St. Clair Hospital_HouseCall Vol X Issue 3

VOLUME X ISSUE 3

A NEW ERA IN

CARDIAC SURGERY St. Clair Hospital welcomes pioneering cardiothoracic surgeon Andy C. Kiser, M.D., FACS, FACC, FCCP

NEW ERA IN CARDIAC SURGERY

2 I HouseCall I Volume X Issue 3

TRANSFORMING Cardiac Care

Cardiothoracic surgeon Andy C. Kiser, M.D., FACS, FACC, FCCP, learned at an early age to be a problem solver. Growing up on a tobacco farm in North Carolina, he witnessed his father’s practical approach to issues and took to heart his father’s advice. “When I was growing up, my Daddy always told me to think about what I was doing,” he says. “That was great advice and it’s been my approach to solving problems.

When I see a challenge, I focus on it completely and think my way through it until I have a solution.”

t was a lesson well learned, and it has served Dr. Kiser well in an exceptionally accomplished career that now brings him to St. Clair Hospital as the newly appointed Chief of Cardiac Surgery. An internationally recognized leader in the highly specialized field of cardiothoracic surgery, Dr. Kiser has pioneered innovative approaches to heart surgery that are transforming the treatment of certain heart conditions, including atrial fibrillation, a disorder of the heart’s rhythm, as well as valve and coronary disease. He conceived and developed the innovative convergent hybrid ablation procedure for the treatment of persistent atrial fibrillation, the most common heart rhythm disturbance and a leading cause of stroke. He also has extensive experience in the surgical treatment of cardiac valve disease and coronary artery disease, and as a thoracic surgeon, in the treatment Andy C. Kiser, M.D., FACS, FACC, FCCP

of diseases of the lungs, chest wall and esophagus, including cancers.

Continued on Page 4

Volume X Issue 3 I HouseCall I 3

NEW ERA IN CARDIAC SURGERY Continued from Page page 3

Dr. Kiser is the inventor of a number of medical devices, an entrepreneur and an educator. He is a Fellow of the American

and an invigorating sense of enthusiasm for the future of cardiac care at St. Clair. “St. Clair has a tradition of high quality cardiac

College of Surgeons, the American College of Cardiology and the

care,” Dr. Kiser says. “The program is well known and highly

American College of Chest Physicians. Dr. Kiser is the founder

regarded. I’m proud to build on the legacy of longtime St. Clair

and CEO of Advanced Cardiac Access Training Institute in North

cardiothoracic surgeon G. Frederick Woelfel, Jr. My job is to

Carolina, which has provided education and advanced training in

continue that excellence and advance it. I’ll be doing cutting-edge,

surgical skills and procedural simulation to other surgeons across

minimally invasive procedures. (Please see sidebar on Heart Valve

the United States and around the world. Dr. Kiser has authored

Problems, Page 7.) A lot of changes are on the horizon in cardio-

numerous scientific papers and textbook chapters on cardio-

thoracic surgery and I enjoy helping to usher in those advances

thoracic surgery and a wide range of other topics.

and that technology. I had positive expectations, but the first time

With his arrival at St. Clair, Dr. Kiser brings a wealth of capabilities: exemplary surgical skill, inspiring leadership, a fertile mind

I visited St. Clair, I was blown away by the quality of the institution, the staff and the administration.”

Targeting the highest caliber of cardiac care Cardiac care is one of the most critical services that a hospital can offer a community, and St. Clair has excelled in this regard.

St. Clair’s highly respected cardiac care program features a spectrum of cutting-edge services that are continually being expanded and enhanced in a quest to improve, innovate and excel. Outstanding elements of the program include advanced emergency cardiac care; an expansive, first-rate, 24-hour cardiac catheterization lab that performs 2,000 procedures annually; and the latest cardiac diagnostics, including cardiac MRI, the most advanced imaging technology for diagnosing heart disease, under the direction of Christopher E. Pray, M.D., FACC, medical director of noninvasive cardiology. It also includes a comprehensive cardiac electrophysiology lab that provides the most progressive diagnostics and treatment to people suffering with cardiac rhythm disorders, also known as arrhythmias. At St. Clair, cardiothoracic surgeons perform open-heart surgery, including coronary artery bypass grafts and valve repair and replacement.

ANDY C. KISER, M.D., FACS, FACC, FCCP Dr. Kiser earned a B.S. in biology with honors and distinction, and a medical degree with honors from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason-Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser is employed by St. Clair Cardiovascular Surgery Associates, part of St. Clair Medical Services.

To contact Dr. Kiser, please call 412.942.5728.

4 I HouseCall I Volume X Issue 3

Dr. Kiser, center, gestures as he introduces himself to fellow physicians and other clinicians in an Operating Room at St. Clair.

Dr. Kiser is best known for his pioneering work on minimally invasive valve surgery and coronary artery surgery, along with his hybrid procedure to treat atrial fibrillation. His procedures for valve repair, including the

“

A LOT OF CHANGES ARE ON THE HORIZON FOR CARDIOTHORACIC

suprasternal (above the sternum, or breastbone) transcatheter (via a

SURGERY AND I WANT TO HELP USHER

flexible catheter inserted through the skin) aortic valve replacement,

IN THOSE ADVANCES AND THAT

known as TAVR, make it possible to avoid sternotomy, the large chest incision of open-heart surgery that has been the standard for valve surgery. Dr. Kiser played a primary role in developing and perfecting the suprasternal TAVR procedure in 2015 and performed the world’s first one on a human patient.

TECHNOLOGY.

