Download Report

YOURHEART
our commitment
HEARTANDVASCULAROUTCOMESREPORT
Heart and Vascular Outcomes
T
hecardiologistscardiothoracicsurgeonsandvascularsurgeonsatRogueValleyMedicalCenter
arepleasedtopresentthissecondbiennialeditionoftheHeartandVascularOutcomesReport
Thereportreviewstheactualvolumesandpatientoutcomesforeachcardiovascularprocedurecovers
newtechnologiesandprovidesanoverviewoftheentireheartandvascularprogramThedatareﬂects
ourdedicationtotreatingawiderangeofcardiovasculardiseases
AsphysiciansweallstrivetoprovidethebestpossiblecareforourpatientsSincetheinceptionofthe
cardiacprogramyearsagoatRogueValleyMedicalCenterwehavealwaysbelievedthatteamwork
amongphysiciansisessentialfordeterminingthebesttreatmentoptionforeachpatientWealsoaimfor
excellenceinallareasandtechniquessothatwecanachievethebestpossibleresultsOurperformance
improvementprogramprovidestimelyfeedbacksothatwecanmakecontinuousimprovements
Wehopeyouﬁndthisinformationinterestingandusefulandwelookforwardtoacontinuedcollaboration
withyousothattogetherwecanprovideyourpatientswiththebestpossibleoutcomes
—ThephysiciansandsurgeonsoftheHeartandVascularCenteratRogueValleyMedicalCenter
TheHeartofRogueValleyMedicalCenter
OurMission
Asanteexiststoprovide
qualityhealthcareservicesina
compassionatemannervaluedby
thecommunitiesweserve
OurVision
Asantewillberecognizedfor
medicalexcellenceforoutstanding
customerserviceandasa
greatplacetowork
TheValuesin
WhichWeBelieve
Excellenceineverythingwedo
Respectforall
Cardiac disease is the leading cause of death in Oregon and California. Fortunately, effective therapy is available.
Rogue Valley Medical Center, a part of the Asante family, is a tax-exempt 378-licensed-bed facility created by and
for the people of Southern Oregon and Northern California over 50 years ago. It is a nationally recognized program
providing highly specialized heart and vascular care.
RogueValley
MedicalCenter
Opens
Cardiac
FirstCardiac
FirstOpen
IntensiveCare Catheterization HeartSurgery
UnitOpens LaboratoryOpens
CardiacFacilitiesatRVMC
t Cardiac Intensive Care Unit (16 beds)
t Heart Center (52 telemetry beds)
t Cardiac Catheterization Laboratories
· 2 outpatient labs
· 5 inpatient labs
t Cardiovascular Recovery Unit
t 3 Operating Rooms for cardiovascular procedures
· 2 dedicated to open heart procedures
· The region’s only endovascular angiographic suite
t Imaging Department
· Echocardiography
· Stress Nuclear
· Cardiac CT
Honestyinallourrelationships
Servicetothecommunity
physiciansandeachother
Teamworkalways
Physiciansallboardcertiﬁed
t 16 Cardiologists
t 4 Cardiothoracic Surgeons
t 5 Vascular Surgeons
t 6 Cardiac Anesthesiologists
t 4 Intensivists
t 17 Hospitalists
FirstCoronary
Balloon
Angioplasty
ASSET
Program
Established
PatientTower
Constructed
OtherTeamMembers
includingphysicianassistants
nursestechniciansandclinicians
The first number represents the total number of
people working in that department. Numbers in
parenthesis represent people with 10 or more years’
experience in that particular field.
t Operating Room 13 (9)
t Cardiac Perfusionists 4 (4)
t Cardiac Catheterization Laboratory
· RVMC 21 (20)
· RVMC Lab at the Cardiovascular Institute 11 (4)
t Cardiovascular Recovery 12 (3)
t Cardiac Intensive Care Unit 47 (16)
t Heart Center 145 (38)
t Cardiac Clinical Case Managers 6 (3)
t Cardiac Rehabilitation 8 (5)
t Echocardiographers 8 (6)
t Vascular Ultrasound 3 (2)
t Stress Testing 6 (2)
t Cardiopulmonary 7 (3)
t Clinical Quality Analysts 4 (3)
Heart and Vascular Outcomes
Table of Contents
CoronaryArteryDisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
VascularSurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
CardiacCatheterizationandCoronaryIntervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RVMCCardiovascularLabattheCardiovascularInstitute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MyocardialInfarctionTheASSETProgram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HypothermiaforCardiacArrestPatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EnhancedExternalCounterpulsation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ComprehensiveVascularCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AorticAneurysmRepair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CarotidEndarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CarotidStenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .–
Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
NoninvasiveDiagnosticTesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CardiacCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CoronaryCalciumScore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ElectrophysiologyProgram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DiagnosticElectrophysiologyStudies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TiltTableTesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IntracardiacAblation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PulmonaryVeinAntralIsolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DeviceImplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LeadExtractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PreventiveCardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
HeartTransplantCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TherapiesontheHorizon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CongenitalHeartDisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . QualityOurApproach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-
AdultCongenitalHeartDisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CardiovascularScreeningforYoungCompetitiveAthletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PhysicianBiographies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
CardiacSurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
CardiacRehabilitationProgram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SecondaryPrevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CardiacEducators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ContactInformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CardiothoracicSurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CoronaryArteryBypassGra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ValveProcedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MinimallyInvasiveValveProcedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STSRiskAdjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EndovascularTreatmentofThoracicAorticAneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TransmyocardialRevascularization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AtrialFibrillation/MazeProcedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CORONARYARTERYDISEASE
Coronary Artery Disease
CardiacCatheterizationandCoronaryIntervention
Coronary
interventionalprogram
startedatRVMC
Cardiac catheterization facilities at Rogue Valley Medical Center were established in 1973. Five catheterization and
angiographic laboratories are dedicated to state-of-the-art diagnostic coronary angiography, coronary interventions,
peripheral angiography and interventions, electrophysiologic procedures, and device implants. Board certification
in cardiology is required of all cardiologists. Cardiologists who perform coronary interventions are board certified
in interventional cardiology.
Expertise is maintained by focusing procedural experience within a small group of high-volume, experienced
interventionalists whose complication rates and outcomes exceed national benchmarks. Coronary interventional
volume for the institution and for each interventionalist exceeds volume recommendations established by the
Leapfrog Group, Thomson Healthcare, and the American College of Cardiology. A proven record of satisfactory
outcomes and active participation in quality improvement programs is mandatory for all physicians.
RVMC continues to adhere to the percutaneous
coronary intervention (PCI) guidelines written and
recommended by the American Heart Association,
the American College of Cardiology, and the Society
of Cardiac Angiography and Interventions. These
guidelines are as follows:*
t Operators perform at least 75 procedures at
high-volume hospitals (more than 400 procedures
per year) with on-site cardiac surgery.
t Operators and institutions should have outcomes
comparable to those reported in contemporary
national data registries.
t For ST-segment elevation myocardial infarction
(STEMI), emergent PCI should be performed
by experienced operators who do more than 75
elective PCI procedures per year and, ideally, at
least 11 PCI procedures for STEMI each year.
Ideally, these procedures should be conducted in
institutions that perform more than 400 elective
PCIs per year and more than 36 primary PCI
procedures for STEMI per year.
RVMCcathlabteam
*SmithSCJrFeldmanTEHirshfeldJWJrJacobsAKKernMJKing
SBIIIMorrisonDAO’NeillWWSchaﬀHVWhitlowPLWilliamsDO
ACC/AHA/SCAIguidelineupdateforpercutaneouscoronary
interventionAreportoftheAmericanCollegeofCardiology/American
HeartAssociationTaskForceonPracticeGuidelinesACC/AHA/SCAI
WritingCommieetoUpdatetheGuidelinesforPercutaneous
CoronaryInterventionCirculation–
Heart and Vascular Outcomes
AnnualVolumeofDiagnosticCoronaryAngiograms
RVMC
RVMCLabatCardiovascularInstitute
coronary
interventionshavebeen
performedsince
CombinedVolume
Theﬁveinterventional
cardiologistsareboardcertiﬁedin
bothcardiovasculardiseaseand
interventionalcardiologyandprovide
around-the-clockcoverage
AnnualVolumeofCoronaryInterventionalProcedures
atRogueValleyMedicalCenter
CurrentUseofBareMetalStents
andDrug-ElutingStents
TypeofStentUsed
Year
BareMetalStent
Drug-ElutingStent
RVMCcardiovascularrecoverystaﬀ
cardiacprocedures
havebeenperformedat
RVMCsince
CORONARYARTERYDISEASE
Coronary Artery Disease
Stentbetweenﬁngers
CourtesyofCordis
Pressurewiremeasurementofahemodynamically
signiﬁcantcoronaryarteryblockage
CourtesyofVolcano
Pressurewireandintravascular
ultrasonographyprovideadditional
physiologicandanatomicinformation
regardingcoronaryarteryplaques
Drug-elutingstent
Stent
CourtesyofFairmanStudios
Intravascularultrasoundimagecross-sectionalviewofa
coronaryarterywithaneccentricatheromatousplaque
Workhorseballoonforangioplasty
CourtesyofBostonScientiﬁc
CourtesyofCordis
Cuingballoonwithsurgicalblades
mountedontheballoon
CourtesyofBostonScientiﬁc
CourtesyofVolcano
Diamond-coatedburrthatspinsat
revolutionsperminutetodrill
throughheavilycalciﬁedlesions
CourtesyofBostonScientiﬁc
Heart and Vascular Outcomes
GilGilbertson
GrantsPassOregon
Chronictotalocclusioninmid-rightcoronaryartery
Simultaneousleandrightcoronaryinjectionsto
visualizetheentirerightcoronaryarteryandlengthof
occlusionNotetheinchcoronarywirehalfway
throughtheocclusion
Stentdeployedwithballooninﬂation
Twostentsrequirednoremainingblockage
Sheriff Gilbertson had noted debilitating angina
for two months. Coronary angiography showed a
long occlusion in the mid-right coronary artery with
faint collaterals to the distal vessel. Fortunately, he had
normal left ventricular systolic function. At the time
of percutaneous coronary intervention, simultaneous
left and right coronary angiography was performed
to determine the full length of the blockage and to
visualize the destination of the coronary wire. A special
coronary wire was utilized to cross the hard blockage,
and two coronary stents were deployed with good
result. Gil is now symptom-free and has no
physical limitation.
CORONARYARTERYDISEASE
Coronary Artery Disease
RVMCCardiovascularLabattheCardiovascularInstitute
Each year 16 cardiologists and five vascular surgeons perform a high volume of diagnostic cardiac catheterizations,
peripheral angiograms, and peripheral vascular interventions at the RVMC Cardiovascular Lab. Located in a comfortable,
state-of-the-art facility within the outpatient facilities of the Cardiovascular Institute (CVI) on the RVMC campus, the
RVMC Cardiovascular Lab allows elective studies to be performed conveniently; total stays average just four hours.
PeripheralInterventionVolume
CathlabstaﬀatCVI
Awiderangeofdiagnostic
andinterventionalprocedures
areperformedinseven
state-of-the-artcatheterization
laboratoriesﬁveatRVMC
andtwoatCVI
PeripheralAngiographyVolume
Includesupper-andlower-extremityangiographyrenalangiography
mesentericangiographyandiliacangiography
Includescarotidangiographyrenalangiographymesenteric
angiographyupper-andlower-extremityangiography
andabdominalangiography
CardiacCatheterization/CoronaryAngiographyVolume
PeripheralAngiographyComplications
Stroke
MyocardialInfarction
Death
Nostrokemyocardialinfarction
ordeathfromto
Heart and Vascular Outcomes
MyocardialInfarctionTheASSETProgram
ASSETProgram
MissionStatement
ASSET (Acute ST-Segment Elevation Task Force) is a regional heart attack response team that coordinates the
simultaneous activation of paramedics, emergency departments, and the cardiac catheterization laboratory at RVMC
for rapid identification, triage, and treatment of ST elevation myocardial infarction patients (severe heart attacks)
throughout Southern Oregon and Northern California. The ASSET program has received national recognition for
its dramatic reduction in death rates from heart attacks and is serving as a model for other programs in development
across the country. The program represents the integration of care supported by the efforts of hospitals within the direct
ASSET service area, hospitals within the regional support services area whose initial management may include
thrombolytic therapy followed by emergent transfer for possible rescue PCI, and those hopitals having PCI
capability supported by the cardiothoracic surgical program at RVMC.
