Rex Healthcare, part of UNC Health Care, plans to offer transcatheter aortic valve replacement (TAVR), a minimally-invasive procedure to treat patients with severe symptomatic aortic stenosis.
The procedure will be offered to older patients who are not well enough to undergo open-heart surgery for aortic valve replacement. The aorta is the main artery carrying blood out of the heart; blood flows from the heart through the aortic valve into the aorta. In aortic stenosis, the aortic valve does not open fully, decreasing blood flow from the heart. TAVR is an alternative to open-chest surgery; the TAVR device and procedure have been studied extensively in the United States and have been used successfully in Europe since 2002.
During the TAVR procedure, doctors guide an artificial heart valve through a catheter that has been placed into the femoral artery, between the thigh and the heart. The technology was developed by Edwards Lifesciences.
Dr. Lance Landvater, co-medical director of Rex Cardiothoracic Surgery Specialists, is leading a team of cardiothoracic surgeons, interventional cardiologists, non-invasive cardiologists and other specialists to implant the device and establish a new UNC/Rex Heart Valve Center. The team also includes Dr. Andy Kiser, chief of the UNC Division of Cardiothoracic Surgery; Dr. Christian Gring, Dr. Matthew Hook and Dr. R. Lee Jobe of Wake Heart & Vascular; Dr. Timothy Gruebel of American Anesthesiology of North Carolina; and Dr. James Zidar, president of Rex Heart & Vascular Specialists.
The new heart valve center at Rex plans to perform the first TAVR procedure in May.
To learn more about the procedure, click here.
Two Raleigh cardiothoracic surgeons have started a new practice affiliated with Rex Healthcare, part of the UNC Health Care system. Lance E. Landvater, M.D., and Robert B. Peyton, M.D., are leading Rex Cardiothoracic Surgery Specialists and will be clinical associate professors in the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill.
Drs. Landvater and Peyton will work closely with Rex Heart & Vascular Specialists, Rex Heart & Vascular Services, Rex Thoracic Specialists and Rex Vascular Surgery Specialists, providing patients with a wide range of diagnostic tests, surgical procedures and other treatment on the main Rex campus.
Both doctors have practiced cardiothoracic surgery in Raleigh since the late 1980s, offering heart bypass surgery, valve replacements and other cardiac procedures.
Dr. Landvater is a graduate of Bowman Gray School of Medicine at Wake Forest University and completed his Surgery and Cardiothoracic Surgery residencies at George Washington University Medical Center in Washington, D.C.
Dr. Peyton is a graduate of the New York University School of Medicine and completed his Surgery and Cardiothoracic Surgery residences at Duke University Medical Center in Durham.
Their office is located at 2800 Blue Ridge Road, Suite 403, Raleigh, NC, 27607. Telephone: 919-784-7110.
Benjamin E. Haithcock, M.D., assistant professor in the UNC Division of Cardiothoracic Surgery, holds a joint appointment as assistant professor in the UNC Department of Anesthesiology as of Oct. 15, 2011. Dr. Haithcock also has been appointed assistant professor of surgery on the tenure track as of Oct. 15; since 2007, he had been clinical assistant professor of surgery. He also serves as associate program director for thoracic surgery in the UNC Division of Cardiothoracic Surgery as of September 2011 and as surgical director of the Lung Transplant Program at UNC Hospitals.
Nirmal K. Veeramachaneni, M.D., a thoracic surgeon and assistant professor in the UNC Division of Cardiothoracic Surgery, is co-investigator on a UNC research project funded by the American Cancer Society, “Lung cancer surgery: Decisions against life saving care – the intervention." Samuel Cykert, M.D., is principal investigator on the ACS study, which focuses on an intervention to optimize surgical rates for early stage non-small cell lung cancer and reduce disparities in the care of African American patients with this disease.
Lung cancer is the leading cause of cancer death in the United States. The only reliable treatment is removing tumors when the disease is at an early stage, but patients – especially African Americans - do not always move forward with surgery.
The $1.8 million American Cancer Society grant funds the project from July 1, 2011, to June 30, 2016. To read more about the project, click here.
Brett C. Sheridan, M.D., a cardiac surgeon and associate professor in the UNC Division of Cardiothoracic Surgery, has been reappointed by the U.S. Food and Drug Administration as a consultant to the FDA’s Circulatory System Devices Panel. He will also serve as a consultant to other panels of the FDA’s Medical Devices Advisory Committee, and to its Center for Devices and Radiological Health.
As a consultant, Dr. Sheridan reviews and evaluates data on safety and effectiveness of marketed and investigational devices. He has served in this role since 2007, and was recently reappointed to serve until November 2015.
The Thoracic Surgery Directors Association (TSDA) hosted its fourth annual Cardiothoracic Surgery Boot Camp, July 14-17, 2011, at UNC's Friday Center in Chapel Hill. First-year residents from 24 cardiothoracic surgery residency programs attended the camp to learn surgical techniques and get extensive hands-on practice.