”

ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL

Continued on Page 6

Volume X Issue 3 I HouseCall I 5

NEW ERA IN CARDIAC SURGERY Continued from Page 5

THE CONVERGENT PROCEDURE FOR ATRIAL FIBRILLATION avoids incisions in the chest

TRADITIONAL SURGERY

Open Chest

MINOR ENTRY PROCEDURE During minimally invasive procedures, Dr. Kiser approaches the heart through a two- or three-inch incision, at the top or the bottom of the sternum. For the patient, the advantages of the minimally invasive approach over open-chest procedures are substantial: traditional open-chest surgery entails cutting through the breastbone and opening up the chest. It involves greater blood loss; a longer hospital admission, including an intensive-care stay; greater post-operative pain and a higher risk of complications. Aortic valve surgery, whether it is performed with a minimally invasive approach or open-chest approach, requires stopping the heart while placing the patient on a heart-lung bypass machine.

Although not everyone is a candidate for the minimally invasive approach, Dr. Kiser

Between the Ribs

believes that it will become more customary as new technologies emerge and openheart surgery will be less common in the future.

Transforming the treatment of arrhythmia As the inventor of the paracardioscopic (directly visualizing the heart with a camera from inside the pericardium, the sac around the heart) convergent hybrid ablation

discipline. “Treating atrial fibrillation means starting with medications to regulate

“

the heart rate and thin the blood,” Dr. Kiser says. “The next step is catheter ablation,

WILL BE LESS COMMON IN

which is less invasive than surgery. St. Clair Hospital’s Dr. (Jeffrey C.) Liu performs

THE FUTURE.

procedure to treat atrial fibrillation, Dr. Kiser is transforming the treatment of this arrhythmia. “Convergent” means a converging of both expertise and technology from cardiothoracic surgery and cardiac electrophysiology; it combines the strengths of each

cryoballoon and radiofrequency catheter ablations at St. Clair to target a precisely mapped area of tissue in the heart muscle to create a controlled scar, which blocks abnormal electrical signals that trigger episodes of atrial fibrillation, thus restoring a normal heart rhythm. Our surgery is for those who are difficult to treat, because of a large heart, long-standing atrial fibrillation, or a need for a repeat ablation. Ablation targets the pulmonary veins, isolating them because they have an irritable focus that sparks the arrhythmia. We plan to start a program for this at St. Clair and Dr. Liu will be a great partner.” (Please see sidebar on Atrial Fibrillation, Page 8.)

Continued on Page 9

6 I HouseCall I Volume X Issue 3

OPEN-HEART SURGERY

”

ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL

TREATING HEART VALVE PROBLEMS WITH ADVANCED TECHNOLOGIES

Open-heart surgery without opening the chest Picture yourself traveling to the city on the

Parkway West, inbound. Traffic is flowing, but

then, just ahead, sit the dreaded orange cones

Most heart valve problems involve the aortic and mitrial valves.

and barrels of a construction zone. Both lanes are forced to merge into a much smaller space; before

AORTIC VALVE

AORTA

long, traffic is backed up and congested, and

between the left ventricle and the aorta

you’re late for work, or school, or a game.

Blood flows through your heart like vehicles

LEFT ATRIUM

traveling on a highway. The blood flows through

the heart’s chambers, the atria and the ventricles.

RIGHT ATRIUM

The atria are the receivers — blood returns to

MITRIAL VALVE

LEFT VENTRICLE

them from the body and the lungs, while the

ventricles are the heart’s primary pump, rhyth-

between the left atrium and the left ventricle

RIGHT VENTRICLE

mically propelling the blood to the lungs and the body. The heart’s blood flow is regulated by

four valves — structures that open and close to

allow the passage of fluid in one direction only.

Together, the valves enable a healthy, one way

NORMAL

Aortic STENOSIS

Mitral REGURGITATION

flow: the flaps on the valves close after the blood

flows through, preventing blood from being forced backward.

Valve problems usually involve the aortic and

mitral valves. When they are damaged, two conditions can result: stenosis, or narrowing; and regurgitation, or backflow. Stenosis means less

open

closed

The valve fully opens and closes.

open

closed

The valve doesn’t open enough.

At St. Clair Hospital, open heart valve surgery

is performed by cardiothoracic surgeons when

blood can flow to its destination and the heart

the valves are diseased or damaged and causing

is usually due to calcium deposits that thicken

diseased valve is preferred to replacement of the

mitral valve becomes weakened, it fails to close

cutting through the sternum (breastbone) and

atrium. This condition, mitral valve regurgitation,

a heart-lung bypass pump. This device takes

open

closed

The valve doesn’t fully close and leaks.

artery in the groin and guiding it to the aortic valve to place it. Dr. Kiser has further refined this procedure, facilitating TAVR by developing a

will pump harder, eventually weakening. Stenosis

worsening symptoms. Usually, repair of the

suprasternal approach that accesses the aortic

the valve tissue and narrow the opening. If the

valve with a prosthetic. The procedure involves

TAVR approach avoids large chest incisions as

completely and may prolapse back into the

stopping the heart while placing the patient on

is often asymptomatic, but it also allows blood

over the function of perfusion, the process in

to leak backward. In both cases, one is likely to

experience symptoms such as shortness of

which oxygenated blood is delivered to the

body’s tissues. Post-operatively, the patient will

valve from above the sternum. “The suprasternal

well as femoral punctures; it results in many

advantages for the patient: a shorter procedure,

faster ambulation, less discomfort and earlier discharge,” Dr. Kiser explains.

More than 5 million people are diagnosed with

valve disease every year in the U.S. Some have a

breath, fatigue, leg swelling and chest pain, and

recover in St. Clair’s Cardiovascular Surgical Unit.