ASSETRegionalSTEMIreceiving
hospitalforPrimaryPCI
tRogue Valley Medical Center
ASSETServiceAreaSTEMIreferring
hospitalsforPrimaryPCI
t Ashland Community Hospital t Fairchild Medical Center
t Providence Medford Medical Center
t Three Rivers Community Hospital
ASSET RegionalSupportServiceArea
hospitalsprovidingthrombolytictherapy
withemergenttransfertoRVMC
tCurry General HospitaltLake District Hospital
tSutter Coast Hospital
ASSETServiceArea
O R E G O N
Coos Bay
Coquille
Bandon
ASSETServiceArea
ASSETRegional
SupportServicesArea
Roseburg
Myrtle Point
Myrtle Creek
Port Orford
Paisley
Chiloquin
Gold Beach
Redwood
Grants Pass
Rogue River
Cave Junction
CardiothoracicSurgerySupport
tMercy Medical CentertSky Lakes Medical Center
Tofacilitatetheaccurateandrapid
diagnosistreatmentandtransport
ofpatientswithacuteST-Segment
ElevationMyocardialInfarction
STEMIfromthroughouttheregion
totheRogueValleyMedicalCenter
cathlabforemergentPercutaneous
CoronaryInterventionPCI
Brookings
RVMC
Medford
Klamath Falls
Ashland
Harbor
Dorris
ParticipatingHeartSpecialists
t"TBOUF$BSEJPWBTDVMBSBOEɨPSBDJD4VSHFPOT
t4PVUIFSO0SFHPO$BSEJPMPHZ--$
Happy Camp
Crescent City
Yreka
Montague
C A L I F O R N I A
cardiologistsandfourcardiothoracic
surgeonsworktogethertoprovide
carearound-the-clock
Malin
Tulelake
5
CorePartnership—EmergencyServices
t"NFSJDBO.FEJDBM3FTQPOTF".3
t"TIMBOE'JSF3FTDVFt+BDLTPO$PVOUZ'JSF%JTUSJDUǢ
t.FEGPSE'JSF%FQBSUNFOUt.FSDZ'MJHIUT
t/PSUIFSO4JTLJZPV"NCVMBODF
t3PHVF3JWFS'JSF%JTUSJDU
Altamont
Lakeview
CORONARYARTERYDISEASE
Coronary Artery Disease
DonAckley
MyocardialInfarctionTimeIsMuscle
KenoOregon
Cross-sectionalimageoftheleventricle
duringaninferiormyocardialinfarction
Don developed severe indigestion while playing Yahtzee with his wife at
Fish Lake. Butte Falls Mercy Flights paramedics promptly responded,
and the patient was emergently transported to Rogue Valley Medical
Center by helicopter in minutes. He was taken directly to the cardiac
catheterization laboratory, where emergent coronary angiography revealed
a thrombotic occlusion in his proximal right coronary artery. Mechanical
thrombectomy restored coronary blood flow. Balloon angioplasty was
performed followed by stent deployment to ensure vessel patency. Hospital
arrival-to-balloon time was 18 minutes. The patient did well and was
discharged home three days later. Don is currently asymptomatic with
normal left ventricular systolic function.
hours
hours
hours
Healthyheartmuscle
Deadheartmuscle
iemyocardialinfarctionheartaack
Bloodwithintheheart
CoronaryArteryStenting
Coronaryarteryatheroscleroticplaque
Thromboticocclusionin
proximalrightcoronaryartery
Ballooninﬂation
Bloodﬂowrestoredbut
severeblockageremains
Low-proﬁlestentandballoonadvancedacrossblockage
Ballooninﬂationresultsinstentdeployment
Stentdeployedwith
ballooninﬂation
Widelypatentstentwith
excellentbloodﬂow
Balloonremovedstentmaintainsanopenartery
Heart and Vascular Outcomes
–ASSETPatientsAverageMedianTimetoTreatmentforSTEMI
TimeatReferringHospital
ParamedicTransportTime
TimefromEmergencyDepartmentDoortoCardiacCathLabDoor
CardiacCathLabArrivaltoOpenArtery
minutes
RVMCdoor–to–wiretime
AllASSETPatientsJun–Decn
minutes
RVMCdoor–to–wiretime
minutes
RVMCdoor–to–balloontime
AllASSETPatientsJun–Augn
AllASSETPatientsJan–Decn
minutes
RVMCdoor–to–balloontime
AllASSETPatientsJan–Dec
n
minutes
RVMCdoor–to–balloontime
AllASSETPatientsJan–Decn
minutes*
RVMCdoor–to–balloontime
AllASSETPatientsJan–Decn
TimeinMinutes
ArrivalatRVMC
*Door-to-balloontimeof
ASSETPatientsAverageMedianTimetoTreatmentforSTEMI
Timeat
ReferringHospital
Paramedic
TimeonScene
Paramedic
TransportTime
TimefromEmergencyDepartment
DoortoCardiacCathLabDoor
Patientsoenbroughtdirectly
tothecardiaccatheterization
laboratorybyparamedics
TransferfromReferringHospitaln
minutesplacesRVMC
amongthetopperformers
inthenation
CardiacCathLabArrival
toOpenArtery
Paramedicn
Patientarrivesunnannouncedto
theRVMCEmergencyDepartment
ASSETTeamemergentlyactivated
RVMCn
minutes*RVMCdoor–to–balloontime
AllASSETPatientsn
TimeinMinutes
ArrivalatRVMC
CORONARYARTERYDISEASE
Coronary Artery Disease
PatientswithDoor-to-BalloonTimewithinMinutes
–
TotalnumberofSTEMIpatientsfromto
RVMCEmergencyDepartmentstaﬀ
STEMIMortality
ASSETSTEMIPatients
TransferfromReferringHospital
Paramedic
RVMC
Total
–
Heart and Vascular Outcomes
HistoricalMyocardialInfarctionMortalityRates
HistoricalNationalHospitalMortalityRatesforSTElevationMyocardialInfarctionHeartA!ack
Apercentmortality
rateisamongthelowest
reportedinthenation
s
s
s
ASSETProgramatRVMC
–n
SourceClinicalPracticeGuidelinesAHCPRPublicationNo-
percentofpatientshad
hospitaldoor–to–balloontimes
withinminutesin
makingASSEToneofthe
elitemyocardialinfarction
programsinthecountry
STElevationMyocardialInfarctionIn-HospitalMortalityComparisonRVMCVersusOtherHospitals
NationalRegistryof
MyocardialInfarction
“SimilarHospitals”
RVMC
ASSET
ServiceArea
patientstreatedatRVMCforSTEMI
fromJunethroughDecember
CORONARYARTERYDISEASE
Coronary Artery Disease
NationalRecognition
Primarypercutaneous
coronaryinterventionisthe
mostcomplexmultidisciplinary
andtime-sensitivetherapeutic
interventionintheworldof
medicinetoday
“An Approach to Shorten Time to Infarct Artery Patency in
Patients with ST-Segment Elevation Myocardial Infarction”
American Journal of Cardiology
2007;99:1360–63.
Theprocess
ismeasuredinminutes
Theoutcomes
aremeasuredinmortality
Teamworkandsmooth
transitionsareessential
—IvanRokosMD
STEMISystemsMay
“Integration of Pre-Hospital Electrocardiograms
and ST-Elevation Myocardial Infarction Receiving
Center (SRC) Networks: Impact on Door-to-Balloon
Times Across 10 Independent Regions”
Journal of the American College of Cardiology:
Cardiovascular Interventions
2009;2(4):339-46.
Heart and Vascular Outcomes
Cardiac arrest (ventricular fibrillation) results in
impaired blood flow to the brain. A prolonged cardiac
arrest (more than five minutes) can cause brain damage
(anoxic encephalopathy). On occasion the heart can
be stabilized, but the patient remains unresponsive
due to inadequate cerebral perfusion. Inducing
mild hypothermia to a core body temperature of
33 degrees C via an external cooling blanket reduces
cerebral metabolism and edema and increases the
likelihood of making a meaningful neurologic recovery.
This treatment has been proven to save one additional
life for every seven patients treated and is currently
recommended by the American Heart Association.
At Rogue Valley Medical Center, 40 patients were
treated from November 2006 through December
2009. Eighteen patients survived, and seven required
rehabilitation care.
CumulativeSurvivalinthe
HypothermiaandNormothermiaGroups
Hypothermia
C
Normothermia
NoTemperatureAdjustment
Survival
HypothermiaforCardiacArrestPatients
SteveFredricksen
Days
SourceTheHypothermiaaerCardiacArrestStudyGroup
NewEnglandJournalofMedicine–
HypothermiaPatientSurvivors
Nov
throughDec
n
n
n
Averageage
years
Averagelengthofstay
days
CourtesyofAbboNorthwesternHospital
MedfordOregon
Steve is a radiologic technologist and
former cardiac catheterization lab manager
at Rogue Valley Medical Center who suddenly
collapsed at an auto body shop. The owner
promptly provided cardiopulmonary
resuscitation (CPR), and paramedics found
Steve in ventricular fibrillation. He was
successfully electrically cardioverted to sinus
rhythm. Subsequent coronary angiography
showed severe left main and three-vessel
coronary artery disease. An intra-aortic
balloon pump was placed. He was initially
unresponsive due to anoxic encephalopathy,
and hypothermia was induced. He fortunately
made a full neurologic recovery and underwent
six-vessel coronary artery bypass graft surgery.
He made a complete recovery and has
returned to work without limitation. Steve
remains a valued and important member
of the cath lab team.
CORONARYARTERYDISEASE
Coronary Artery Disease
EnhancedExternalCounterpulsation
For patients with debilitating chronic angina not
amenable to coronary revascularization (stent or
bypass surgery), Enhanced External Counterpulsation
(EECP) is a well-tolerated, atraumatic, noninvasive
procedure that can reduce the symptoms of angina
pectoris, presumably by increasing coronary blood
flow to ischemic areas of the heart.
DuringanEECPtreatmentthepatient’s
calvesandthighsarewrappedwithcompressive
cuﬀsthatareinﬂatedanddeﬂatedaccording
tothecardiaccycleThisresultsinimproved
diastoliccentralaorticpressureand
increasedcoronaryperfusionpressure
The EECP device uses a series of compressive cuffs
wrapped around the patient’s calves, thighs, and
buttocks and synchronizes their inflation and deflation
to the cardiac cycle. During diastole the cuffs inflate
sequentially from the calves proximally, resulting
in augmented diastolic central aortic pressure and
increased coronary perfusion pressure (when coronary
artery flow is maximal). Rapid and simultaneous
decompression of the cuffs at the onset of systole reduces
the systolic pressure and the cardiac workload.
Patients typically undergo 35 one-hour sessions
over a seven-week period and should first be evaluated
by a cardiologist. There have been 170 patients since
the program was established in 2003.
percentofpatientsnoted
animprovementindistancethat
canbewalkedinsixminutes
ApprovedbythefederalFoodandDrug
AdministrationFDAandMedicare
ChangeinNitroglycerinUsen"
ChangeinChestPainn"
TwoWeeksAer
CompletionofTherapy
AtCompletionofTherapy
OneYearLater
Good
Slight
Unchanged
Improvement Improvement
OneYearLater
RVMCcardiopulmonaryandEECPstaﬀ
Although the mechanism at work is unclear
(possibly improved collateral flow), studies have
repeatedly shown that 60 to 80 percent of patients
experience the following results:
t Reduced frequency and intensity of chest pain
t Increased exercise tolerance
t Reduced need for anti-anginal medications
(such as nitroglycerin)
t Improved sense of well-being and quality of life
Worse
Large
Reduction
inUse
Slight
Reduction
inUse
Unchanged
Worse
ARRHYTHMIAS
Arrhythmias
Heart and Vascular Outcomes
ElectrophysiologyProgram
TiltTableTesting
Rogue Valley Medical Center’s electrophysiology (EP) program provides comprehensive diagnostic and therapeutic
management of simple and complex heart rhythm disorders, device management for heart failure, evaluation and
management of syncope, and sudden-death risk assessment and management. Our large procedure volumes, well-equipped
electrophysiology laboratories, and highly experienced electrophysiologists and staff account for the excellent patient
outcomes and are comparable to the nation’s highest-rated programs. Both electrophysiologists at RVMC are certified
by the American Board of Internal Medicine in cardiovascular disease and electrophysiology.
