Excela Health Heart, Vascular & Lung Institute Newsletter | Fall 2020

Advancing Cardiovascular, Thoracic and Pulmonary Care in Our Region.

Fall 2020 I Volume 1

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Excela Health Part of National Clinical Study Regarding Cardiogenic Shock The Excela Health Advanced Lung Center Finding Cancer Sooner Thoracic and Pulmonary Services Advances in Caring for the Patient with an Abdominal Aortic Aneurysm Moving Afib Patients Off Blood Thinners New Appointments Fast Facts: Quality at Excela Health Cardiovascular Services, Referring Patients Awards and Accolades

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Dear Colleague, I would like to welcome you to a new communique from Excela Health in which we will be providing you with insights into our burgeoning programs in cardiovascular, thoracic and pulmonary medicine.

You’ll find useful information on the wide scope of services we offer, new appointments to our staff, our awards and accolades and data reflective of the quality of services we provide.

Importantly, each edition will also feature a robust look at a particular advance or development at Excela that is indicative of how we are changing the paradigm of care available in our region.

We continue to recruit outstanding specialists in their respective fields and combine the best in technology and technique. And we take great pride in providing a partnership in which you can be most confident for the treatment of your patients.

My colleagues and I thank you for your trust in Excela Health.

Sincerely, James Adisey, MD, FACC Medical Director, Heart, Lung and Vascular 1

Excela Health Part of National Clinical Study Regarding Cardiogenic Shock The number of patients who suffer a severe heart attack coupled with cardiogenic shock is on the rise.

Excela Health is part of a national clinical study aimed at improving the survival rates for these patients, using the latest research-based evidence and advanced tools at Excela’s Heart and Vascular Center to help standardize life-saving interventions for people worldwide.

Excela was invited to join the National Cardiogenic Shock Initiative (NCSI) last August. The project is under the auspices of the Henry Ford Hospital, which first brought together cardiologists from four highly competitive healthcare systems in southeast Michigan in 2016 to improve outcomes for patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). While there are many reasons for cardiogenic shock, heart attack is the leading cause, and this deadly combination historically has had an in-patient survival rate as low as 30 percent. The initiative was expanded beyond the university hospital setting with Excela Westmoreland Hospital one of only two in western Pennsylvania accepted into the project which is now closed to new participants.

The aim of NCSI is to bring together experienced centers across the nation who are experts in mechanical reperfusion therapies and have considerable experience with the use of mechanical circulatory support devices to systematize care in AMICS. The goal is to dramatically decrease the duration patients remain in cardiogenic shock and attempt to decrease total usage and duration of vasopressors and inotropic agents to control blood pressure and heart muscle contractions artificially.

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Excela Health Part of National Clinical Study Regarding Cardiogenic Shock (continued) Project participants have agreed to follow the NCSI treatment algorithm and submit data so that patient outcomes can be analyzed.

Juan Chahin, MD, FACC, FSCAI, Director of Excela Health’s catheterization lab in the Heart and Vascular Center, is the primary investigator for the initiative which focuses on the use of Impella, the only percutaneous temporary ventricular support device approved by the FDA as safe and effective for use in AMICS. Impella is not a new tool to Excela Health cardiologists who having been using the device for protective percutaneous coronary intervention (PCI) for the past four years. PCI, a nonsurgical technique also known as coronary angioplasty, is used to treat obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).

Impella is a transcatheter axial flow pump, delivered percutaneous through the femoral approach or groin, with the ability to provide 2.5 to 4.0 liters per minute of forward blood flow. The device is designed to provide sufficient forward cardiac flow to support vital organs in the majority of patients who present with AMICS. The catheter-based ventricular assist device is inserted into the left ventrical across the aortic valve to support heart function by pulling blood from the ventrical into the aorta creating the same effect that happens with the natural pumping motion of the heart.

outcomes of patients admitted to Excela Health’s Intensive Care Unit. The ICU clinical team is now being educated on how to identify cardiogenic shock should it occur in their recovering cardiac patient so that a life-saving intervention can ensue.

The Excela Advanced Lung Center Finding cancer sooner Nearly 230,000 individuals in the United States will be diagnosed this year with lung cancer.

As clinicians, we know that early detection of the disease provides the best chance for cure. We also know that historically, fewer than one in seven individuals who are diagnosed with lung cancer present at an early or curable stage.

There are alarmingly high rates of lung cancer rates in Pennsylvania. The situation in Westmoreland County is exacerbated by its older population that includes many current and former smokers who, in addition, have significant occupational exposure to lung cancer causing agents.

This calculus is the driving force behind the Excela Health Advanced Lung Center, a highly robust nexus for cancer detection and screenings.

Our results have been material. Working in concert with our referring constituencies, the Center has performed nearly 8,000 low-dose lung cancer CT scans since its inception in 2016. In June of this year alone, we completed just under 400 low-dose lung cancer CT scans for lung cancer detection.

By employing Impella in situations where the severe heart attack is coupled with cardiogenic shock, survival rates have been demonstrated to increase to as high as 76 percent, which is what makes Excela’s participation so significant.