Valve disease can be asymptomatic or very

some pioneered by Andy C. Kiser, M.D., FACS,

the result of age- and lifestyle-related changes in

at St. Clair, employ minimally invasive technology

risk factors for coronary artery disease, including

your doctor may be able to hear a heart murmur.

Progressive approaches to valve surgery,

mild, even when the heart is working extra hard

FACC, FCCP, the new Chief of Cardiac Surgery

valve. Eventually, though, the heart may begin

and will soon be an option at St. Clair. Dr. Kiser,

manage symptoms: diuretics to remove excess

primary role in developing the new technologies

to compensate for a narrowed or malfunctioning

congenital predisposition to valve problems, but

more often valve stenosis and regurgitation are

the heart. Infections can scar the heart valves, and obesity, diabetes, high blood pressure and

to decompensate. Medications can be helpful to

an inventor as well as a surgeon, has played a

smoking, can contribute. Many people with valve

fluid; anti-arrhythmics to regulate the heart

and surgical devices that have made these

those who do can rest assured that they will find

and promote good blood flow. If left untreated,

transcatheter aortic valve replacement, or TAVR,

therapy, the “traffic” congestion of heart valve

sudden cardiac death.

taining a bioprosthetic valve through the femoral

and one can live a healthy, long life. n

rhythm; and medications to control blood pressure

valve disease can lead to heart failure, stroke and

breakthroughs possible. One of these options,

treats atrial stenosis by inserting a catheter con-

disease do not need surgery, but in Pittsburgh state-of-the-art care at St. Clair. With specialized

disease can be returned to a more normal flow

Volume X Issue 3 I HouseCall I 7

NEW ERA IN CARDIAC SURGERY Continued from Page 6

St. Clair is among the nation’s leaders for treatment of

ATRIAL FIBRILLATION Atrial fibrillation, often called AFib, is the most common form of arrhythmia, or heart rhythm disorder, affecting millions of Americans. It can be a challenge to diagnose and treat, but St. Clair Hospital is at the cutting-edge of AFib care, with a highly

what is AFib? Atrial fibrillation, or AFib, is an irregular heartbeat, or a condition in which the atria fail to contract in a strong, rhythmic way. When the heart is in AFib, it may not be pumping enough oxygen-rich blood out to the body.

COMMON SYMPTOMS OF A FIB

specialized electrophysiology (EP) lab and a dynamic team with nationally recognized expertise. Jeffrey C. Liu, M.D., FHRS, the

medical director of St. Clair’s EP Lab, has been offering advanced, state-of-the-art

care to St. Clair patients since 2013. Now he has been joined by renowned cardiothoracic surgeon Andy C. Kiser, M.D., FACS,

FACC, FCCP, the newly appointed Chief of Cardiac Surgery at St. Clair, who has

advanced AFib treatment with approaches that combine surgical and ablation technologies. Dr. Kiser and Dr. Liu will partner to offer the convergent hybrid procedure, a collaborative approach pioneered by Dr. Kiser that is among the newest and most

Racing, fluttering or palpitations of the heart

Lightheadedness

2.7 MILLION PEOPLE IN THE U.S. HAD

AFIB IN 2010

12 MILLION PEOPLE COULD HAVE

AFIB BY 2050

Shortness of breath

9%

OF PEOPLE AGE 65 AND OLDER HAVE BEEN DIAGNOSED WITH THE CONDITION

Sometimes there are no noticeable symptoms and diagnosis is by exam.

5x

The greatest risk of AFib is stroke. A patient with AFib is 5 times more likely to have a stroke than someone who doesn’t have atrial fibrillation.

innovative treatments for persistent AFib. AFib is primarily a disease of aging, Dr. Kiser explains, and the incidence is likely to rise as the U.S. population ages. According to the Centers for Disease Control and Prevention, 9 percent of people age 65 and older have been diagnosed with the condition. There are degrees of severity, but it is never a benign diagnosis: AFib is a complex and chronic condition that can be debilitating, severely impacting quality of life. Furthermore, it is potentially deadly, as one of the leading causes of stroke. AFib occurs when the heart’s upper chambers,

8 I HouseCall I Volume X Issue 3

the atria, beat erratically, so that blood does

because every patient presents in a unique

not flow as it should. Blood pools in the

way. Some have no symptoms and find out

heart and this stasis can produce clots which

they have AFib when they are in the hospital

may travel to the brain, causing a stroke,

for another reason; they may never need

which can have devastating consequences,

treatment. Others are more symptomatic,

including blindness, paralysis and even

and when symptoms are severe, it can be

death. As the heart quivers and races, it

profoundly life altering.” Symptoms of AFib

cannot pump effectively, and it works harder

may include a racing heart, palpitations

and harder in an attempt to compensate.

(fluttering feeling in the chest), shortness

Eventually, that can produce heart failure.

of breath, anxiety and severe fatigue that

“AFib is very common; I see it more than

is out of proportion to one’s activities,

any other condition,” says Dr. Liu. “The

which results from a lack of oxygen to

treatment of AFib has to be individualized,

the body’s cells.

Continued from Page 6

Dr. Liu, a board-certified specialist in cardiac electrophysiology, is the medical director of St. Clair’s Electrophysiology Lab. “St. Clair provides cardiac care at a level that is usually found at academic Treatment includes medication to control heart rate and rhythm; blood thinners to prevent clotting and reduce stroke risk; a procedure known as catheter ablation, which

medical centers,” Dr. Liu says. “We offer the people of this community access to state-of-the-art cardiac care, close to home, including cardiac ablations for arrhythmias.

