hospital stay after the surgery is five to seven days. "The blood pressure control is often what dictates how long the children need to stay in hospital," Dr. Mill said.
Maryam was flown to the United States in June Rita Bigham, a retired teacher from Chapel Hill and a UNC Hospitals volunteer, and her husband, Eric, worked with , a nonprofit group based in Mooresville, N.C., to arrange Maryam's trip and treatment. Solace for the Children brings children from Afghanistan and other war-torn countries to the United States to live with host families and receive medical care. Maryam’s care is being covered by the Rita and Eric Bigham Cardiology Special Project Fund, which the Bighams established with the Medical Foundation of North Carolina. Maryam has been staying since June 21 with a host family, Ashley Lewis and her family, in Raeford, and also has been paired with a "heart sister," Hannah Saye, 6, of Pinehurst, who had surgery for a heart defect when she was a newborn. Dr. Mill also did Hannah's surgery.
Dr. Mill, a pediatric cardiac surgeon, came to UNC in 1988 to be director of the UNC Heart and Heart-Lung Transplant programs. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina.
Dr. Mill helped the American Board of Thoracic Surgery develop the requirements for the first specialty certification in congenital cardiac surgery and in 2009 became one of the first physicians to earn that certification. He was chief of the Division of Cardiothoracic Surgery from 2000 to 2011 and has been director of the UNC cardiothoracic surgery residency program since 1998.
Dr. Mill earned an M.D. at the University of Colorado and did his residency in General Surgery there. He completed a residency in Thoracic Surgery and a fellowship in Heart and Heart-Lung Transplantation, both at Stanford University, where he trained with pioneering heart surgeon Norman Shumway.
Contact: Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, firstname.lastname@example.org
Tammy Allred, RN, OCN, is thoracic oncology and sarcoma nurse navigator at UNC Hospitals, helping lung cancer and sarcoma patients and their families at all stages of diagnosis and treatment. She's a good person to have on your side. UNC's Lineberger Cancer Center profiled Tammy in a recent article. Read it .
Congratulations to William E. Stansfield, M.D., who received the "Physician Teacher of the Year" award from residents in the UNC Department of Anesthesiology at a resident graduation dinner on June 22, 2013. Dr. Stansfield is a cardiac surgeon and an assistant professor of surgery in the UNC Division of Cardiothoracic Surgery.
Andy C. Kiser, MD, chief of the UNC Division of Cardiothoracic Surgery, presented an abstract, "Evaluation of integrated bipolar and unipolar epicardial ablation," at the International Society for Minimally Invasive Cardiac Surgery (ISMICS) meeting in Prague, Czech Republic, on June 13, 2013. Co-authors on the abstract were Hayden Pappas, MD, Kelly Garner, RN, Anil Gehi, MD, and Paul Mounsey, MD.
Read the abstract here.
Dr. Sheridan is a cardiac surgeon at UNC and is associate professor of surgery in the UNC Division of Cardiothoracic Surgery. He is director of Mechanical Circulatory Support and Cardiac Transplantation at UNC Hospitals. He has been chief editor of Cardiology Journal on eMedicine.com since 2007.
Mark Joseph, MD, a fellow in the UNC Division of Cardiothoracic Surgery, and Andy C. Kiser, MD, a professor of surgery and chief of the division, are authors of two chapters in the recently published TSRA Clinical Scenarios in Cardiothoracic Surgery. Their chapters are "Cardiac Trauma" and "Management of the Porcelain Aorta."
The TRSA Clinical Scenarios are published by the Thoracic Surgery Residents Association, American Association for Thoracic Surgery, Chicago. They are available here.
An article in EMS World, an online publication for EMS workers, features the lung transplant research of Thomas M. Egan, M.D., of the UNC Division of Cardiothoracic Surgery. Dr. Egan has studied the use of lungs for transplant from people who have died outside the hospital of sudden cardiac arrest. In a recent project, Dr. Egan worked with Wake County, NC, Emergency Medical Services to identify and help expedite the transport of cardiac arrest victims whose lungs could be evaluated by Dr. Egan's research team. Dr. Egan gave training to Wake County EMS crews on criteria for potential lung donors.
Read the article here.
Benjamin Haithcock, M.D., was honored May 10 as a "Friend of Nursing" at UNC Hospitals in a ceremony marking the 2013 Nursing Staff Recognition Week.
Dr. Haithcock is a thoracic surgeon and is surgical director of UNC Hospitals' Lung Transplant Program and a physician in the UNC Multidisciplinary Thoracic Oncology Program, which treats patients with lung cancer and other chest cancers. He is assistant professor of surgery in the UNC Division of Cardiothoracic Surgery and has a joint appointment as assistant professor of anesthesiology at UNC.
At the ceremony, Dr. Haithcock was praised as "an exceptional surgeon providing excellent patient care."
"He serves as an outstanding role model for physicians and nurses, is always respectful of his colleagues and is a nurse advocate," his award citation stated. "The nursing staff’s relationship with Dr. Haithcock is the ideal physician-nurse alliance, exemplified by his willingness to collaborate and plan the care of his patients with all members of the interprofessional team."