This simple, noninvasive test is used to evaluate
for neurocardiogenic (vasovagal) physiology as a part
of the evaluation of patients with syncope. The test
is often used to evaluate patients with recurrent
syncope of unknown cause unlikely to be related
to pathologic arrhythmia, such as those with
structurally normal hearts.
Diagnostic EP studies are routine heart catheterization procedures used to identify and guide the treatment of
heart rhythm disorders. Sophisticated, state-of-the-art three-dimensional (3D) electroanatomical mapping systems
are used (like a global positioning system for the heart) to guide the clinician’s understanding and treatment of
complex arrhythmia mechanisms. Often these diagnostic procedures are done in the same setting as therapeutic
intracardiac ablations, pacemaker insertions, or defibrillator implants as indicated. These tests have a complication
rate well below 1 percent.
ElectrophysiologyStudies
LoopRecorderImplants
NumberofDiagnostic
ElectrophysiologyStudies
Numberof
TiltTableStudies
DiagnosticElectrophysiologyStudies
ARRHYTHMIAS
Arrhythmias
JamesWatson
IntracardiacAblation
LasVegasNevada
Ablations are catheter-based procedures performed
to treat a variety of arrhythmias, including many
forms of supraventricular tachycardia, atrial flutter,
atrial fibrillation, and some types of ventricular
tachycardia. Radiofrequency energy is used to ablate
arrhythmia foci and reentrant circuits to manage
tachyarrhythmias. Cure rates for many arrhythmias
exceed 95 percent, with complication rates usually
less than 1 percent.
+BNFTJOJUJBMMZQSFTFOUFEXJUIOPOJTDIFNJDDBSEJPNZPQBUIZDISPOJDBUSJBMëCSJMMBUJPOBOEWFOUSJDVMBS
tachycardia (VT) originating from the right ventricular outflow tract. His atrial fibrillation was initially
controlled with dofetilide and carvedilol, but his ventricular tachycardia remained refractory to medical
therapy. He underwent radiofrequency ablation of two separate VT foci, utilizing a 3D basket catheter in the
right ventricular outflow tract (figure 1). This allowed simultaneous recording from 64 locations and permitted
single-beat mapping and ablation of his abnormal foci (figure 2). Fourteen months later he presented with
recurrent atrial fibrillation and congestive heart failure, with left ventricular ejection fraction 30 percent
refractory to dofetilide and dronedarone. He underwent radiofrequency ablation for his atrial fibrillation,
utilizing antral isolation supplemented by targeting of complex atrial electrograms and including them in our
lesion set. Three-dimensional mapping software reconstructed the left atrium and guided our lesion set (figure 3).
+BNFTJTOPXGSFFPGBUSJBMëCSJMMBUJPOBOEWFOUSJDVMBS
tachycardia. His left ventricular function has returned
to normal, and he is off all anti-arrhythmics.
Patientswithhighly
symptomaticatrialﬁbrillation
whofailedanti-arrhythmic
therapyoenbeneﬁtfrom
intracardiacablationtherapy
NumberofAblationProcedures
figure 2— Electrogramsofright
ventricularoutﬂowtractablation
figure 1— Biplaneimageofbasketcatheterin
rightventricularoutﬂowtract
figure 3— AtrialﬁbrillationDmapping
Fromtotherehasbeenonlyoneprocedure-related
deathpatientwithsevereischemiccardiomyopathyandelectrical
stormierefractoryventriculartachycardia
Heart and Vascular Outcomes
IntracardiacAblationComplications
Death
MyocardialInfarction
Stroke
Tamponade
figure 1— Dvoltagesubstratemapoftheleventricle
PulmonaryVeinAntralIsolation
Pulmonary vein antral isolation, also known as atrial
fibrillation ablation, is used to treat problematic atrial
fibrillation when anti-arrhythmic medications fail. The
procedure isolates nests of atrial fibrillation–generating
tissue in the posterior part of the left atrium and
sometimes the superior vena cava. Mapping systems are
used to generate atrial geometry that is then merged
with computerized axial tomography (CT) scans of
the posterior atria and the pulmonary veins to guide
ablation and electrical isolation of areas of the heart
that trigger and sustain atrial fibrillation. Cure rates
vary with the extent of cardiac pathology and range
from 50 to 80 percent.
NinaKiskadden
JacksonvilleOregon
Nina is an active volunteer firefighter who was walking up a steep hill when she collapsed
due to ventricular tachycardia. Coronary angiography showed an occlusion in her distal
obtuse marginal artery. Left ventriculography showed evidence of a prior small posterolateral
myocardial infarction. The patient’s ventricular tachycardia was not hemodynamically
tolerated for routine mapping and ablation. A three-dimensional voltage substrate map of the
left ventricle was constructed, which demonstrated the posterolateral scar and arrhythmogenic
corridor bordered by the mitral annulus (figure 1). Substrate mapping is a relatively new way
of approaching ventricular tachycardias that cannot be mapped due to hemodynamic collapse.
Radiofrequency ablation between the posterolateral scar and the mitral annulus obliterated
the clinical ventricular tachycardia. The patient has had no recurrence and has led a very
active lifestyle, including horseback riding. We use 3D mapping systems that provide
electroanatomic information defining scar tissue, normal tissue, and transitional tissue.
The abnormal circuits are ablated, providing an option to a previously “impossible” situation.
ARRHYTHMIAS
Arrhythmias
DeviceImplantation
RVMC’s electrophysiology laboratory implants the full range of cardiac rhythm management devices, including
pacemakers, implantable cardioverter defibrillators (ICDs), implantable loop recorders, and cardiac resynchronization
(biventricular, or Bi-V) devices for the management of heart failure. ICDs have dramatically reduced arrhythmic
and all-cause mortality in at-risk individuals. Biventricular pacing (with and without an ICD) has become a routine
part of managing patients with advanced heart failure. Pacing leads are used to synchronize activation of the right and
left ventricles to improve contractile dynamics, left ventricular ejection fraction, exercise capacity, and survival.
PacemakerandImplantableCardioverterDeﬁbrillatorVolumes
LakeviewOregon
Kathy is a retired waitress who presented
with progressive and severely debilitating
heart failure, left ventricular ejection fraction
(LVEF) 30 percent, 3+ mitral regurgitation,
and 4+ tricuspid regurgitation (0–4 scale)
despite good medical therapy, including
high-dose diuretics. Coronary and bypass
graft angiography revealed a severe stenosis
at the origin of the posterior descending
artery. A coronary stent was deployed with
good result. She also had a left bundle branch
block with dyssynchronous contractility of
her septal wall. She underwent implantation
of a biventricular pacemaker/intracardiac
defibrillator. Four months later Kathy was
asymptomatic with LVEF 60 percent, 1+ mitral
regurgitation, and 1+ tricuspid regurgitation.
DeviceImplantationComplicationRates
PercentageofPatients
EKathyOverton
PopulationTotalCombined
ProcedureRelated
Deaths
Infections
Hematoma
Requiring
Re-Exploration
Pneumothorax
Lead
Dislodgement
Chamber
Perforation
ComplicationratesareforpacerbiventricularpacerandICDimplantsFordeviceimplantscomplicationratesaredeﬁnedasprocedure-relatedmortality
infectionhematomarequiringre-explorationpneumothoraxleaddislodgmentandperforation
Heart and Vascular Outcomes
LeadExtractions
DistributionofDeviceImplantation
ICDs
Bi-VDevices
Pacemakers
The effectiveness and the dramatic increase in the use
of implanted cardiac devices have resulted in the need
for complex device management and, at times, the
removal of implanted pacing and ICD systems, including
leads that have been in place for an extended time.
Laser lead extraction is used to remove highly fibrosed
lead systems from the heart and the vascular system
after extended use. Although serious intrathoracic
bleeding can occur during lead removal, careful
planning, monitoring, and technique by experienced
physicians have led to a high success rate.
RVMCparticipates
intheAmericanCollegeof
Cardiology’sICDRegistry
Biventricularpacing/ICDleadsinheart
CourtesyofBostonScientiﬁc
Pacemakersanddeﬁbrillatorsare
implantedandmanagedonlyby
physicianswhoarecertiﬁedby
theHeartRhythmSociety
ARRHYTHMIAS
Arrhythmias
IndicationsforICDTherapy
CardiacarrestduetoventricularﬁbrillationVF
orventriculartachycardiaVTunrelatedtoa
reversiblecause
SustainedVTassociatedwithstructural
heartdisease
Syncopeofundeterminedoriginwithinducible
VTattimeofelectrophysiologicstudiesEPS
NonsustainedVTinpatientswithischemic
cardiomyopathyejectionfractionEF≤ percentandinduciblesustainedVTatEPS
“Cardiacsyncope”inpatientswith
cardiomyopathyandnoexplanationof
mechanismofsyncopeaerEPS
a Syncopeinseingofcardiomyopathy
warrantshospitalizationandreferralto
arrhythmiaspecialist
Patientswithpotentiallylethalgeneticdisorders
andhigh-riskcharacteristics
a ProlongedQTsyndrome
i Recurrentsyncopedespitetreatment
withbeta-blockers
ii Signiﬁcantfamilyhistoryofunexplained
suddencardiacdeathSCDespecially
ifpatienthassyncope
iii VF
b Brugadasyndrome
i SyncopewithspontaneousBrugadaEKG
ii VF
c Hypertrophiccardiomyopathy
i Hypertrophy≥ mm
ii Signiﬁcantfamilyhistory
iii NonsustainedVT
iv Syncope
v Abnormalbloodpressureresponsetoexercise
vi VT/VF
d Rightventriculardysplasia
i Syncope
ii SigniﬁcantfamilyhistoryofSCD
iii VT/VF
Heart Transplant Care
PrimarypreventionofSCDinpatientswith
ischemiccardiomyopathyandEF≤ percent
a Receivingoptimalmedicaltherapy
b Atleastdaysaermyocardialinfarction
c Lifeexpectancyofatleastoneyearwithgood
functionalstatus
d ClassI–IIIcongestiveheartfailureCHF
e ClassIVCHFifcandidateforbiventricularpacing
PrimarypreventionofSCDinpatientswith
nonischemiccardiomyopathyandEF≤ percent
a Receiptofoptimalmedicaltherapyfor
pastthreetoninemonths
b ClassII–IIICHF
c ClassIVCHFifcandidateforbiventricularpacing
BasedontheDeviceImplantationGuidelinesandtheSeptember
PreventionofSuddenCardiacDeathGuidelines
IndicationsforBiventricularPacing
ClassI–IVheartfailuresymptomswithle
bundlebranchblockLBBBorintraventricular
conductiondefectIVCDwithQRSms
a Receiptofoptimalmedicaltherapyfor
pastthreetoninemonths
b EF≤ percent
Anypatientwithsigniﬁcantcardiomyopathythat
requiressustainedventricularpacingsupport
a Rightventricularapicalpacingisknown
tobedetrimentalinthispatientsubset
b Itisreasonabletoupgradeapatientfroma
dual-chamberpacingdeviceifEF≤ percent
andClassIII–IVCHFsymptomsarepresent
Patientswithatrialﬁbrillationwhorequire
atrioventricularnodalablation
a Heartfailuresymptoms
b Leventriculardysfunction
Mark Huth, MD, PhD, FACC, specializes in
the care of patients who have had heart transplants.
He earned both his doctor of philosophy and his
medical degree and served as an assistant professor of
medicine at the University of Washington in Seattle.
Myocardial biopsies are performed to monitor for
rejection. Coronary angiography and intravascular
ultrasonography are available to monitor coronary
allograft vasculopathy.
CONGENITALHEARTDISEASE
Congenital Heart Disease
Heart and Vascular Outcomes
AdultCongenitalHeartDisease
Care of the adult congenital heart disease (ACHD)
patient is a rapidly growing subspecialty of cardiology.
These patients are survivors of childhood congenital
heart operations and interventional procedures and
include those adults who have undiagnosed cardiac
disease of a congenital origin. Based on conservative
estimates of 800,000 such patients in the United
States, it is estimated that there are 12,000 Oregonians
with ACHD.
Care of these patients is highly complex and can
often involve multiple specialties. Unique issues
during non-cardiac surgery, general medical care,
and high-risk obstetrical care are some of the concerns
addressed by ACHD specialists.