“No doubt, to be able to recruit a surgeon of Dr. Kiser’s reputation

Dr. Liu performs; and surgery. Ablation is a precise and

will only enhance what we do. He brings a progressive approach to

strategic creation of scar tissue within the heart to interfere

valve work and will bring a lot of surgical advances to St. Clair. He is

with the conduction of the chaotic electrical impulses

an innovator and a pioneer; he is modest about his accomplishments,

that cause the atria to fibrillate.

but he actually invented the surgical tool used in the hybrid ablation

There are two kinds of ablation procedures: cryoballoon, which uses freezing technology, and radiofrequency, which uses heat. Surgery for AFib is essentially surgical ablation; it can be an open-heart procedure called the Cox Maze, which creates a maze of scars by cutting,

procedure for atrial fibrillation. We have a robust atrial fibrillation program at St. Clair and it continues to grow. The high caliber of our program is among the attractions that brought Dr. Kiser to St. Clair and with his experience, credentials and vision, he will definitely help us further advance the program to new levels.”

burning or freezing; or the Mini-Maze, a minimally invasive procedure performed via a two-inch incision at the bottom of the sternum. Dr. Kiser performs the procedure using the Subtle Cannula, a tool that he designed from an airway tube; it consists of a hollow, semi-rigid tube through which he passes a camera and the ablation device.

The convergent hybrid procedure employs the best

Continued on Page 10

“

DR. KISER’S EXPERIENCE AND CREDENTIALS,

elements of ablation and Mini-Maze surgery in a single

PLUS HIS VISION, WILL

operation. “‘Convergent’ means a converging of expertise

DEFINITELY HELP US

and technology from cardiothoracic surgery and electrophysiology,” Dr. Kiser explains. “We will start a program

TAKE THE PROGRAM

for this procedure at St. Clair.”

TO THE NEXT LEVEL.

Another option for treating AFib is an implanted device called a Watchman™ that is placed percutaneously (through the skin) and guided through a catheter into the left

JEFFREY C. LIU, M.D., FHRS, ELECTROPHYSIOLOGIST, ST. CLAIR HOSPITAL

”

atrium. “Some patients with AFib cannot take oral blood thinners,” Dr. Kiser says. “This is an alternative which reduces the risk of stroke for those people. The Watchman

Jeffrey C. Liu, M.D., FHRS

does not change the electrical impulses; it’s a mesh closure device that occludes the left atrial appendage, a small muscular pouch in the upper left atrium that functions as

JEFFREY C. LIU, M.D., FHRS

a decompression chamber. The left atrial appendage is

Dr. Liu earned a B.S. in general science while studying in the accelerated six-year B.S./M.D. program at The Pennsylvania State University, State College, before earning his medical degree at Jefferson Medical College, Philadelphia.

He completed a residency in internal medicine at the University of Maryland Medical Center, served as Chief Resident at the Baltimore VA Medical Center, and completed fellowships in cardiovascular medicine and clinical cardiac electrophysiology at UPMC. Dr. Liu is board-certified in cardiology, cardiac electrophysiology and internal medicine by the American Board of Internal Medicine. He practices with South Hills Cardiology Associates, part of St. Clair Medical Services.

where most of the blood clots that come from the heart originate. The Watchman seals it off.

“All of these measures mitigate the risk of stroke with AFib. We will have a comprehensive program at St. Clair and we’ll take care of people with AFib and reduce their risk of stroke. With treatment, you can return to a quality life without atrial fibrillation.” n

To contact Dr. Liu, please call 412.942.7900.

Volume X Issue 3 I HouseCall I 9

NEW ERA IN CARDIAC SURGERY Continued from Page 9

Multidisciplinary approach improves outcomes James R. Edgerton, M.D., FACC, FACS, FHRS, is a leading cardio-

atrial fibrillation, but is also dedicated to the team approach. Dr. Kiser will develop cross-disciplinary approaches that will complement the great cardiac care that St. Clair Hospital is known for,” says Dr. Edgerton.

Although he has lived in North Carolina for his entire life, Dr. Kiser

thoracic surgeon and the medical director of the Heart Arrhythmia Center

has an important connection to Pittsburgh, and especially to the South

at the Baylor Scott and White Heart Hospital near Dallas, Texas, and

Hills: his wife, Heather, is a native of Peters Township and her parents

a spokesperson for The Society of Thoracic Surgeons. A colleague of

and sisters still reside here. His brother-in-law, St. Clair Hospital cardi-

Dr. Kiser, he is familiar with his work. “The incidence of atrial fibrillation

ologist James W. Marcucci, M.D., initially told him of the opportunity at

is increasing tremendously as the U.S. population ages, and many more

St. Clair. “I never thought I would move to Pittsburgh, but this was a

people are seeking treatment,” Dr. Edgerton says. “Patients are becoming

great opportunity,” says Dr. Kiser. “We have a son, Austin, who is 24 and

increasingly savvy about the various treatment options for atrial fibrillation

works with me on my inventions and patents. He developed a simulator

and they are flocking to the places that have a multidisciplinary approach.

to help me train other surgeons. Our daughter Hannah, 22, recently

These places break down the ‘silo’ mentality, in which each specialty acts

graduated from the University of North Carolina and married Paul Ambrose,

independently of the others, and develop a collaborative approach. One

a U.S. Army Black Hawk helicopter pilot. They are serving our country

of those collaborative approaches is the convergent hybrid procedure

in Fort Rucker, Alabama. I’m very proud of them all.

developed by Dr. Kiser.