The camp uses life-like simulators for surgical procedures. This year, procedures included cardiopulmonary bypass, aortic valve repair, anastomosis, lung ventilation, and lobectomy. Three UNC cardiothoracic surgeons - Richard Feins, M.D., Andy Kiser, M.D., and Nirmal Veeramachaneni, M.D., were among the faculty members. Read more .
In a conversation broadcast on National Public Radio's "Story Corps" series, Howell Graham remembers getting a double lung transplant at UNC in 1990. He was the first cystic fibrosis patient to undergo a double lung transplant at UNC Hospitals. At that time, lung transplantation was still a very new procedure, but the surgery, performed by Thomas M. Egan, MD, of the UNC Division of Cardiothoracic Surgery, was a success: Graham is now believed to be the longest-surviving double-lung transplant patient in the world.
UNC heart surgeon Andy Kiser, M.D., reflects on the remarkable story of one of his patients, Jakeina Sutton of Rose Hill, N.C., a 16-year-old who recently received a heart and kidney transplant. For Jakeina, this was her second heart transplant. Michael R. Mill, M.D., director of congenital cardiac surgery at UNC, performed her first heart transplant when Jakeina was only four months old. Read her story here.
Dr. Benjamin E. Haithcock and Dr. Michael R. Mill of the UNC Division of Cardiothoracic Surgery, who have been recognized as “top regional doctors” by Castle Connolly Medical Ltd. Thirty UNC Health Care physicians were on the list, which is based on recommendations of peers and evaluation by a national research panel that includes physicians.
Andy C. Kiser, M.D., has been named chief of the UNC Division of Cardiothoracic Surgery, effective July 1, 2011.
Dr. Kiser is a cardiothoracic surgeon who joined UNC as professor of surgery on Nov. 1, 2010. He is recognized as an international leader in arrhythmia surgery, having pioneered the paracardioscopic procedures to treat atrial fibrillation. He is a Fellow of the American College of Surgeons, American College of Cardiology, and the American College of Chest Physicians.
Dr. Kiser, a native of Moore County, N.C., earned his M.D. degree at UNC-Chapel Hill and completed his training in both General and Cardiothoracic Surgery at UNC, finishing in 2000. He practiced cardiac and thoracic surgery in Pinehurst until he joined the UNC faculty in November 2010. Since his return to UNC, Dr. Kiser has increased his clinical activity in minimally invasive cardiac and thoracic surgery, heart failure, and transplantation.
He replaces Michael R. Mill, M.D., who led the division as interim chief from 1998 to 1999 and as chief from 2000 to 2011.
Dr. Mill 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. He has served as Director of the UNC Comprehensive Transplant Center since 1994 and has performed 150 heart transplants, including 50 pediatric heart transplants, here. He also started the mechanical cardiac assist device program at UNC. He specializes in pediatric cardiac surgery and will continue to serve as a faculty member and attending physician at UNC.
“The Department of Surgery especially appreciates the 13 years that Dr. Mill has provided strong leadership for the division, and his continued direction of the congenital heart surgery program,” said Anthony Meyer, chairman of the UNC Department of Surgery.
Dr. Mill has been active on regional and national levels with Carolina Donor Services, the United Network for Organ Sharing, the Society of Thoracic Surgeons, the Thoracic Surgery Directors Association, the American Association for Thoracic Surgery, the Congenital Heart Surgeons Society, and the Southern Thoracic Surgical Association. He 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.
Dr. Mill was director of the UNC cardiothoracic surgery residency program during his time as chief. He served on the Residency Review Committee for Thoracic Surgery of the Accreditation Council for Graduate Medical Education, and participated in writing the requirements for the six-year integrated residency in cardiothoracic surgery, which enables medical-school graduates to enter a cardiothoracic residency straight from medical school and streamline their surgical training. (Previously, the path to becoming a cardiothoracic surgeon included about eight years of training after medical school.)
While Dr. Mill was chief, UNC added a six-year integrated residency in cardiothoracic surgery, which is now in its second year.
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 at Stanford University, where he trained with pioneering heart surgeon Norman Shumway.
Dr. Meyer said he would work with Dr. Kiser “to continue to further the goals of the Division of Cardiothoracic Surgery.” There are seven surgeons and six physician extenders in the division, which offers advanced treatments for a wide range of diseases and problems.
The division “is committed to caring for patients with complex cardiovascular problems such as aortic dissection, advanced heart failure, chronic atrial fibrillation, and lung or esophageal cancer,” Dr. Kiser said. “Collaboration is important, both within UNC Hospitals and statewide. Our vision is to develop more clinical partnerships with our colleagues.”