Therearetwo
echosonographers
whoareboardcertiﬁed
inpediatricecho
At RVMC, and in conjunction with the Pediatric
and Adult Congenital Cardiac Units at Oregon
Health Sciences University (OHSU), we are able
to deliver state-of-the-art care with multimodality
imaging, electrophysiological (EP) evaluation and
treatment, outpatient follow-up, and cardiac surgical
care. Other issues addressed by the ACHD section
include preparticipation screening for young athletes,
patients with Marfan syndrome, and other inherited
diseases of the cardiovascular system.
Brian Morrison, MD, FACC, specializes in the care
of ACHD patients. He trained at the internationally
known UCLA Adult Congenital Heart Disease
Center—the first and one of the largest of its kind
in the United States. He has served as an assistant
clinical professor at the OHSU Division of Pediatric
Cardiology for the past 12 years and has spoken
at national meetings.
Cardiovascularcausesofsudden
deathassociatedwithsports
Agegreaterthanorequaltoyears
s "UIFSPTDMFSPUJDŐDPSPOBSZŐ
arterydisease
Agelessthatyears
s )ZQFSUSPQIJDŐDBSEJPNZPQBUIZ
s "SSIZUINPHFOJDŐSJHIUŐWFOUSJDVMBSŐ
cardiomyopathyordysplasia
s 1SFNBUVSFŐDPSPOBSZŐBUIFSPTDMFSPTJT
s $POHFOJUBMŐBOPNBMJFTŐPGŐ
coronaryarteries
s .ZPDBSEJUJT
s "PSUJDŐSVQUVSF
s 7BMWVMBSŐEJTFBTF
s 1SFȬFYDJUBUJPOŐTZOESPNFTŐBOEŐ
conductiondiseases
s *POŐDIBOOFMŐEJTFBTFT
s $POHFOJUBMŐIFBSUŐEJTFBTFŗŐ
operatedorunoperated
CardiovascularScreeningforYoungCompetitiveAthletes
toyears
Familyandpersonalhistoryphysicalexamination-leadEKG
PediatricEchocardiographyVolumes—RVMC
PositiveFindings
NegativeFindings
Eligibility
forCompetition
FutherExaminations
Nonivasiveechocardiographystresstest-HHolterCardiacMR
Invasiveangiographyendomyocardialbiopsyelectrophysiologicstudy
NoEvidenceof
CardiovascularDisease
Modified from: Corrado D, Pelliccia A, BjØrnstad HH, et al.
Cardiovascular preparticipation screening of young competitive athletes
for prevention of sudden death; proposal for a common european protocol.
Consensus statement of the Study Group of Sport Cardiology of the Working
Group of Cardiac Rehabilitation and Exercise Physiology and the Working
Group of Myocardial and Pericardial Diseases of the European Society
of Cardiology. European Heart Journal. 2005;26:516-24.
Diagnosisof
CardiovascularDisease
ManagementAccordingto
EstablishedProtocols
CARDIACSURGERY
Cardiac Surgery
CardiothoracicSurgery
The cardiothoracic program at Rogue Valley Medical Center has been in existence for more than 33 years, during
which time our surgeons have performed more than 15,000 cardiac operations. Excellence in cardiothoracic surgery
requires an integrated team effort. It represents the collective experience gained over the many years of the program
as well as a continuing commitment to innovation and expertise provided by physicians, operating-room staff, Coronary
Care Unit (CCU) nurses, and support staff. A team of four cardiothoracic surgeons, each of whom individually
performs more than 100 operations per year, along with their cardiac anesthesia colleagues perform more than 600
cardiac operations each year. Excellence in postoperative care is achieved by a team of highly experienced CCU nurses,
who along with intensivists and cardiologists have cared for thousands of cardiac patients.
Cardiacsurgicalprogram
establishedyearsago
NumberofSurgeriesPerformed
CardiacSurgeriesPerformed·–YearTotal"
DistributionofCardiacProcedures
Nosternalwound
infectionsiemediastinitis
inand
CoronaryArtery
BypassGra
CABGTotal
Isolated
CABG
AorticValve
Replacement
AVRTotal
MitralValve
Replacement
MVRTotal
Isolated
AVR
MitralValve
RepairTotal
Isolated
MVR
SurgicalAtrial
Fibrillation
AblationMaze
Transmyocardial
Revascularization
Heart and Vascular Outcomes
CoronaryArteryBypassGra#
STSoverallsurgicalbenchmark
STSnationaldatabasecombined
resultspersurgicalcategoryfrom
overparticipants
CABGMortalityRateforFirstOperation
RVMC
SocietyofThoracicSurgerySTSComparableHospitalBenchmark
n
n
n
n
n
n
n
n
n
n
Forand
therewerenodeathsinpatients
whorequiredasecondthird
orfourthcoronaryartery
bypassgrasurgery
MortalityRateforSecondThirdorFourthCABGSurgeryReoperation
RVMC
STSBenchmark
n
n
n
n
n
n
n
n
percentofﬁrst-time
CABGsurgerypatients/
receivedaninternalmammary
arterygrainand
MortalityRatebyAgeforOpenHeartSurgery-
-
n
-
n
-
n
-
n
-
n
-
n
-
n
-
n
-
n
CARDIACSURGERY
Cardiac Surgery
ValveProcedures
ValveProcedureVolume
TracyHanson
TrailOregon
Tracy was born with mitral valve
prolapse (2 to 3 percent of the population)
and a pectus excavatum (a chest wall
deformity). As an adult, she developed
severe mitral regurgitation which began to
cause her left ventricle to enlarge. She had
borderline normal left ventricular systolic
function and noted more dyspnea than was
expected during strenuous exertion. She
underwent simultaneous bileaflet repair of
her mitral valve and reconstruction of her
chest wall deformity. Tracy made a full
recovery and has excellent left ventricular
function and no residual mitral regurgitation.
Her chest wall deformity has been corrected
and she is enjoying an active lifestyle.
Severeregurgitantjet
Flailmitralvalveleaﬂet
Le#atrium
Valveleaﬂettipsdonotcoapt
Transesophagealecho
Le#ventricle
Dopplersignalshowingtheseverelyleakyvalve
Transesophagealecho
Heart and Vascular Outcomes
MinimallyInvasiveValveProcedures
MinimallyInvasiveValveProcedureVolume
The minimally invasive thoracoscopic video-assisted
mitral/tricuspid valve procedure allows valve repair
or replacement to be performed without sternotomy.
Rogue Valley Medical Center cardiac surgeons use
this technique primarily for patients who require
mitral valve replacement, mitral valve repair for
degenerative prolapse, or tricuspid valve repair.
Minimally invasive surgery offers a better cosmetic
outcome and can reduce pain, likelihood of infection,
and length of hospital stay.
Standardsternotomy
Cardiacanesthesiologists
SteveCannonMDLindyDeatherageMD
JamesFaraoniMDBrianHallMD
ThomasHammondMDRobertTrujilloMD
Smallthoracicincision
Therearesixboard-certiﬁed
cardiacanesthesiologiststrainedin
transesophagealechocardiography
Repairedvalve$noregurgitation
Vascularaccess
Standardsternotomyonleminimallyinvasive
approachformitralvalverepaironright
CourtesyofEdwardsLifesciences
Valveaerrepairleaﬂetstouchnomitralregurgitation
Transesophagealecho
CARDIACSURGERY
Cardiac Surgery
WilliamBickers
GrantsPassOregon
#JMMJTB+PTFQIJOF$PVOUZ1VCMJD8PSLTFNQMPZFFXIPIBECFFOEJBHOPTFE
with a heart murmur as a child. Strenuous activity such as football had not
been permitted as a teenager. As an adult, he pursued a physically active
lifestyle. Over the past two years, he developed progressive exertional angina
and was cut from a sports team. He was subsequently diagnosed with critical
aortic stenosis. Echocardiography showed a unicuspid aortic valve with peak
gradient 145 mm Hg, mean gradient 98 mm Hg, and valve area 0.6 cm2
consistent with critical aortic stenosis. He underwent aortic valve replacement
with implantation of a mechanical aortic valve prosthesis. Bill has resumed
working out and is now running on a regular basis without any symptoms.
DistributionofPrimaryValveProceduresn"
ProstheticHeartValves
IsolatedAorticValveRepair/Replacement
IsolatedMitralValveRepair/Replacement
TricuspidValveReplacement/Annuloplasty
AorticValveRepair/ReplacementCABG
MitralValveRepair/ReplacementCABG
Aortic/MitralValveRepair/ReplacementCABG
OtherValveProcedures
Pericardialtissuevalvebioprosthetic
Implantedmechanicalaorticandmitralvalves
CourtesyofEdwardsLifesciences
CourtesyofCarboMedics
Porcinetissuevalve
bioprosthetic
CourtesyofMedtronic
StJudeMedicalmechanicalvalve
CourtesyofStJudeMedical
Intraoperativetransesophageal
echocardiographyisperformed
routinelyonpatientsundergoing
valvesurgeryatRVMC
Heart and Vascular Outcomes
IsolatedMitralValveRepairMortalityRate
RVMC
STSRiskAdjustment
The purpose of the risk adjustment is to allow STS
database participants to compare their performance
with other participants (e.g., overall STS, like
participants, region or state). By accounting for and
controlling patient risk factors that are present prior
to surgery, risk adjustment “levels the playing field”
as best as possible. Comparing unadjusted event rates
would unfairly penalize participants that perform
operations on higher-risk patients. Risk adjustment
more accurately represents a participant’s performance
relative to that of a reference group presented with
the same patient population.
STSBenchmarkRisk-AdjustedRate*
n
n
n
n
n
n
n
*NoteSTSdidnotcalculateriskadjustmentonthispopulationuntil
IsolatedMitralValveReplacementMortalityRate
STSBenchmarkRisk-AdjustedRate
RVMC
n
n
n
n
n
n
n
n
n
n
n
IsolatedAorticValveReplacementMortalityRate
STSBenchmarkRisk-AdjustedRate
RVMC
n
n
n
CARDIACSURGERY
Cardiac Surgery
EndovascularTreatment
ofThoracicAorticAneurysm
Until recently, treatment of a descending thoracic
aortic aneurysm required an open and morbid surgical
procedure associated with a significant risk of paraplegia.
A new endovascular approach is safer and less invasive
and involves accessing the femoral artery, advancing
a stent graft to the descending thoracic aorta, and
deploying the stent graft across the aneurysm to seal
it off. Patients often go home in one to two days.
MarjorieMcBeth
AshlandOregon
Marjorie suffered from a ruptured thoracic
aortic aneurysm. In the past this would have
been a mortal event for a woman of her age.
Using the minimally invasive endograft stent
technology available at RVMC, surgeons
repaired Marjorie’s ruptured aneurysm.
RVMC’s hybrid operating room was developed
with the technology to complete such complex
procedures. Three years after surgery, Marjorie
is alive and healthy. She continues to enjoy
her family and relish her retirement life.
ThoracicAortaProcedureVolumes
OpenSurgeryofAscendingAortaAorticArch
and/orDescendingThoracicAorta
EndovascularStentGraof
DescendingThoracicAorta
Leventricularassistdevice
CourtesyofAbiomed
AnAbiomedleventricular
assistdeviceisavailablefor
patientswithsevereleventricular
dysfunctionandassociated
congestiveheartfailure
Heart and Vascular Outcomes
TransmyocardialRevascularization
Transmyocardial revascularization (TMR) is an option for patients with stable angina refractory to medical treatment
and not amenable to standard coronary revascularization. A carbon dioxide laser is used to fire single high-energy
pulses to create smooth, straight microchannels in the wall of the left ventricle. TMR is occasionally used in conjunction
with standard CABG to treat an area of myocardium that cannot be revascularized with bypass grafts or stents.
Clinical trials have demonstrated TMR to be a safe and effective means of obtaining long-term relief of angina,
improved heart muscle perfusion, and improved quality of life. This technology was introduced at Rogue Valley
Medical Center in 2001.
TransmyocardialRevascularizationProcedureVolume
RVMCCardiacIntensiveCareUnitstaﬀ
AtrialFibrillation
RVMCopenheartsurgicalteam
MazeProcedureVolume
MazeProcedure
The Maze procedure uses a cryoablation technique
to create lines of nonconducting scar tissue at the
pulmonary vein orifices and within the walls of the
atria to prevent the propagation of electrical excitation
originating in the pulmonary veins into the atria and
the sustained disorganized electrical activity within
the atria which lead to initiation of sustained atrial
fibrillation. The procedure is appropriate for individuals
with highly symptomatic atrial fibrillation who have
failed conventional therapy.