“The addition of Dr. Kiser adds this important element to the treatment of patients at St. Clair. He is not only a leader in the treatment of

“My father was a tobacco farmer and my mother was a nurse who was in the first class of family nurse practitioners at the University of North Carolina. She opened a clinic in Carthage, North Carolina, and to

The Kiser family (left to right): Claytie (Dr. Kiser’s father); Hannah Ambrose (daughter); Heather (wife); Andy Kiser, M.D.; Austin (son); and Nancy (Dr. Kiser’s mother).

10 I HouseCall I Volume X Issue 3

the people there, she was viewed as a doctor. I decided to become a doctor after I had a football injury in high school. I had to see an orthopedic surgeon and I was impressed by him and what he did. I thought surgery looked very interesting. I eventually went to medical school at UNC and I was given a job in the cardiology research program; as a fourth year student, I met Dr. Benson Wilcox, the chief of cardiothoracic surgery at UNC, who became my mentor and role model.

He mentored me all the way through; I was simply blessed all the way.”

“

I HOPE I CAN BE A SURGEON WHO REFLECTS WHAT THE COMMUNITY SEES IN ST. CLAIR HOSPITAL.

ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL

”

Dr. Kiser has a private pilot’s license and is a certified scuba diver, but his favorite way to relax is by spending time with his family or working on new inventions. “I’m very busy and I enjoy coming up with innovations. That has opened many doors for me and introduced me to many people. It’s a profession, but it’s also a hobby. For me, it isn’t work, but fun; it’s how I relax.”

The clinical aspect of his work is always challenging and satisfying, says Dr. Kiser, and he enjoys contributing to advances in clinical care and inventing. But his greatest satisfaction comes, not from having a groundbreaking impact on heart surgery, but from impacting individual lives. “When the things I have done change a patient’s life for the better, it feels wonderfully satisfying. Maybe they stop smoking or develop a new healthy lifestyle; they have a new lease on life and they contribute more to the community. People see a new opportunity

Andy C. Kiser, M.D., FACS, FACC, FCCP

for their lives after they have been through cardiac surgery. They've been dealt a blow, but then they are able to overcome it and have a renewed life. To see the impact of my work in that way — that’s the best.”

Developing a high quality cardiothoracic program, says Dr. Kiser, depends primarily on the team: “This is a team sport, and I am very impressed with the team at St. Clair. There are many specialties and disciplines, and they have a wonderful level of expertise. If you want to know the quality of a hospital, look to the nurses; many of the nurses at St. Clair have been there long term and that says a lot.

“A high quality program is patient-centered and patient education is a priority. We’ll have a multidisciplinary approach to educating patients with atrial fibrillation and valve disease, with representatives from Nursing, Dietary, Pharmacy and Respiratory Therapy. With the clinical collaboration between St. Clair and Mayo Clinic, we’ll be able to share best practices.

“I’m also looking forward to collaborating with the physicians at McGinnis Thoracic and Cardiovascular Associates, especially Dr. George Magovern, Dr. Stephen Bailey, and their colleagues.

“At St. Clair, the community embraces the Hospital and the Hospital provides so much. It’s a great relationship — an ideal one.

I hope I can be a surgeon who reflects what the community sees

in St. Clair Hospital.” n

Volume X Issue 3 I HouseCall I 11

DUNLAP FAMILY OUTPATIENT

Longtime benefactors name St. Clair’s new outpatient center with largest gift in Hospital’s history Construction of St. Clair Hospital’s new outpatient center is just getting underway in earnest, but it already has a name: DUNLAP FAMILY OUTPATIENT CENTER.

T

he multi-million dollar, 280,000-square-

tient center and a central utility building to

foot building has been named in honor of

support it. The investment represents the

Anna and Ed Dunlap and their family for

largest expansion at the Hospital’s main campus

their very generous donation to its construction,

in four decades and is in response to the 130

as well as their longtime commitment toward

percent growth in St. Clair’s outpatient volume

the Hospital. (St. Clair’s Fourth Floor Conference

since 2006.

Center, off its main lobby, is also named after the Dunlaps, and the Hospital’s nationally recognized

hensive diagnostic and therapeutic outpatient

Emergency Room also has benefitted from the

services, including: laboratory; medical imaging;

Dunlaps.)

cardio-diagnostics; physical and occupational

“What I find most impressive about St. Clair

EDWARD B. DUNLAP JR., FOUNDER, AND CHIEF EXECUTIVE OFFICER, CENTIMARK CORPORATION

“

is that the Hospital continues to function inde-

with 10 operating rooms, two procedure rooms, and 51 pre- and post-surgical rooms; a spacious

while still maintaining the caring and compassion

endoscopy (GI) suite with six exam rooms; other

of a neighborhood hospital,” says Ed, who serves

multidisciplinary clinical programs; conference

as Honorary Co-Chair of the Hospital’s Ground-

space; multiple seating options; a café serving

breaking Growth Campaign, which is designed

chef-prepared offerings; underground and valet

to raise funds for constructing the new outpa-

parking; and a commercial pharmacy.

important to us because it’s important to the health of the community.

12 I HouseCall I Volume X Issue 3

therapy; an infusion center; outpatient surgery

pendently by enhancing its services and facilities,

The Groundbreaking project is

EDWARD B. DUNLAP JR., FOUNDER AND CHIEF EXECUTIVE OFFICER, CENTIMARK CORPORATION

The new six-story building will offer compre-

”

CENTER Ed is the Founder and Chief Executive Officer of Washington

Help us build on our commitment to the community

County-based CentiMark Corporation, the leader in the commercial roofing and flooring industry in the U.S. and Canada. He and his wife are also the owners/operators of the iconic LeMont restaurant on Mt. Washington. They both agree that St. Clair offers the latest treatments and the newest technologies, but they reserve their biggest praise for the Hospital’s people. “From the moment you walk in the door, every person wants you to have a good experience,” says Ed. “You get exceptional care at St. Clair.”