The division is part of the UNC Center for Heart and Vascular Care, which now has a one-call referral service (866-862-4327) to enable physicians to arrange consultations as well as admissions and transfers of patients to UNC Hospitals for care.
Congratulations to Ruben Bocanegra, a physician's assistant in the UNC Division of Cardiothoracic Surgery, who received a UNC "Star Heels" award at the UNC Department of Surgery's Grand Rounds on June 8, 2011.
Bocanegra, a longtime employee of the division, assists cardiac surgeons in the operating room. He was complimented for being a technically superb surgeon, for having a phenomenal work ethic, and for being an excellent, knowledgeable and patient teacher of residents, nurses and medical students.
The Star Heels program allows university departments to recognize and award excellent employees. Winners receive a Visa gift card and a certificate.
A new heart and a new kidney have given a 28-year-old Wilson woman a second chance at life. In late March, Crystal Sharpe became the 11th recipient of a heart and kidney transplant at UNC Hospitals. She had been ill with kidney problems since she was 7.
Andy Kiser, M.D., of the UNC Division of Cardiothoracic Surgery and UNC Center for Heart and Vascular Care, was Crystal's heart transplant surgeon.
“She should begin to start living a normal life,” Dr. Kiser said. “She doesn’t have to do dialysis anymore, but we do have to continue monitoring her heart and kidney to make sure they are working as they should. She has such a wonderful attitude and a strong support network in her family. She is very dear to a lot of the staff because she was in the hospital so long. We are very optimistic she will do fine.”
To read about Crystal and her mother and their experience at UNC in a story by Elizabeth Swaringen of UNC Health Care, click here.
The Agency for Healthcare Research and Quality (AHRQ) has awarded a three-year, $1.05 million grant to the University of North Carolina at Chapel Hill to study use of simulators for cardiac surgery training. The multi-institution project will study whether resident physicians who are learning cardiothoracic surgery can become safer surgeons by using surgery simulators to acquire skills before they operate on people.
Richard H. Feins, M.D., a thoracic surgeon in the Division of Cardiothoracic Surgery at UNC, is principal investigator of the project, which will involve cardiothoracic surgery residents at UNC and physicians and residents at seven other institutions:
Massachusetts General Hospital (Jennifer Walker, M.D.); Mayo Clinic (Harold Burkhart, M.D.), Johns Hopkins University (John Conte, M.D.), University of Rochester (George Hicks, M.D.), Stanford University (James Fann, M.D.), Vanderbilt University (Jonathan Nesbitt, M.D.), University of Washington (Nahush Mokadam, M.D.).
In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Dr. Feins' study intends to show that training in cardiac surgical techniques can be improved by using surgery simulation technology combined with a rigorous, simulation-based curriculum.
The project will determine the effectiveness of using simulator-based training of resident surgeons in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. The simulators are mannequins with computer-controlled pig hearts placed inside the chest area.
Assessment data from each site will be entered into a study database which will be developed and managed at the University of North Carolina. While the study will test the hypothesis that cardiac surgery residents can be trained to be safer surgeons by using appropriate simulator-based training, the results should apply equally well across a broad spectrum of surgical practice.
AHRQ is part of the U.S. Department of Health and Human Services. The grant period is May 1, 2011, to April 30, 2014.
The Convergent procedure, pioneered by Andy Kiser, a UNC cardiac surgeon, is an innovative, minimally invasive procedure that provides effective treatment of patients with chronic atrial fibrillation. A cardiac surgeon and an electrophysiologist work together to treat the inside and outside of the heart, redirecting electric impulses so that the patient reaches normal heart rhythm. The procedure offers 80 to 90 percent success rates. UNC is the only hospital in the state offering the procedure.
Ex-vivo perfusion offers a chance to evaluate lungs for transplant and also offers the chance to modify the lung to make it suitable for transplantation. Dr. Thomas Egan is featured in a recent update in the American Journal of Transplantation.
Richard H. Feins, MD, of the UNC Division of Cardiothoracic Surgery, was among 60 UNC Hospitals doctors recently named to the America's Top Doctors list, published by Castle Connolly Medical Ltd. Read more .
An article in the Winter 2011 issue of Endeavors, UNC’s research magazine, describes the cardiac surgery simulators that Richard Feins, M.D., and others have developed to teach surgery skills to resident physicians. The simulators use a pig heart inside a mannequin; the heart is connected to a computer that can help to create “adverse events” such as arrhythmias or cardiac arrest that might occur during surgery. Read the article here (PDF).
UNC has become a leader in use of ventricular assist devices (VAD) to treat patients with heart failure. A VAD is a mechanical circulatory device that provides continuous blood flow, replacing the function of a failing heart. UNC heart surgeon Brett Sheridan, MD, says use of the devices has become more common as their size, reliability and function have improved. Read about VADs and the experience of UNC patient Brian Ainsley in an article from UNC Health Care’s magazine, Well.