RVMCHeartCenterstaﬀ
VASCULARSURGERY
Vascular Surgery
ComprehensiveVascularCare
Five board-certified vascular surgeons provide
around-the-clock elective and emergent care for
a wide spectrum of peripheral vascular disorders.
Outpatient angiography and peripheral vascular
interventions are performed in the outpatient
angiography suite within CVI. Complex surgical
reconstructive procedures, including a high-volume
endovascular program for the management of
abdominal aortic aneurysms, are performed within
our region’s only state-of-the-art dedicated endovascular
angiographic operating room located at Rogue Valley
Medical Center.
Vascular surgeons, cardiothoracic surgeons, and
cardiologists provide an integrated approach to the
management of complex thoracic and abdominal aortic
disease, combining thoracotomy and endovascular
approaches to the management of thoracoabdominal
aortic aneurysms and acute aortic dissections.
Vascular surgeons, interventional cardiologists,
and neurologists work together to provide a
comprehensive management of carotid artery
disease, using either surgical endarterectomy
or percutaneous stent procedures.
PeripheralAngiographyVolume
InpatientandOutpatient
Includescarotidangiographyrenalangiographymesenteric
angiographyupper-andlower-extremityangiography
andabdominalangiography
Iliacarteries
Aneurysm
Aorta
Fiveboard-certiﬁed
vascularsurgeonsprovide
around-the-clockcoverage
Stentgra#
Stentgraplacedacrossaneurysmeﬀectivelysealingitoﬀ
CourtesyofMedtronic
Theperipheralvasculature
CourtesyofAbboVascular
Heart and Vascular Outcomes
Femoralarteryaccess
Abdominal
aorticaneurysm
Opensurgicalrepairofabdominalaorticaneurysm
CourtesyofMedtronic
Endovascularapproachvia
thefemoralarterieslessinvasive
CourtesyofMedtronic
ElectiveEndovascularStentGra#RepairIn-HospitalMortalityRate
Abdominalaorticaneurysm
CourtesyofMedtronic
n
n
n
n
n
n
n
ElectiveAbdominalAorticAneurysmSurgicalVolume
TotalRepairs
OpenSurgicalRepair
EndovascularStentGraRepair
Leapfrogrecommendsthat
AnnualHospitalVolumesfor
abdominalaorticaneurysmrepair
bemorethanperyear
VASCULARSURGERY
Vascular Surgery
CarotidEndarterectomy
NaturalHistoryofCarotidDisease
RiskofIpsilateralStroke
While the patient is under general anesthesia, an incision
is made in the skin over the carotid artery. The carotid
artery is clamped and incised, and the atherosclerotic
plaque is removed (endarterectomy). This is similar to
removing the inner layers of an onion. The artery and
the skin are then surgically closed.
Symptomatic patients: transient
ischemic attack (TIA)/stroke:
t 70 to 99 percent stenosis: 13.0 percent per year
t 50 to 69 percent stenosis: 4.4 percent per year
Asymptomatic patients
t >60 percent stenosis: 2 to 3 percent per year
SourceNASCETNASCETIIACASandACSTtrials
IsolatedCarotidEndarterectomyIn-HospitalDeath/StrokeRate
Death
Stroke
n
n
n
n
n
n
n
TotalCarotidArteryRevascularizationProcedures
IsolatedCarotidEndarterectomy
SimultaneousCarotidEndarterectomyandCardiacSurgery
CarotidStent
Carotidstentprogrambeganin
Heart and Vascular Outcomes
WhoShouldBeConsidered
forCarotidStenting?
Stentacross
carotidartery
plaque
Bloodﬂow
tobrain
High surgical risk patient:
t Symptomatic patient with ≥50 percent stenosis
t Asymptomatic patient with ≥80 percent stenosis
CriteriaforIncreasedSurgicalRisk
t Congestive heart failure Class III/IV and/or
left ventricular ejection fraction <30 percent
t Open heart surgery indicated
t Recent myocardial infarction
t Unstable angina
t Severe pulmonary disease
t Contralateral carotid occlusion
t Contralateral laryngeal nerve palsy
t Irradiated neck
t Previous carotid endarterectomy
with recurrent stenosis
t High cervical internal carotid artery lesions
t Common carotid lesions below the clavicle
t Severe tandem lesions
Filtertraps
particlesfrom
plaquebut
permits
bloodﬂow
Equipment
placedvia
femoralartery
inleg
Internal
carotidartery
Carotidstentdeployedﬁlternotyetretrieved
CourtesyofAbboVascular
HighSurgicalRiskPatients
Stenting
Endarterectomy
FreedomfromMajor
AdverseEvent
Normal surgical risk patient:
t Standard of care is carotid endarterectomy
t National Institutes of Health (NIH)–sponsored
CREST study randomly assigns patients to either
carotid stenting or surgical endarterectomy
P
DaysA#erInitialProcedure
SourceGurmHSYadavJSFayadPetalLong-termresultsofcarotidstentingversusendarterectomyinhigh-riskpatientstheSAPPHIREStudy
NewEnglandJournalofMedicine
-
VASCULARSURGERY
Vascular Surgery
CarotidStentVolume
carotidstentprocedures
havebeenperformedat
RVMCsince
Sept
RVMChasreceivedtheAmerican
HeartAssociationGetWithThe
Guidelines®–Strokeaward
CarotidStentinginHigh-RiskSurgicalPatients
ComparisonwithMAVERICIICarotidStentRegistry
-DayOutcomes
MAVERICII
RVMC
Theregion’sonlystate-of-the-art
dedicatedendovascularangiographic
operatingroomislocatedatRVMC
DeathStroke
Myocardial
Infarction
Death
Stroke
Major
Stroke
Minor
NIHstrokescaleperformedbeforeandaereachprocedure
MAVERICIIhadthebestoutcomesofanyreportedcarotidstentregistry
Myocardial
Infarction
PatientsatNormalSurgicalRisk
NIH–SponsoredCRESTTrial
Rogue Valley Medical Center was one of 110 centers
in North America chosen to participate in the National
Institutes of Health–sponsored CREST trial. This study
randomized normal surgical risk patients with carotid
artery disease to carotid endarterectomy versus carotid
stenting with distal emboli protection. The screening
process for treating physicians is rigorous; only
experienced physicians with an excellent track record
are chosen. Eleven patients participated in the study,
and nine received carotid stents. All patients did well,
with no death, stroke, or myocardial infarction.
Heart and Vascular Outcomes
LlynPayne
BrookingsOregon
Llyn, an avid knitter, attended a yarn workshop in central Oregon and had a myocardial infarction. Coronary angiography revealed severe blockages
in the left main and proximal left anterior descending arteries, occluded proximal right coronary artery, and left ventricular ejection fraction 30 percent.
She was not felt to be a candidate for coronary artery bypass graft surgery. She returned to her home city, where she subsequently had a stroke with
right hemiparesis and expressive aphasia. She was subsequently transferred to Rogue Valley Medical Center for further care. Carotid studies revealed
an occluded left carotid and left subclavian arteries and severe stenosis of the right internal carotid artery. She was also in cardiogenic shock, requiring
dopamine for blood pressure support. Coronary stenting of the left main and proximal left anterior descending arteries with femoral artery–femoral
venous bypass backup was performed in the hybrid surgical suite. The patient had severe bilateral iliac artery disease that required bilateral iliac artery
stent deployment prior to placement of the large bypass cannulae (figure 1). Intravascular ultrasound–guided coronary stent deployment was performed
in both the left main and left anterior descending coronary arteries (figure 2). Her blood pressure immediately improved, the dopamine was stopped,
and beta-blockers and angiotensin converting enzyme (ACE) inhibitors were eventually started. She subsequently underwent carotid stenting with
distal emboli protection, with good result (figure 3). Llyn has made a good neurologic recovery, has no further angina, and has resumed knitting.
Severestenosisat
originoflemain
andinproximalle
anteriordescending
coronaryarteries
figure 1— Severeblockagesin
bothcommoniliacarteries
Stentsdeployedinbothcommon
iliacarterieswithballooninﬂation
Stentsdeployedwithwidely
patentiliacarteries
figure 3—
Cerebral
angiographyaer
stentdeployment
withexcellent
collateralstothe
leanteriorand
middlecerebral
arteries
figure 2— Stentsdeployedinlemain
andproximalleanteriordescending
coronaryarterieswithgoodresult
Severestenosisinproximalright
internalcarotidarterylecarotid
arteryoccluded
Successfulrightcarotidarterystent
IMAGING
Imaging
NoninvasiveDiagnosticTesting
Rogue Valley Medical Center offers a full spectrum of
noninvasive diagnostic testing for cardiovascular diseases:
t Echocardiography (transthoracic,
transesophageal, pediatric)
t Treadmill stress testing
t Nuclear stress testing
t MUGA scans
Echocardiography is a noninvasive ultrasonographic
assessment of cardiac structure and function, including
evaluation of ischemic and nonischemic ventricular
dysfunction, cardiomyopathy, valvular heart disease,
and congenital malformations. Invasive transesophageal
assessment is also performed in the inpatient and
outpatient settings, as well as intraoperative assessment
of cardiothoracic surgical procedures.
t Holter/event monitors
t Tilt table testing
t Vascular imaging
Transesophagealechois
availablearound-the-clock
atRVMC
t Cardiac CT angiography,
coronary calcium scoring
Echocardiogram
EchocardiographyVolumes—RVMCandTRCH
Echo
TransesophagealEcho
PediatricEcho
RVMCechocardiographyimagingstaﬀ
Heart and Vascular Outcomes
Treadmill stress testing provides electrocardiogram
(EKG) assessment for exercise-induced ischemia or
arrhythmias, including chronotropic competence.
Treadmill testing is used predominantly in patients who
are able to exercise and have a normal baseline EKG.
TotalStressTests—RVMCandTRCH
RVMCnuclearimagingstaﬀ
Nuclearstresstesting
RVMCvascularimagingstaﬀ
Treadmillstresstesting
IMAGING
Imaging
Nuclear stress testing allows a noninvasive assessment
of coronary blood flow and cardiac function; it is
performed with exercise or pharmacologic stress
protocols. It is useful in assessment of ischemia with
a baseline abnormal EKG, a nonspecific or possibly
false-positive treadmill result, moderate probability
for coronary artery disease, localization of ischemia
in known coronary artery disease, or risk
stratification after a cardiac event.
Cardiologiststrainedin
Multiple gated acquisition scans are used for evaluation
of right and left ventricular systolic performance.
Transesophageal
echocardiography
Nuclearstresstests
CardiacCT
A Holter monitor continuously records a patient’s
heart rhythm for 24 hours. The patient notes any
symptoms, which allows correlation of the heart
rhythm to any concerning symptoms.
An event monitor is worn for approximately
one month. When a patient has symptoms (such
as palpitations, light-headedness, or dizziness), the
patient pushes a button to record the heart rhythm.
This information is then transmitted over the
telephone to the physician for review.
Tilt table testing is a noninvasive assessment for
vasovagal (neurocardiogenic) syncope.
Vascular imaging consists of ultrasonographic
assessment of carotid and peripheral vascular disease,
including atherosclerotic blockage, aneurysm formation,
and deep venous thrombosis.
Cardiac magnetic resonance imaging (MRI) is used
to evaluate for arrhythmogenic right ventricular
dysplasia, constrictive pericarditis, and myocardial
viability following infarction.
PeripheralVascularImagingVolumes—RVMCandTRCH
ArterialUltrasoundofArmsandLegs
CarotidArteryUltrasound
VenousUltrasoundofLegs
Holter/LoopEventMonitor—RVMCandTRCH
Heart and Vascular Outcomes
CardiacCT
CoronaryCalciumScore
Coronary calcium score is a screening heart scan
used to detect calcium deposits found in atherosclerotic
plaque in the coronary arteries. The calcium score is
then used to evaluate risk of future coronary heart
disease and events.
Coronary arterial calcification is part of the development
of atherosclerosis (hardening of the arteries), occurs
almost exclusively in atherosclerotic arteries, and is
absent in the normal vessel wall. A score of 0 implies
a low likelihood of coronary obstruction but cannot
totally exclude the presence of atherosclerosis. A high
score indicates a significant plaque burden and an
increased relative risk of future heart and vascular
events. It should be understood that calcification does
not imply significant obstruction, nor is it site specific
for a stenotic lesion; rather, it indicates the extent of
atherosclerosis throughout the coronary arteries.