Ed and his family are so impressed with St. Clair that their

GROUNDBREAKING GROWTH – C A P I TA L C A M PA I G N –

The generosity of philanthropic individuals like Ed and Anna Dunlap makes possible St. Clair Hospital’s largest expansion in decades, thereby securing high quality health care in our community for generations to come.

philanthropic relationship with the Hospital spans more than

Funding for the $150 million expansion is being supported by

20 years. “The new outpatient center is going to be our most

government grants, tax-exempt bonds and Hospital funds, but it

important contribution,” he says. “It’s going to streamline

is private philanthropy that will ensure the project is completed.

the way the Hospital is providing care to patients.”

Ed is hoping that others who have also experienced

Through decades of expansions, improvement and innovations,

St. Clair’s high-tech, high-touch patient care will join him and

the people of this region have stood by St. Clair Hospital,

his family in supporting St. Clair’s Groundbreaking Growth

continually lending their support and showing their faith in our

Campaign. “This fundraising effort will help lead St. Clair into

ability to deliver excellent health care. That unwavering commitment

the next generation of health care,” says Ed. “The Groundbreaking project is important to us because it’s important to the health of the community. This Hospital benefits the

has allowed us to remain an independent, nationally recognized leader in patient safety, quality, patient satisfaction and value.

community significantly. It makes getting excellent health care convenient. I think it’s the best hospital in the area.”n

EVERY GIFT MAKES A DIFFERENCE St. Clair Hospital Foundation asks that you please join in this transformative effort that will lead the Hospital into the next generation of health care. To donate to the Groundbreaking Growth campaign, please use the envelope included in this issue of HouseCall, donate online at stclair.org/giving, or call us at 412.942.2465.

{

Thank You!

Ed and his family are so impressed with St. Clair that their philanthropic relationship with the Hospital spans more than 20 years. “The new outpatient center is going to be our most important contribution,” he says. “It’s going to streamline the way the Hospital is providing care to patients.”

Volume X Issue 3 I HouseCall I 13

TREATING ADDICTIONS

ST. CLAIR HOSPITAL AND GATEWAY REHAB

Partner in the fight against substance abuse

“

We want

people to know that if they have a problem with opioid abuse or

S

t. Clair Hospital is funding a new program

resources were needed to

with Gateway Rehab to help individuals and

meet the demand for treat-

families who are struggling with opioid use

ment, and that people in

disorder (OUD) and other forms of addiction. For

seeking treatment needed

St. Clair patients, the service will provide immediate

immediate access to it.

and coordinated care, beginning in the Emergency

Accordingly, the Hospital,

substance abuse of any

Room (ER), through recovery and beyond, with the

through the Community

kind, they can come to

hope of not only saving lives but also improving the

Benefit Committee of its

quality of those lives. The program is the result of

Board of Directors, decided

a year-long effort that brought multidisciplinary

to make a substantial grant

experts from both facilities together, to brainstorm,

to fund this special program.

us. ...We’re right here, we care and we never close.

”

JULIA M. D’ALO, M.D., EMERGENCY MEDICINE PHYSICIAN, ST. CLAIR HOSPITAL

learn from each other and strategize. The new addiction treatment program provides behavioral

“We felt that in order to respond with the best approach possible, we needed to consult the best

health care, clinical medical care, and socioeco-

experts available. We were familiar with Gateway

nomic support with an approach that is holistic,

and we knew they had the expertise we needed.

pragmatic and deeply humane.

Gateway is a Pennsylvania Opioid Use Disorder

“We recognized that substance abuse, and opioid abuse in particular, was a significant and growing concern for many that we serve,” says G. Alan

14 I HouseCall I Volume X Issue 3

Paul Bacharach, President and Chief Executive Officer, Gateway Rehab

Center of Excellence (COE); it was one of the first rehab facilities in the state to be so chosen.

“St. Clair and Gateway complement each

Yeasted, M.D., FACP, Senior Vice President and

other,” Dr. Yeasted adds. “We each bring different

Chief Medical Officer Emeritus at St. Clair. “Our

strengths to this. Paul Bacharach, Gateway President

Emergency Room, inpatient units and primary care

and CEO, suggested that we model this new initia-

physician offices were increasingly confronting

tive on their Center of Excellence program. We are

OUD as the problem worsened and the number

truly thrilled to work with Gateway, which has long

of overdoses climbed. We realized that additional

been recognized as a leading light in the fight

but the abstinence-based models of treatment

want much more than that,” explains Julia

people at both institutions — the ER physicians,

don’t work well with OUD. The new model is

D’Alo, M.D., an emergency medicine physician

case managers, social workers, behavioral

Medication Assisted Treatment, or MAT. This

at St. Clair. “They need a bit of our humanity,

against addiction. All the credit goes to the

health staff, our chief nursing officer and

is evidence-based treatment that shows that

to feel personally cared for, as much as they

others — who planned it and will be a part of it.”

using certain medications decreases the over-

need our clinical expertise. They also need

Paul says that this program is timely. “Opioid

dose rate and keeps people in recovery programs

immediate help. We now give one of the

use disorder, and other forms of substance

longer. It is now widely accepted that MAT

approved medications right away in the ER,

abuse, is becoming a bigger problem across

and behavioral therapy, plus psychosocial

where the physicians have been certified to

the region. St. Clair was committed from the

interventions, are a safe, efficient and effective

give them. We call Gateway to summon a

start to meeting the increased demand for

model of care.”