Dr. Haithcock joined the UNC faculty in July 2007 after completing his cardiothoracic surgery residency at UNC. He received his M.D. from Michigan State University in 1998 and completed a General Surgery residency at Henry Ford Hospital in Detroit in 2004. He earned a B.S. in chemistry from the University of Michigan.
His clinical interests include thoracic oncology, including cancer of the lung and esophagus; heart and lung transplantation; end-stage lung disease; and minimally-invasive thoracic surgery.
At UNC, Dr. Haithcock is an active researcher and teacher. He has served as a member of UNC Hospitals’ Ethics Committee. He has been an investigator in a Cancer and Leukemia Group B (CALGB) trial of lobectomy vs. sublobar resection for small peripheral non-small cell lung cancer. He also has been a co-investigator with Thomas M. Egan, MD, on several lung transplant studies, including an NIH grant for study of ex-vivo (outside the body) perfusion and ventilation of lungs to assess transplant suitability.
Richard H. Feins, M.D., professor of surgery in the Division of Cardiothoracic Surgery at The University of North Carolina at Chapel Hill, is one of three 2013 winners of the Distinguished Academic Achievement Award at the University of Vermont College of Medicine.
The award, recognizing outstanding scientific or academic achievement, was presented May 31, 2013, during the medical school's alumni reunion.
(In the photo above, University of Vermont College of Medicine alumni award winners are, left to right: Douglas Losordo, M.D., Halleh Akbarnia, M.D., Jack Murray, M.D., Edward Havranek, M.D., Joyce Dobbertin, M.D., Richard Feins, M.D., Omar Khan, M.D.)
Dr. Feins, a 1973 graduate of the University of Vermont medical school, trained in general surgery and cardiothoracic surgery at the University of Rochester in Rochester, N.Y., where he served on the faculty until 2005. He then joined the faculty at the University of North Carolina at Chapel Hill as a thoracic surgeon and professor of surgery.
Dr. Feins, center, with Betsy Sussman, M.D., a radiologist at the University of Vermont medical school, and Rick Morin, M.D., dean of the school.
Dr. Feins has been a national leader in education of future thoracic surgeons and in simulation-based training for surgery residents. He is principal investigator of a three-year grant from the Agency for Healthcare Research and Quality (Improved patient safety by simulator based training in cardiac surgery) that is studying whether use of surgery simulators improves training of cardiothoracic surgery residents and leads to better patient safety. Seven other institutions (Johns Hopkins University, Massachusetts General Hospital, Mayo Clinic, University of Rochester, Stanford University, Vanderbilt University and the University of Washington) are participating in the study along with UNC. The study is now in its third year.
Dr. Feins has served as a director of the American Board of Thoracic Surgery and as its chair from 2007 to 2009. He also has served on the Board of Directors of the Society of Thoracic Surgeons, the Joint Council for Surgical Education, the Thoracic Surgery Foundation for Research and Education, and the General Thoracic Surgery Club.
He is co-director of the national Cardiothoracic Surgery Resident Boot Camp, held in Chapel Hill each summer to train incoming cardiothoracic surgery residents.
Faculty, resident physicians and staff of the UNC Division of Cardiothoracic Surgery are authors on five abstracts that were presented in poster sessions at the International Society of Heart and Lung Transplantation meeting, April 24-26, 2013, in Montréal.
Four faculty members, Thomas Egan, Andy Kiser, Brett Sheridan and William Stansfield, two residents, Staci Beamer and Kristen Sell, and Egan lab members John Blackwell and Lolita Forrest are among the authors. Boming Dong, former research associate in the Egan lab, and William Simmons, former research coordinator for the Egan lab, are also authors.
Four of the posters are on display in the lobby on the third floor of Burnett-Womack Building.
Egan TM, Dong B, Tikunov A, Semelka C, Kuan P-F, Macdonald J. Metabolomic profile of rat lung tissue after death: Effect of delayed post-mortem O2-ventilation.
Egan TM, Dong B, Tikunov A, Semelka C, Blackwell J, Simmons W, Kuan P-F, Macdonald J. Effect of ex-vivo lung perfusion (EVLP) on metabolomics profile of human lungs.
Venkataraman A, Blackwell J, Simmons W, Beamer S, Forrest L, Randell S, Egan T. Beware cold agglutinins in organ donors: Ex-vivo lung perfusion (EVLP) of lungs from a Category 1 non-heart-beating donor (NHBD) with a cold agglutinin.
Sell KA, Sheridan BC, Kiser AC, Bowen A, Katz JN, Stansfield WE. Heartmate II inflow cannula position on chest x-ray predicts inotrope dependence.
Alhosaini H, Katz JN, Jensen BC, Stansfield W, Sheridan BC, Chang PP. A novel link between G6PD deficiency and hemolysis events in patients supported with continuous-flow left ventricular assist devices.
Dr. James L. Cox will be unable to present Surgery Grand Rounds on May 1; his travel has recently been limited and he will not be able to come to Chapel Hill.