Coronary CT angiography consists of high-resolution
three-dimensional 3D pictures of the moving heart
and great vessels that are used to determine whether
a patient has significant coronary atherosclerosis or
any structural abnormality of the heart and the
surrounding structures.
LightspeedVCT
CoronaryArteryCalciumScore
MedicareCoveragefor
CoronaryCTAngiography
t Patients with acute chest pain presenting in an
emergency room (or equivalent) when necessary
to rapidly differentiate among reasonably probable
aortic, pulmonary, and/or coronary etiologies
t First-line testing for coronary artery disease
in nondiabetic patients with intermediate risk
factors presenting in an emergency room (or
equivalent) with chest pain syndrome or other
symptoms strongly suggestive of coronary disease,
and who have normal or borderline enzymes and
EKGs, when negative findings will result in
avoiding invasive coronary angiography
t Equivocal or suspected inaccurate stress (or stress
imaging) test in patients with low to intermediate
risk factors when a negative CTCA will result in
avoiding invasive coronary angiography
t Clinical findings strongly suggestive of a congenital
anomaly of the coronary vessels or great vessels
DcardiacCTimage
CourtesyofGEHealthcare
CumulativeIncidenceofCoronaryEvents
-sliceCTscannersareavailable
atRogueValleyMedicalCenterand
ThreeRiversCommunityHospital
CourtesyofGEHealthcare
–
>
–
YearstoEvent
SourceDetranoRGuerciADCarrJJetalCoronarycalcium
asapredictorofcoronaryeventsinfourracialorethnicgroups
NewEnglandJournalofMedicine-
PREVENTIVECARDIOLOGY
Preventive Cardiology
Cardiacrehabilitationis
recommendedbytheAmerican
HeartAssociationandtheAmerican
CollegeofCardiology
RVMCandTRCHareboth
certiﬁedbytheAmerican
AssociationofCardiovascular
andPulmonaryRehabilitation
percentofpatients
notedimprovementin
strengthandendurance
CardiacRehabilitationProgram
SecondaryPrevention
Cardiac rehabilitation is a program of monitored
exercise and education that provides an essential
service to patients with heart disease. It is recommended
for those who have had a cardiac event such as a
myocardial infarction, heart surgery, coronary artery
stenting, or angina within the past year. Research
continues to show that participation in cardiac rehab
reduces mortality by about 25 percent. Physical
strength and endurance are improved by an
average of 50 percent.
After a heart attack, stent, or open heart surgery, patients
have many questions about what happened and what to
expect in the future. The Cardiac Rehabilitation program
is designed to address these concerns, providing
information and support to improve patient health
and reduce the risk of future cardiac issues.
The RVMC Cardiac Rehabilitation program has been
in place since 1998; it and the program at Three Rivers
Community Hospital (TRCH) are two of the 11 certified
programs in the state of Oregon. They are the only
QSPWJEFSTPGDBSEJBDSFIBCJMJUBUJPOQSPHSBNTJO+BDLTPO
+PTFQIJOF,MBNBUI%FM/PSUF$VSSZ-BLFBOE
Siskiyou Counties. The programs are directed by
cardiologists, and the multidisciplinary team is
trained in Advanced Cardiac Life Support.
percentofpatientshavegood
bloodpressurecontrolatthe
completionoftheprogram
Goals:
t Educate patients and families regarding
cardiac disease and treatment
t Build healthy habits of diet, exercise, and
tobacco cessation
t Optimize a sense of well-being and function
for patient and family
t Determine the level at which a patient
can safely exercise
t Increase endurance
Recent international research shows that positive
changes in diet, exercise, and tobacco use reduce
patient risk within six months after an acute coronary
syndrome. Patients who adhere to a good diet and
exercise reduce their risk of myocardial infarction (MI)
by nearly half compared with those who did not comply
with lifestyle improvement regimens. Patients who
continue to smoke and ignore advice to improve diet
and exercise are 3.8 times more likely to suffer an MI,
stroke, or death within six months than nonsmokers
who modify their diet and exercise.
To boost post–MI survival rates, study authors
recommended programs such as cardiac rehabilitation
that teach and support lifestyle changes.
percentofpatients
reportcontinuedhome
exercisecompliance
Coverage
RVMCcardiacrehabstaﬀ
Medicare and most other insurers cover patients who
in the previous year have had angina, myocardial
infarction, coronary artery stenting, bypass surgery,
valve surgery, or heart transplantation.
Heart and Vascular Outcomes
patientsatRVMCsince
patientsatRVMCin
patientsatTRCHin
percentofpatientswerevery
satisﬁedwiththeirexperience
percentofourprevioussmokers
weresmoke-freeattheconclusion
oftheircardiacrehabprogram
CardiacEducators
RVMC Cardiac Clinical Case Managers, who are all
registered nurses, visit with patients who have had
heart failure, angina, or a heart attack. They teach
patients about the nature of their illnesses and the
steps they can take to avoid future problems. These
nurses also work with patients who have cardiac
procedures, such as open heart surgery, placement of
a coronary or carotid stent, insertion of a pacemaker,
or implantation of a defibrillator. Cardiac Clinical
Case Managers provide an additional level of care
and answer patients’ questions. They review
important instructions, discuss the procedure, and
show patients actual balloons, stents, pacemakers,
and defibrillators. The purpose of their visits is to
ensure that patients understand their medical
condition and upcoming outpatient care plan.
Patientsexperiencedanaveragewaist
circumferencereductionofinches
RogueValleyMedicalCenter
CardiacRehabilitation
Third Floor Northwest
2825 East Barnett Road
Medford, OR 97504
(541) 789-4466
SomeCommentsfromPatients
“Fantastic staff and program…professional and
friendly…I owe them everything.”
ThreeRiversCommunityHospital
CardiacRehabilitation
“Felt like part of the family…”
520 SW Ramsey Avenue
Grants Pass, OR 97527
(541) 472-7474
“Not only good for one’s health but also for your
emotional well-being…don’t change a thing”
RVMCCardiacClinicalCaseManagers
“A sincere and unequivocal thank-you for all you did
for me during the past three months…You helped me
physically, emotionally, and intellectually…you created
an environment of hope and optimism. Your work is
deeply appreciated.”
THERAPIESONTHEHORIZON
Therapies on the Horizon
DabigatranAReplacementforWarfarin?
Dabigatran (Pradaxa®) is an oral thrombin inhibitor
that may replace warfarin. In the RE-LY trial, 18,000
patients with atrial fibrillation were randomized to
dabigatran and warfarin. The dabigatran 150 mg bid
group had a significantly lower risk of stroke/systemic
embolization and intracranial hemorrhage than the
warfarin group did. The FDA approved this medication
on October 19, 2010. This medication does not require
INR testing or any dietary restriction. There are also
fewer drug interactions. Dabigatran is not yet approved
for deep venous thrombosis, pulmonary embolism,
or mechanical heart valves. The cost is unknown
but will almost certainly be more expensive than
generic warfarin.
Source: Schulman S, Kearon C, Kakkar AK, et al. Dabigatran
versus warfarin in the treatment of acute venous thromboembolism.
New England Journal of Medicine. 2009;361:2342-52.
CarotidStentinginNormal
SurgicalRiskPatients
TandemHeartPercutaneous
VentricularAssistDevice
Carotid artery disease accounts for approximately
30 percent of all strokes. For a normal surgical risk
patient with a severe atherosclerotic blockage in the
carotid artery, the standard of care has historically
been surgical carotid endarterectomy. In the NIHsponsored CREST trial, 2,502 normal surgical
risk patients were randomized to surgical carotid
endarterectomy and carotid stenting with distal
emboli protection with a filter. At 2.5 years the
combined endpoint of death, stroke, and myocardial
infarction showed no statistically significant difference
between the treatments (6.8 percent versus 7.2 percent).
The carotid endarterectomy group had a slightly lower
risk of stroke (2.3 percent versus 4.1 percent), whereas
the carotid stent group had a slightly lower risk of
myocardial infarction (2.3 percent versus 1.1 percent).
This percutaneously placed device is designed for
critically ill patients in cardiogenic shock who are
refractory to intra-aortic balloon pumping, inotropes,
and vasopressors. These patients may be having a
myocardial infarction, having difficulty coming off
the bypass pump at the time of open heart surgery,
or undergoing a high-risk percutaneous coronary
intervention (e.g., left main). This technology provides
both cardiac (pumps blood) and pulmonary (oxygenates
blood) support for a failing heart, hopefully long
enough to give the heart a chance to recover. This
device can be placed in either the operating room
or the cardiac catheterization laboratory.
Source: Brott TG, Hobson RW, Howard G, et al. Stenting
versus endarterectomy for treatment of carotid-artery stenosis.
New England Journal of Medicine. 2010;363:11-23.
TranscatheterAorticValveImplantation
TreatingHigh-RiskAorticStenosisPatientswithaPercutaneousApproach
For patients with severe symptomatic aortic stenosis who are poor candidates for open heart surgery and standard
aortic valve replacement, transcatheter aortic valve implantation (TAVI) via a percutaneous approach was recently
found to be superior to medical therapy. In fact, the PARTNERS trial showed an absolute risk reduction of 20
percent at one year (50.7 percent mortality rate at one year in the medical therapy group, 30.7 percent mortality rate
at one year in the TAVI group). This technology typically requires access via the femoral or axillary artery. A large
balloon is advanced across the stenotic valve and inflated (balloon valvuloplasty) to split apart the valve commissures.
A valve within a stent is then mounted on a balloon, advanced across the diseased valve, and inflated at high pressure
to deploy the stent valve. The balloon is then removed, and the patient has a bioprosthetic valve in place—all while
the heart is beating. The native valve is crushed to the side and is under the stent valve structure. The second part of
the PARTNERS trial is comparing high surgical risk patients who were randomized to TAVI versus open heart
surgery with aortic valve replacement. These results should be available in spring 2011. This technology is currently
being reviewed by the FDA.
Source: Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot
undergo surgery. New England Journal of Medicine. 2010;363:1597-1607.
TheTandemHeartdevice
CourtesyofCardiacAssists
Heart and Vascular Outcomes
Le#AtrialAppendageOccluderPreventing
StrokesinAtrialFibrillationPatients
The feared outcome of atrial fibrillation is embolic stroke.
The left atrial appendage is typically the site for thrombus
formation. A left atrial appendage occluder (plug) has
been developed and can be delivered from the inferior
vena cava through the atrial septum via a transseptal
puncture. In the PROTECT-AF study, patients with
atrial fibrillation were randomized to warfarin versus a
left atrial appendage occluder. For patients who received
the left atrial appendage occluder, warfarin was stopped
after 30 days and both groups were followed for an
average of three years. The left atrial appendage occluder
had a higher risk of adverse safety events at the time of
implantation, such as pericardial effusion (4.8 percent),
device embolization (0.6 percent), and stroke (1.1 percent).
Despite these risks at the time of implantation, the left
atrial appendage occluder group had a lower risk of
stroke (“non-inferior by trial design”). As mandated by
the FDA, a second clinical trial will soon be under way
to better clarify whether the benefits of this left atrial
appendage occluder outweigh the risks. If approved,
it is unclear if the left atrial appendage occluder will
be available only for patients who are unable to take
anticoagulation therapy (e.g. warfarin) or for all atrial
fibrillation patients at increased risk of stroke.
Fourteenhospitalists
providecareformanycardiac
patientsAllhospitalists
areboardcertiﬁed
RVMChospitalists
ArthurAungMDTinoBauerMDErinBrenderMD
AgnieszkaDobieckaMDChristinaFordMDJonathan
GellMDGregoryGrunwaldDOStevenHerschMD
ElizabethHirniDOAhsanJaﬀarMDJoseMondesiMD
KennethSanfordMDDonnaTribelhornMD
EeLinWanMD
FourintensivistsatRVMCare
boardcertiﬁedincriticalcare
medicinewithonewhois
additionallyboardcertiﬁedin
pulmonarymedicine
Source: Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous
closure of the left atrial appendage versus warfarin therapy for
prevention of stroke in patients with atrial fibrillation: a
randomised non-inferiority trial. Lancet. 2009;374:534-41.