Recovery Support Specialist (RSS), who will

Medication Assisted Treatment is primarily

treatment and rehabilitation with an approach that offers a rapid and effective response.”

A public health crisis

come to the ER as quickly as possible. This

for the treatment of addiction to opioids such

person is a peer who has been through

as heroin and prescription pain relievers that

recovery and becomes the patient’s mentor,

contain opioids. It blends behavioral therapy

advocate and helper for a year. Gateway will

and the administration of one of three FDA-

have a bed for the person for an immediate

health emergency in 2017 by the U.S. Depart-

approved medications: methadone, naltrexone

admission, or an outpatient appointment the

ment of Health and Human Services. Although

or buprenorphine, also known as Suboxone.

very next day.”

The opioid epidemic was declared a public

The program enables Gateway to hire care

few hospitals have had programs to treat opioid

These medications normalize brain chemistry,

use disorder, it has become more of an issue as

block the euphoria or “high” of opiates, and

coordinators who help manage other issues

the opioid epidemic has worsened and overdose

relieve physiologic cravings without the nega-

that often lead to relapse, such as unemploy-

deaths have increased, heavily impacting

tive effects of the abused substance. People

ment and homelessness, explains Paul. In

emergency services. “Addiction treatment

can take these medications and function

addition, the RSS assists the patient with basic

has long been considered a behavioral health

normally; others cannot tell that they have

lifestyle needs, such as transportation to

problem, but the onset of the opioid crisis

taken it.

appointments. The goal is for the RSS to engage

Traditionally, a person who comes to the

shifted it to the medical realm,” says Jason D.

the patient to want recovery: the RSS is living

Kirby, D.O., Medical Director at Gateway. “This

ER with a drug overdose receives emergency

proof that one can recover and life can get

occurred because of the medical complications

medical care to stabilize them, plus treatment

better. The services provide a nexus of support:

associated with opioid abuse, such as infections,

for related medical problems. They often

medication, social and medical care coordination,

endocarditis and organ failure,” he says. “Addic-

receive a referral to a facility that can provide

a caring personal relationship, and behavioral

tion has both behavioral and medical dimensions,

detoxification and rehab. “People need and

health care.

Continued on Page 16

WHAT DO WE KNOW ABOUT THE OPIOID CRISIS?

NEARLY

200

AMERICANS DIE

every day from

OPIOID

%

21

OF

2.1

MILLION

4OF 5 OUT

PATIENTS prescribed

a b u s e d

HEROIN USERS

OPIOIDS

OPIOIDS

LAST YEAR

prescription

MISUSE THEM

OVERDOSES

first misused

OPIOIDS

Source: www.cdc.gov/nchs/products/databriefs/db329.htm

Volume X Issue 3 I HouseCall I 15

TREATING ADDICTIONS Continued from Page 15

Dr. Kirby is well qualified to treat substance abuse disorders, with experience in both emergency medicine and addiction medicine. He is

standards; by teaming up with Gateway, St. Clair is offering the very highest level of care to an underserved population. The fact that St. Clair

a former ER physician who witnessed firsthand the devastating impact

tapped Dr. Yeasted, the CMO Emeritus, to lead this effort is a strong

of substance abuse. “St. Clair is strategically located for this. The ER

statement about the importance of this to the Hospital, the medical

there gets 64,000 visits annually — making it the busiest in western

staff, the administration and the community.”

Pennsylvania. They are a high volume, high quality ER and they see a high number of drug overdose patients.”

Dr. D’Alo shares her colleagues’ commitment to caring for persons with OUD and extends a compassionate invitation to the community from the St. Clair ER staff: “We want people to know that if they have

An innovative approach “It’s a novel idea to pair St. Clair and Gateway,” Dr. Kirby continues.

a problem with opioid abuse or substance abuse of any kind, they can come to us. We want to help and we know how to help. We have treat-

This program gets people from the acute setting of the ER to Gateway

ment that works, that can get them to recovery. If your life is not what

right away, which is critically important because there is a small window

you want it to be, it can get better. We’re right here, we care and we

of opportunity to get the person into treatment. Before, we had no clear

never close.” n

path to treatment; people were stopped by many barriers. If they had to sit in the ER and wait for a bed to open in a treatment program, they would get tired of waiting and leave, putting them at risk to resume using and at a higher risk to overdose. Now, patients can be transferred immediately from St. Clair’s ER to our facility, to begin addiction treatment

Alarming Increase in Overdose Death Rates

directly after treatment for an overdose. With MAT, you don’t feel the withdrawal symptoms, so you are less likely to use. The goal is that nobody leaves the ER, goes home and gets into trouble. This saves lives.”

Mallory S. Ciuksza, M.D., an internal medicine physician with

In 2015, more than 33,000 Americans died of an opioid overdose

St. Clair Medical Services, regularly treats people with addiction and asked to serve on the planning committee. “As a primary care physician,

Over 64,000 in 2016

I take care of the person with addiction and often other members of the family who are impacted by the addiction: the father whose blood pressure

Overdose deaths in 2017

is high despite medication, because of his anxiety, or the mother who

70,237

neglects her diabetes because she is so focused on her son with opioid use disorder. I see the impact on the whole family. It touches every part of a community, and so it requires a community solution.

“This program with Gateway is a huge step in the right direction,

2015

putting systems in place to help more people who want to be helped.

The COE designation means that this program meets the highest possible

Source: www.cdc.gov/nchs/products/databriefs/db329.htm

“

We want to help and we know how to help.