Although Excela Health is in the early stages of submitting data to the NCSI registry, recent cases affirm that had this new protocol not been in place, several patients would have not survived their cardiac emergency.

There is also a second opportunity to improve 2

Our cancer detection rate has been 2.9 percent.

Moreover, it is important to note that the vast majority of these patients-69 percent-have been diagnosed at an early stage when therapy is most effective.

This is a most gratifying statistic for myself and our CONTINUED ...

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The Excela Advanced Lung Center Finding cancer sooner (continued) team, and is strong validation of the value of low dose CT scanning in screening for lung cancer.

The Center provides the patient with an effective amalgam of technology, technique and touch in their respective treatment plans We utilize low dose CT augmented with DynaCAD advanced visualization tools to detect both benign and malignant nodules that are not revealed in a standard, conventional x-ray. A weekly multimodality conference is Early stage lung cancer in the held to review the scans. right lower lobe of the lung.

Should surgical intervention be warranted as follow-up to the result of the imaging, many eligible patients can be treated with minimally invasive procedures utilizing our da Vinci robotic surgical system.

We understand the daunting pressure and anxiety that a possible diagnosis of cancer can cause for a patient and their loved ones. Thus, most Center patients receive a personal phone call within 24 hours with their results of the scan.

Our Center prides itself on cultivating a supportive and understanding environment of care. It includes a multi-disciplinary team comprised of surgeons, radiologists, pulmonologists, respiratory therapists, imaging technicians, and specially trained nurses.

We, along with our administrative staff, are focused on the tangible and intangible needs of the patients while maintaining communication and dialogue with the referring physician throughout the duration of treatment and beyond.

By any metric, the Excela Health Advanced Lung Center provides a highly experienced and highly qualified group of professionals in Westmoreland County to assist you in the care of your patients that are at risk for lung cancer. We would be privileged to serve you in that capacity.

Michael Szwerc, MD, FACS Medical Director, Robotic Surgery Director of Center Lung and Thoracic Disease

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Eligibility for Lung Cancer Screening Low Dose CT: n

Age: 55 to 77

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Smoking History: • Current smokers who have smoked at least a 30 pack year smoking history (One pack of cigarettes a day for 30 years or 2 packs a day for 15 years).

• Former smokers who have quit within the last 15 years and also have at least a 30 pack year smoking history.

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No signs or symptoms of lung cancer.

To request an appointment, call 724-689-1440 or complete the form on ExclaHealth.org.

Thoracic and Pulmonary Services • Robotic assisted lung resection • Robotic assisted esophageal resection • Robotic/Laparoscopic assisted Paraesophageal Hernia Repair • Robotic assisted Nissen/Toupet/Dor fundoplication • Endoscopic sympathectomy for hyperhidrosis • Thoracic outlet procedures • Bronchoscopy with EBUS biopsy • Navigational Bronchoscopy • Video Mediastinoscopy • Tracheal surgery • Esophageal, bronchial, tracheal stenting • Chest wall resection and reconstruction • Management of pleural effusions • Pulmonary nodule management • Lung cancer screening • Robotic assisted Heller myotomy for achalasia • Mesothelioma surgery • Chemotherapy ports • Diaphragmatic plication/repair of diaphragmatic hernia • Esophageal diverticulectomy • Management of pneumothorax • Management of mediastinal masses • Robotic assisted thymectomy

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Advances in Caring for the Patient with an Abdominal Aortic Aneurysm With Abdominal Aortic Aneurysms (AAA) affecting over three million Americans a year, recent advances in the surgical intervention of the condition have revolutionized the approach to patient care.

Historically, AAA’s were repaired by what could be characterized as a complex, open procedure.

Now, the utilization of endovascular aortic aneurysm repair –or EVAR-has created a new paradigm in patient management.

Through this technique, the aneurysm is excluded from blood circulation by the use of an endograft, which is delivered to the site via two small incisions; one over each common femoral artery.

Intraoperative angiogram of AAA before the endograft is placed.

An intraoperative angiogram of AAA after the endograft is placed and the AAA has been repaired.

little to no post-operative pain. Most patient are discharged a day after surgery.

It is important to underscore that certain anatomic criteria must be met for patients to undergo endovascular repair of the aneurysm. Similarly, there are additional anatomic considerations to qualify for pEVAR. Current guidelines recommend repairing AAA’s in men when they reach 5.5 cm in maximum diameter, and in women when they reach 5cm.

It is also advised to intervene on aneurysms that are detected to be growing faster than expected.

Risk factors for AAA’s include tobacco use, family history, hypertension, hyperlipidemia and an age of greater than 65 years.

Once an EVAR of pEVAR has been performed, patients will require life-long surveillance of the aneurysm. There is a risk of ruptures with EVARs and up to 20 percent of patients will need a secondary procedure to maintain the repair.

For the convenience of the referring physician, our program offers in-office ultrasound for size surveillance, thus eliminating the need for PCPs to order the imaging or follow it once the patient has established care with us. Clearly, prompt communication with the referring physician relative to results and recommendations is a priority for us.