DEchocardiography
Echocardiography is a powerful cardiac imaging
modality that typically uses two-dimensional
ultrasonography and color Doppler with a transthoracic
window. Three-dimensional echo technology coupled
with a transesophageal approach is now available and
can be particularly helpful when assessing heart valves,
septal defects, and other forms of structural heart
disease, especially at the time of open heart surgery.
RVMCintensivists
PeteyLaohaburanakitMDFCCPFranciscoPazMD
IlanaPorzecanskiMDKrishnamurthyUmapathyMD
TamaraDixonNPJamesStubenrauchPA
Anintensivistispresentinthe
hospitalaround-the-clockHospitals
withanintensivistprogramare
associatedwithbeeroutcomes
andlowermortalityrates
QUALITYOURAPPROACH
Quality: Our Approach
The divisions of cardiology and cardiothoracic
surgery believe in the importance and the value of a
robust quality improvement approach to the delivery
of healthcare. With the assistance of the performance
improvement staff, clinical outcomes are compared
with external benchmarks to continuously identify
areas of potential improvement and to provide
patients with information useful in their own
healthcare decisions.
RVMC has participated in the development of
$FOUFSTGPS.FEJDBSF.FEJDBJE4FSWJDFT$.4
projects and strives to achieve high levels of compliance
with the current CMS Core Measures for Best Practice.
Guidelines and best practices from a wide range of
resources, including the Leapfrog Group, the Institute
for Healthcare Improvement 100K Lives Best Practices
campaign, the American College of Cardiology, and
the Society of Thoracic Surgery, are used to define
standards of care and goals for improvement.
LeapfrogGuidelines
CoronaryArteryBypassGra#ing
PercutaneousCoronaryIntervention
t Favorable hospital volume
(450 or more procedures per year)
t Participation in Society of Thoracic Surgeons
data collection
t STS score better than national average
for risk-adjusted mortality
t Minimum surgeon volume per year for CABG
(100 cases per year)
LeapfrogEvidence-Based
HospitalReferralSafetyStandard
t Favorable hospital volume
(400 or more procedures per year)
t Participation in the American College of
Cardiology National Cardiovascular Data
Registry (ACC-NCDR) or > 80 percent
adherence to the Leapfrog Expert Panel
t Endorsed Process Measures for Quality
Score better than the national average for
risk-adjusted mortality
t Minimum surgeon volume per year for PCI
(100 cases per year)
RecommendedAnnualVolume
AmericanHeartAssociation
“GetWithTheGuidelines®”Award
Recipient·CoronaryArteryDisease
GoldStatusand
RVMCVolume
Volume
Itisourbeliefthat…
Experiencedboard-certiﬁedphysicians
% patientvolume
% well-designedhospitalsystem
% regularoutcomesreviewwith
appropriatefeedback
" Qualitygoodoutcomes
Through participation in national initiatives, we support
transparent public reporting of healthcare quality data
and participate in the following initiatives:
t $FOUFSTGPS.FEJDBSF.FEJDBJE4FSWJDFT
Hospital Compare (www.hospitalcompare.hhs.gov)
t Consumer Reports (www.consumerreports.org/health)
Percutaneous
Coronary
Intervention
CoronaryArtery
BypassGraing
AorticValve
Replacement
AbdominalAortic
AneurysmRepair
RVMCperformanceimprovementstaﬀ
Heart and Vascular Outcomes
AcuteMyocardialInfarctionCMSQualityMeasure
CongestiveHeartFailureCMSQualityMeasure
Compliance
Compliance
Aspirin
atDischarge
Aspirin
atArrival
Smoking
Cessation
ACEInhibitor/Angiotensin
ReceptorBlockerforLVSystolic
DysfunctionatDischarge
PrimaryPercutaneous
CoronaryIntervention
WithinMinutes
LeVentricularLV
Assessment
Smoking
Cessation
ClearDischarge ACEInhibitor/Angiotensin
Instructions
ReceptorBlockerforLV
SystolicDysfunction
Beta-Blocker
atDischarge
CoronaryArteryBypassGra#SurgeryCMSQualityMeasure
Compliance
RVMCistheonlyOregonhospital
tohavereceivedrecognitionfromthe
DepartmentofHealthandHuman
Servicesforhavingalowerthan
nationalaverageinallthreeareas
Prophylactic
AntibioticsWithin
Hour
Aspirin
atDischarge
Prophylactic
AntibioticsDiscontinued
WithinHours
Prophylactic
Antibiotics
Selection
Beta-BlockerWithin
Peri-Operative
Period
ControlledAM
Post-Operative
SerumGlucose
UrinaryCatheter
Removedby
Post-Operative
Day
Appropriate
HairRemoval
MortalityFollowing
AcuteMyocardialInfarction
ReadmissionFollowing
AcuteMyocardialInfarction
ReadmissionFollowing
CongestiveHeartFailure
GoldAwardtobepresented
inNovemberbythe
AmericanCollegeofCardiology’s
ACTIONRegistry
ThomsonSolucientTop
Hospitals®Cardiovascular
BenchmarksforSuccessAward
····
PHYSICIANBIOGRAPHIES
Physician Biographies
Asante Cardiovascular and Thoracic Surgeons
CharlesCarmeciMDFACS
DavidLFolsomMDFACS
RogerVHallMDFACS
CardiovascularandThoracicSurgery
CardiovascularandThoracicSurgery
CardiovascularandThoracicSurgery
Specialties Coronary artery bypass graft surgery,
valve surgery, thoracic aortic aneurysm repair,
minimally invasive valve surgery, thoracic oncology,
minimally invasive thoracic surgery, thoracic aortic
aneurysm surgery, and stent grafts
Specialties Coronary artery bypass graft surgery,
valve surgery, thoracic aortic aneurysm repair,
minimally invasive valve surgery, thoracic oncology,
minimally invasive thoracic surgery
Specialties Coronary artery bypass surgery with
extensive experience in thoracic aortic aneurysm repair,
re-do surgery, valve surgery, thoracic oncology
MedicalDegree University of Utah
MedicalDegree Medical College of Virginia
Internship/Residency General Surgery at
Case Western Reserve University
Internship/Residency General Surgery at
Madigan Army Medical Center
Internship/Residency General Surgery at
Stanford University Medical Center
CardiothoracicSurgeryFellowship University
of Wisconsin
BoardCertiﬁcation American Board of Surgery,
American Board of Thoracic Surgery
Honors/Awards Graduated with honors from
George Washington University (undergraduate
degree) and Medical College of Virginia
CardiothoracicSurgeryFellowshipCase Western
Reserve University
BoardCertiﬁcation American Board of Surgery,
American Board of Thoracic Surgery
MedicalDegree University of Utah
CardiothoracicSurgeryFellowshipLetterman
Army Medical Center
BoardCertiﬁcation American Board of Surgery,
American Board of Thoracic Surgery (recertified 2006)
Honors/Awards Chairman, Department of Surgery
at Rogue Valley Medical Center 2002–2005; Allen
Research Fellow at Wade Park VA Medical Center
Honors/Awards Past President, Medical Staff
at Rogue Valley Medical Center; Past Chairman,
Department of Surgery at Rogue Valley
Medical Center
OﬃceMedford
OﬃceMedford
OﬃceMedford
Heart and Vascular Outcomes
Southern Oregon Cardiology, LLC
GeorgeRWilkinsonMDFACS
JonRBrowerMDFACC
DouglasTBurwellMDFACC
CardiovascularandThoracicSurgery
Cardiology
Cardiology
Specialties Cardiovascular and thoracic
surgery, valve repair, off-pump surgery,
complete aortic reconstruction
Specialties Consultative cardiology, echocardiography,
transesophageal echocardiography, nuclear cardiology,
coronary angiography
Specialties Consultative and preventive
cardiology, echocardiography, nuclear cardiology,
coronary angiography
MedicalDegree University of Iowa
MedicalDegree University of Arizona
Internship/ResidencyGeneral Surgery at
Tripler Army Medical Center
Internship/Residency Neurology and Internal
Medicine at University of Arizona
MedicalDegree University of California,
Los Angeles
CardiothoracicSurgeryFellowshipLetterman
Army Medical Center
CardiologyFellowship University of Arizona
Internship/Residency Internal Medicine at
University of California, Irvine
BoardCertiﬁcation Internal Medicine,
Cardiovascular Disease
CardiologyFellowship University of
California, Irvine
Honors/Awards Residency Excellence in
Teaching (three years)
BoardCertiﬁcation Internal Medicine, Cardiology
BoardCertiﬁcation American Board of
Thoracic Surgery
Honors/Awards Clinical Associate Professor of
Surgery, Uniformed Services Medical School
Dr. Burwell received his undergraduate degree from
Stanford University.
OﬃceMedford
OﬃceMedford
OﬃceGrants Pass
PHYSICIANBIOGRAPHIES
Physician Biographies
Southern Oregon Cardiology, LLC
KentWDautermanMDFACCFSCAI
NicholasHDienelMDFACC
BrianWGrossMDFACC
Cardiology
Cardiology
Cardiology
Specialties Consultative and interventional cardiology
including peripheral vascular disease (e.g., carotid stenting)
Specialties Consultative and preventive cardiology,
complex lipid disorders, congestive heart failure,
echocardiography, nuclear cardiology
Specialties Consultative and interventional
cardiology, heart catheterization, echocardiography,
nuclear imaging
MedicalDegree University of Pennsylvania
MedicalDegree University of Rochester School
of Medicine and Dentistry, New York
MedicalDegree+PIOT)PQLJOT4DIPPMPG.FEJDJOF
Internship/ResidencyandChiefResidency
University of California, San Francisco
CardiologyFellowship University of California,
San Francisco
InterventionalCardiovascularFellowship
Cleveland Clinic
BoardCertiﬁcation Cardiovascular Medicine,
Interventional Cardiology
Honors/Awards Valedictorian, College of Arts
and Sciences, University of Toledo; Top Three
(SBEVBUF+PIOT)PQLJOT4DIPPMPG.FEJDJOF
Internship/Residency Internal Medicine at
University of Michigan
CardiologyFellowshipUniversity of Pennsylvania
Internship/Residency Dartmouth Medical School,
New Hampshire
BoardCertiﬁcation Internal Medicine, Cardiology
CardiologyFellowship University of Washington
Honors/Awards Graduated with highest honors from
Pennsylvania State University (undergraduate); Alpha
Omega Alpha Medical Honor Society
BoardCertiﬁcation Internal Medicine,
Cardiovascular Medicine, Interventional Cardiology
OﬃceMedford
Dr. Dauterman served as a Peace Corps public
health volunteer in Zaïre.
Honors/Awards Oregon American College of
Cardiology Leadership Award, May 2009; Washington
Research Award (American Heart Association),
Intern and Resident of the Year; Oregon Fire Chief’s
Award–Meritorious Service Award; All American
Selection to the All New England Soccer Team
Dr. Gross served as an assistant professor at the
University of Washington, Division of Cardiology.
Research Serves as the local principal investigator for
the NIH-sponsored CREST trial and CAPTURE I
and II, and CHOICE carotid stent registries
OﬃceMedford
OﬃcesMedford, Grants Pass
Heart and Vascular Outcomes
MarkMHuthMDPhDFACC
ToddSKotlerMDFACC
KennethMLightheartMDFACC
Cardiology
Cardiology
Cardiology
Specialties General cardiology, heart failure, heart
transplant, echocardiography, nuclear cardiology,
coronary angiography
Specialties Consultative cardiology, interventional
cardiology, general cardiology, nuclear cardiology
Specialties Consultative cardiology, transesophageal
echocardiography, nuclear cardiology, coronary
angiography, cardiac CT
MedicalandDoctoralDegrees Louisiana
State University
MedicalDegree Stanford University School
of Medicine
MedicalDegree Oregon Health Sciences University
Internship/Residency Internal Medicine at
University of California, Los Angeles
InternshipInternal Medicine at Legacy
Portland Hospitals
CardiologyFellowshipCedars-Sinai Medical
Center, UCLA
Residency Internal Medicine at David Grant
Medical Center, Travis Air Force Base, California
BoardCertiﬁcation Internal Medicine, Cardiology,
Interventional Cardiology
CardiologyFellowshipWilford Hall Medical
Center, Lackland Air Force Base, Texas
Honors/Awards Highest honors from University
of California, Santa Cruz (undergraduate)
BoardCertiﬁcation Internal Medicine, Cardiology,
Nuclear Cardiology
OﬃcesMedford, Grants Pass
Dr. Huth served as an assistant professor at the
University of Washington, Division of Cardiology.