”

JULIA M. D’ALO, M.D., EMERGENCY MEDICINE PHYSICIAN, ST. CLAIR HOSPITAL

16 I HouseCall I Volume X Issue 3

2016

2017

SECOND ANNIVERSARY

ST.CLAIR HOSPITAL & MAYO CLINIC CELEBRATING

Clinical collaboration with Mayo Clinic benefits St. Clair patients

I

n September, St. Clair Hospital marked its second

anniversary as a member of the Mayo Clinic Care Network with several days of special events and lectures.

Timothy B. Curry, M.D., PhD, Director, Education Program,

Center for Individualized Medicine, Mayo Clinic, delivered

grand rounds presentations on pharmacogenomics to physicians and other clinicians at the Hospital and later before a group of community leaders at the Duquesne Club in Downtown Pittsburgh.

Pharmacogenomics looks at the role of the genome (genetic makeup) in prescription drug response and analyzes how a person’s genetic makeup affects that person’s response to a drug or drugs. The intent, said Dr. Curry,

Timothy B. Curry, M.D., PhD, Director, Education Program, Center for Individualized Medicine, Mayo Clinic

an internationally recognized expert, is to optimize drug therapy so a patient receives the maximum benefit of

experts to assist with challenging medical cases, at no

a drug, with minimal side effects.

additional cost. Moreover, St. Clair works with Mayo Clinic

Discussions on pharmacogenomics are just one of many

specialists to enhance patient care through the exchange of

ways in which St. Clair physicians are collaborating with

best practice information, collaboration on the advancement

the world-renowned Mayo Clinic. Through this clinical

of clinical programs, and direct consultation.

collaboration — unique in western Pennsylvania — St. Clair physicians have direct access to the expertise of Mayo Clinic

To learn more about the benefits of the clinical collaboration,

please visit stclair.org/mayo. n

WHAT IS PHARMACOGENOMICS?

Pharmocogenomics is the study of how an individual’s genetic inheritance affects the body’s response to certain drugs.

Volume X Issue 3 I HouseCall I 17

IN THE NEWS

azette Post-G h g r u tsb ned The Pit d a byli ublishe p ly al’s t it n rece Hosp . Clair t S n lans, o story nsion p a p x e s s and it with succes owed it ll o f g then plaudin orial ap it d e n a spital. the Ho

18 I HouseCall I Volume X Issue 3

Reprinted with permission of Pittsburgh Post-GazetteÂŽ.

ASK THE DOCTOR

Ask the Doctor KARIN OLTYAN, M.D.

Q A

Do you have any suggestions on how better to achieve my health goals?

How often have you been seen by a doctor and told to “lose weight” or “get more exercise”?

Thursdays and Saturdays, at 8 a.m. for 30 minutes, by walking on a treadmill at the gym.” In this case, the more

These lifestyle recommendations are important to

specific the goal, the better. Schedule the goal on your

your health, yet often they are too vague, and it is

smartphone or calendar so it becomes part of your routine.

difficult to follow through with the suggestions. Generic

Engage a friend, family member or colleague to work on

recommendations can feel overwhelming, and we often

lifestyle changes with you, to help you remember and stay

find excuses not to do them.

on track with your plan, or even to take on some of the

As a primary care physician, I have seen how lifestyle

responsibilities at home. It is easier to be

changes improve health. They help manage conditions

motivated when someone else is expecting

such as diabetes or high blood pressure, reduce pain from

you, or if you know you have extra help.

osteoarthritis, or even cope with stress. They can help

So before your next office visit,

reduce the number of medications patients are required

think about those lifestyle changes to

to take on a regular basis. So I frequently counsel patients

improve health in a more detailed

about how to more effectively make these changes.

way — set a goal that is reachable,

One way to get started making lifestyle changes is to

be specific about the details, make

develop a short-term goal that you can work on before

it enjoyable, engage with others,

the next office visit. The goal should be realistic and

and think about rewarding yourself

detailed. An example of a goal for weight loss may be

in a healthful way when you do

“lose 5 pounds in one month.” It is good to have a longterm goal, too, such as “I want to lose 30 pounds by next summer,” but the short-term goal is easier to accomplish,

reach the goal. n

Karin Oltyan, M.D.

helps to build your confidence when you reach the goal, and then you can set a new goal for the next visit.

After developing a goal, think about how you want to achieve it. Be specific about what you are going to do — where, with whom, when, how long — and try to make it enjoyable. An example for getting more exercise is: “I will exercise four days a week on Mondays, Tuesdays,

KARIN OLTYAN, M.D. Dr. Oltyan specializes in family medicine. She earned a medical degree at The Pennsylvania State University College of Medicine, Hershey, Pa., and completed a residency in family medicine at Brown University Memorial Hospital of Rhode Island, Pawtucket, R.I. Prior to joining St. Clair, Dr. Oltyan served as an attending physician with Franciscan Medical Group, Burien, Wash. For five years there, Dr. Oltyan also served as Medical Director and Clinical Supervisor of the Youth Health Clinic. She is board-certified by the American Board of Family Medicine. Along with Ruth Christoforetti, M.D., Dr. Oltyan practices with St. Clair Family Practice Associates, part of St. Clair Medical Services.

To contact Dr. Oltyan, please call 412.942.8570.

Volume X Issue 3 I HouseCall I 19

1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org

General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400

IT’S OFFICIAL:

Dunlap Family Outpatient Center

The covered main entrance to the new addition.

(Please see Page 12 for story.)

HouseCall

is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.

@StClairHospital