The UNC Division of Cardiothoracic Surgery hopes to reschedule Dr. Cox's visit at a later date.
Dr. Cox, a cardiac surgeon and emeritus chief of the Division of Cardiothoracic Surgery at Washington University, is best known for developing the Maze Procedure to treat atrial fibrillation.
UNC Health Care and High Point Regional Health System have completed a merger. Read more here. The UNC Division of Cardiothoracic Surgery is affiliating with a cardiac surgery practice in High Point; more information will be available later.
Rex Healthcare, owned by UNC Health Care, will move forward with building a new heart and stroke hospital in Raleigh. Read more here.
Andy Kiser, M.D., and Paul Mounsey, M.D., gave the 2013 McAllister Heart Lecture on Feb. 12 at the N.C. Museum of History in Raleigh. The lecture series, about innovations in heart care, is supported by an endowment created by Hugh A. McAllister, M.D., a distinguished cardiac pathologist and UNC medical school alumnus. Dr. McAllister's endowment supports the and cardiovascular research at UNC.
The title of the talk by Dr. Kiser and Dr. Mounsey was "The Convergent Procedure Collaborative: A Successful Collaboration of Cardiac Surgery and Electrophysiology." Dr. Kiser and Dr. Mounsey offer the Convergent Procedure at UNC - it combines the skills of a surgeon and a cardiologist/electrophysiologist to treat atrial fibrillation and ventricular arrhythmias. A question and answer session followed the talks. More than 100 people attended, including Dr. McAllister.
Three physicians from the UNC Division of Cardiothoracic Surgery were named to U.S. News and World Report's "Top Doctors" list in 2012.
Richard H. Feins, Michael R. Mill and Benjamin E. Haithcock were named to the list. The physicians in the "Top Doctors" list are considered to be among the top 10% of doctors in their regions. Dr. Feins and Dr. Mill were also listed as among the top 1% in the nation in their specialties.
The list is based on ratings of doctors by Castle Connolly Medical, Ltd., publisher of "America's Top Doctors." Castle Connolly bases its ratings on nominations submitted by doctors and reviewed by a physician-led research team.
Three physicians from the UNC Division of Cardiothoracic Surgery are included in the most recent update of The Best Doctors in America® database.
The doctors are Thomas M. Egan, Richard H. Feins, and Michael R. Mill. Dr. Egan and Dr. Feins are thoracic surgeons. Dr. Mill is a cardiac surgeon who specializes in congenital cardiac surgery; he is listed under both Thoracic Surgery and Pediatric Cardiac Surgery in the Best Doctors database.
About 5 percent of physicians in the United States are included in the Best Doctors database; the doctors on the list are chosen through a peer review process.
Project TICKER (Teamwork to Improve Cardiac Kids' End Results) has been underway at N.C. Children's Hospital for two years - it uses teamwork training and integrated clinical pathways (ICPs) to decrease unnecessary variations in clinical care. Clinical pathways have been shown to decrease length of stay in the hospital and lead to better outcomes, especially for surgical populations such as pediatric congenital heart surgery patients.
The project, funded by a grant from the Agency for Healthcare Research and Quality (AHRQ) (award number R18 HS019638) recently received a no-cost extension to continue many of its activities. The principal investigator is Tina Schade Willis, MD; Michael R. Mill, MD, and Karla Brown, RN, MSN, PNP, of the UNC Division of Cardiothoracic Surgery, are investigators on the project.
Tammy Allred, nurse navigator for UNC's lung cancer patients, received a 2012 Oncology Nursing Excellence Award on Nov. 12 at UNC's Lineberger Cancer Research Center. The award is given "in recognition of unwavering compassion and caring for the patients of UNC Cancer Care."
Allred also was recognized by the Lungevity Foundation as best healthcare provider for the month of November. The Lungevity Foundation funds scientific research to find lung cancer early and treat it more effectively; the foundation also provides support for those affected by the disease.
Allred is known to her colleagues as a hard-working and very caring nurse who always goes the extra mile for her patients and their families. She regularly makes presentations about lung cancer care and treatment to national and regional oncology organizations and she is very active with the North Carolina Lung Cancer Partnership.
For the UNC Oncology Nursing Excellence Award, one nominator wrote: “Tammy gives her all in whatever she does. She is the type of nurse and person you want to care for you when you are sick.”
Another nominator wrote: “She dedicates many volunteer hours to the North Carolina Lung Cancer Partnership that works to educate and de-stigmatize lung cancer and also support research in lung cancer.“
Winners of the Nursing Excellence Awards receive a $1500 stipend for professional education activities. The Oncology Nursing Excellence Award is presented in memory of Charmayne S. Gray, an outstanding oncology nurse who died in an auto accident in 2002.
Read more here.
Thoracic surgeons from the UNC Division of Cardiothoracic Surgery - Dr. Benjamin Haithcock, Dr. Nirmal Veeramachaneni, and Dr. Richard Feins - are part of the UNC team that cares for patients who have lung cancer or other chest cancers.