Honors/Awards Summa cum laude from Brigham
Young University, cum laude from Oregon Health
Sciences University, Alpha Omega Alpha Honor Society
in medical school, Housestaff Scientific Research
Second Place Award
OﬃcesMedford, Grants Pass
OﬃcesMedford, Grants Pass
Internship/Residency Louisiana State University
CardiologyFellowshipUniversity of Washington
PostdoctoralFellowshipPhysiology at University
of Washington
BoardCertiﬁcation Internal Medicine, Cardiology
Honors/Awards Honors in physiology from
Rutgers University (undergraduate); Outstanding
Intern and Resident of the Year; Chairman of the
American College of Cardiology’s Oregon GAP
Project in Congestive Heart Failure
PHYSICIANBIOGRAPHIES
Physician Biographies
Southern Oregon Cardiology, LLC
KristinMLinzmeyerMDFACC
DavidJMartinMDFACC
MarkGMoranMDFACCFSCAI
Cardiology
Cardiology
Cardiology
Specialties General and invasive cardiology, heart
disease in women
MedicalDegree Oregon Health Sciences University
Specialties Electrophysiology, intracardiac
ablation, pacemakers, defibrillators, invasive and
noninvasive cardiology
Specialties Interventional cardiology, pacemaker
and defibrillator implantation and follow-up, invasive
and noninvasive cardiology, nuclear cardiology
Internship Internal Medicine at University of Utah
MedicalDegree Dartmouth Medical School
ResidencyInternal Medicine at Oregon Health
Sciences University
Internship/Residency Internal Medicine at
Cedars-Sinai Medical Center, UCLA
MedicalDegree University of California,
Los Angeles
CardiologyFellowshipUniversity of New Mexico
CardiologyFellowshipCedars-Sinai Medical Center
CardiologyFellowship UCLA Medical Center
BoardCertiﬁcation Internal Medicine,
Cardiovascular Disease
BoardCertiﬁcation Clinical Cardiac
Electrophysiology, Cardiovascular Disease
OﬃcesMedford, Grants Pass
Honors/Awards Alpha Omega Alpha Honor Society
in medical school, Phi Beta Kappa
BoardCertiﬁcation Internal Medicine, Cardiology,
Interventional Cardiology; Testamur NASPExAM;
Certified Cardiac Device Specialist IBHRE
OﬃceMedford
Internship/Residency UCLA Medical Center
Honors/Awards California Heart Association
Research Fellow; bachelor’s degree in biology with
highest honors from University of California, Santa
Cruz; Department of Medicine Intern of the Year,
UCLA Medical Center; Fellow Society for Cardiac
Angiography and Interventions
OﬃcesMedford, Grants Pass
Heart and Vascular Outcomes
BrianJMorrisonMDFACC
BrucePa!ersonMDFACC
EricAPenaMDFACC
Cardiology
Cardiology
Cardiology
Specialties Consultative cardiology, pediatric
and adult congenital heart disease
Specialties Consultative and preventative cardiology,
echocardiography, transesophageal echocardiography,
nuclear cardiology, coronary angiography
Specialties Cardiology, electrophysiology
MedicalDegree University of Illinois, Chicago
Internship/ResidencyInternal Medicine at University
of Colorado Health Sciences Center, Denver
CardiologyFellowshipMassachusetts General
Hospital, Harvard Medical School
BoardCertiﬁcationCardiology
Honors/Awards Grove Outstanding Senior Award
Finalist, University of Illinois College of Medicine;
Outstanding Resident Teaching Award, University
of Colorado Health Sciences Center
Dr. Morrison’s training included a senior clinical
research fellowship at Boston Children’s Hospital.
He also spent one year as an instructor and a staff
physician at the Adult Congenital Heart Disease
Center at the University of California, Los Angeles.
MedicalDegree University of South Florida
MedicalDegree University of Pennsylvania
Internship/Residency Emory University,
Atlanta, Georgia
Internship/Residency Internal Medicine at Brigham
and Women’s Hospital, Harvard Medical School
CardiologyFellowship Emory University
CardiologyFellowship Boston University
Medical Center
Honors/Awards Chief Medical Resident
BoardCertiﬁcation Internal Medicine, Cardiology
Honors/Awards Cook Memorial Prize in Economics
at Pomona College, California; President, Alpha Omega
Alpha Honor Society, University of Pennsylvania
School of Medicine
Dr. Patterson earned his master’s degree from the
1SJODFUPOɨFPMPHJDBM4FNJOBSZJO/FX+FSTFZ
OﬃceMedford
OﬃcesMedford, Grants Pass
BoardCertiﬁcation Cardiology, Electrophysiology
Dr. Pena has served on the faculty of the Heart Rhythm
Society’s International Meeting for the past three years.
Research Primary investigator or co-investigator
in many PIVOTAL clinical trials, Miracle ICD,
Companion trial, PAVE trial, and MADIT CRT trial
OﬃceMedford
PHYSICIANBIOGRAPHIES
Physician Biographies
Oregon Surgical Specialists, PC
BradleyEPersoniusMDFACC
StephenJSchnuggMDFACC
JuanMCastilloMDFACS
Cardiology
Cardiology
VascularGeneralandBariatricSurgery
Specialties Consultative and preventative cardiology,
transesophageal echocardiography, pacemakers, complex
lipid disorders, cardiac CT, nuclear cardiology,
cardiac catheterization
Specialties Consultative cardiology, interventional
cardiology, cardiac catheterization, echocardiography
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree University of California,
Los Angeles
MedicalDegree New York University
Medical Center
MedicalDegree Loma Linda University
School of Medicine
Internship/Residency Internal Medicine at
Wadsworth VA Medical Center
Internship/Residency Internal Medicine at Wilford
Hall Medical Center, Lackland Air Force Base, Texas
CardiologyFellowship Wadsworth VA
Medical Center
Internship/Residency General Surgery at
University of Texas Southwestern Medical Center
and Parkland Memorial Hospital
CardiologyFellowshipWilford Hall Medical Center
BoardCertiﬁcation Internal Medicine, Cardiology,
Interventional Cardiology
BoardCertiﬁcation Internal Medicine, Cardiology,
Cardiac Device Specialist
OﬃcesMedford, Grants Pass
VascularSurgeryFellowshipNew York University
Medical Center
BoardCertiﬁcation General Surgery,
Vascular Surgery
Honors/Awards Honors program at New York
University Medical Center; Chairman, Committee
on Cancer by American College of Surgeons for
Rogue Valley Medical Center and Providence
Medford Medical Center
OﬃceGrants Pass
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CREST carotid stent studies
OﬃceMedford
Heart and Vascular Outcomes
MarkAEatonMDFACS
WilliamEFaughtMDFACS
NancyO’NealMDFACS
VascularGeneralandBariatricSurgery
VascularandGeneralSurgery
GeneralSurgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
Specialties General, vascular, and endovascular
surgery, including laparoscopic surgery
Specialties General surgery, including laparoscopic,
breast, and oncologic surgery
MedicalDegree University of New Mexico
MedicalDegree Southern Illinois University
Internship/Residency General Surgery at
University of Texas Southwestern Medical Center
and Parkland Memorial Hospital
Internship/Residency General Surgery at
University of Utah
MedicalDegree University of Texas Southwestern
Medical School, Dallas
Internship/Residency General Surgery at
University of Texas Southwestern Medical Center
and Parkland Memorial Hospital
VascularSurgeryFellowship University of Tennessee
VascularSurgeryFellowship Southern
Illinois University
BoardCertiﬁcation General Surgery,
Vascular Surgery
BoardCertiﬁcation General Surgery,
Vascular Surgery
Honors/Awards Alpha Omega Alpha Honor Society
in medical school
Honors/Awards Alpha Omega Alpha Honor Society
in medical school
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CREST carotid stent studies
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CREST carotid stent studies
OﬃceMedford
OﬃceMedford
BoardCertiﬁcation General Surgery
OﬃceMedford
PHYSICIANBIOGRAPHIES
Physician Biographies
Oregon Surgical Specialists, PC
DavidLStreetMDFACS
DavidKTraulMDFACS
VascularGeneralandBariatricSurgery
VascularGeneralandBariatricSurgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree University of California, Davis
MedicalDegree Medical College of Wisconsin
Internship/Residency General Surgery at
University of California, Davis
Internship/Residency General Surgery at
Medical College of Wisconsin
VascularSurgeryFellowship University of Rochester
School of Medicine and Dentistry
VascularSurgeryFellowship Cleveland Clinic
BoardCertiﬁcation General Surgery,
Vascular Surgery
Honors/Awards Graduation with distinction,
Point Loma College
Research Primary investigator in Endologix
large neck aneurysm study and CAPTURE II
carotid stent study; subinvestigator in PIVOTAL
small aneurysm study and CREST carotid stent study;
and subinvestigator in CHOICE, CAPTURE I
and II, and CREST carotid stent studies
OregonSurgicalSpecialistsPCstaﬀ
BoardCertiﬁcation General Surgery,
Vascular Surgery
Honors/Awards#FTU+VOJPS4VSHJDBM3FTJEFOU
Research Primary investigator in PIVOTAL
small aneurysm study; and subinvestigator in
CHOICE, CAPTURE I and II, and CREST
carotid stent studies
OﬃceMedford
AsanteCardiovascularand
ThoracicSurgeonsstaﬀ
OﬃceMedford
Heart and Vascular Outcomes
Contact Information
Rogue'Valley'Medical'Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .()+-0'123-1444
RVMCCardiovascularLab
Admissions Hotline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(541) 951-0097
Cardiac Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-4466
Emergency Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-7132
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-7100
TDD Hearing-Impaired Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-7104
Imaging Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-4322
Lifeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (541) 789-4440
attheCardiovascularInstitute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ()+-0'626-7774
Asante'Cardiovascular'and'Thoracic'Surgeons . . . . . . . . . . . . . ()+-0'123-)1-4
Charles Carmeci, MD, FACS
David L. Folsom, MD, FACS
Roger V. Hall, MD
George R. Wilkinson, MD, FACS
2954 Siskiyou Blvd.
Medford, OR 97504
Fax: (541) 789-5711
Oregon'Surgical'Specialists5'PC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ()+-0'626-7724
+VBO.$BTUJMMP.%'"$4
Mark A. Eaton, MD, FACS
William E. Faught, MD, FACS
Nancy O’Neal, MD, FACS
David L. Street, MD, FACS
David K. Traul, MD, FACS
Website: www.oregonsurgical.com
520 Medical Center Drive, Suite 300
Medford, OR 97504
Fax: (541) 282-6681
E-mail: [email protected]
520 Medical Center Drive, Suite 150
Medford, OR 97504
Fax: (541) 282-6660
Southern'Oregon'Cardiology5'LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ()+-0'626-7747
+PO3#SPXFS.%'"$$
Douglas T. Burwell, MD, FACC
Kent W. Dauterman, MD, FACC, FSCAI
Nicholas H. Dienel, MD, FACC
Brian W. Gross, MD, FACC
Mark M. Huth, MD, PhD, FACC
Todd S. Kotler, MD, FACC
Kenneth M. Lightheart, MD, FACC
Kristin M. Linzmeyer, MD, FACC
%BWJE+.BSUJO.%'"$$
Mark G. Moran, MD, FACC, FSCAI
#SJBO+.PSSJTPO.%'"$$
Bruce Patterson, MD, FACC
Eric A. Pena, MD, FACC
Bradley E. Personius, MD, FACC
4UFQIFO+4DIOVHH.%'"$$
SouthernOregonCardiologyLLCstaﬀ
Toll-free: (800) 283-0423
Website: www.socardiology.com
Medford Oﬃce
520 Medical Center Drive, Suite 200
Medford, OR 97504
Phone: (541) 282-6606
Fax: (541) 282-6601
Grants Pass Oﬃce
520 SW Ramsey Avenue, Suite 101
Grants Pass, OR 97527
Phone: (541) 472-7800
Fax: (541) 472-7801
EastBarneRoadMedfordOR
·
-
Copyright©–AsanteHealthSystemAllrightsreservedNopartofthispublicationmaybereproduced
inanyformexceptbypriorwrienpermissionPrintedwithsoyinkonrecycledpaper
AHS