EVAR has shown to be safe and comparable to open surgical repair in terms of survival. It is associated with less severe hemodynamic changes, less blood loss and a shorter recuperative period for the patient when compared to traditional surgery.

Excela Health maintains a robust endovascular program at its Westmoreland Hospital for the treatment of AAA’s. Nearly 100 EVARS have been performed since its inception.

Over 30 of these have been entirely percutaneous (pEVAR), which results in no residual scarring and CONTINUED ...

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Advances in Caring for the Patient with an Abdominal Aortic Aneurysm (continued) CT scans are not warranted unless repair is a consideration. Here again, we will facilitate the scan if needed.

A pre-operative CT reconstruction of AAA.

A post-operative CT reconstruction of AAA.

We also stress that it is entirely appropriate to refer AAAs of all sizes, but urge further examination on those that are 4.5cm or greater.

With a mortality rate for ruptured AAAs in the 60 to 80 percent range for non-hospitalized patients, screening, surveillance and surgical intervention when required is of the utmost importance. Our endovascular program at Excela stands ready to partner with you in the care of your patients with Abdominal Aortic Aneurysm.

Moving Afib Patients off Blood Thinners Providers at Excela Health are now performing minimally invasive ligation of the left atrial appendage in selected patients with atrial fibrillation. They are using what is called the Watchman Procedure or surgical clipping to seal off the appendage and close it off from circulation so clots can no longer be formed in the structure.

The elimination of the left atrial appendage significantly reduces the risk of blood clots and in the majority of patients blood thinners can be stopped safely.

Please contact us at 724-689-1355 to discuss this option for your patients or you can refer them to us for a qualifying appointment.

Elizabeth Detschelt, MD FACS Director of Vascular Surgery

New Appointments Robert Pearce, MD Cardiology Education Undergraduate University College Dublin School of Medicine

Training • Kentucky, Univ of Louisville (Louisville) Residency • Allegheny General Hospital (Pittsburgh, PA) Fellowship Certifications • American Board of Internal Medicine

MD University College Dublin School of Medicine

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New Appointments

Euhan (John) Lee, MD Pulmonary and Critical Care Medicine

Joseph Secosky, MD Cardiology Education Undergraduate Washington and Jefferson (Washington, PA) MD University of Pittsburgh School of Medicine Training • Naval Medical Center Residency • Naval Medical Center Residency • UPMC--Montefiore Residency • University of Pittsburgh Medical Center Fellowship Certifications • American Board of Internal Medicine Cardiovascular Disease

Bassel Sayegh, MD

Education Undergraduate Harvard University (Cambridge, MA) MD UMDNJ-University Hospital (Newark,NJ) Training • University of Pittsburgh School of Medicine Residency • University of Pittsburgh Medical Center Fellowship • University of Pittsburgh Medical Center Fellowship Certifications • American Board of Internal Medicine Sleep Medicine-Subspecialty • American Board of Internal Medicine Pulmonary Disease-Subspecialty • American Board of Internal Medicine Critical Care Medicine-Subspecialty

Electrophysiology Education Undergraduate Damascus University MD Damascus University Training • Loyola Univ of Chicago (Illinois) Residency • Allegheny General Hospital (Pittsburgh,PA) Fellowship • University of Pittsburgh Medical Center Fellowship Certifications • American Board of Internal Medicine Cardiovascular Disease • American Board of Internal Medicine Internal Medicine

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Fast Facts: Quality at Excela Health • Door to Balloon - 54 minutes (Top 75th percentile of all hospitals, outperforming like hospitals by 4 minutes) • Transfer Door to Balloon - 87 minutes (Top 75th percentile of all hospitals, outperforming like hospitals by 18 minutes) • Transfer from Outside Hospital Door to Westmoreland’s Door - 60 minutes (Top 75th percentile of all hospitals, outperforming like hospitals by 14 minutes) • TPCI Risk Adjusted Mortality for STEMI Patients – 4.1% (Top 75th percentile of all hospitals, outperforming US registry by 1.93%)

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Cardiovascular Services

Referring Your Patients

• Abdominal Aortic Aneurysm Treatment • Anti-Arrhythmia Surgery • Atrial Fibrillation Surgical Ablation • Cardiac Ablation • Cardiac and Pulmonary Rehabilitation • Cardiac Catheterization • Cardiac Imaging including cardiac MRI, intravascular ultrasound, and CT angiography using our 64-slice CT scanner • Cardiac Valve Repair/Replacement • Coronary and Peripheral Angioplasty • Coronary Artery Bypass Grafting • Deep Vein Thrombosis Care • Echocardiogram and Stress Echocardiogram • EKG • Electrophysiology • Endovascular Surgery • Event and Holter Monitoring • Extracorporeal Membrane Oxygenation (ECMO) • Heart Failure Clinic • Minimally Invasive/Keyhole Aortic Valve Surgery • Minimally Invasive Cardiac Surgery (MICS) • Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)/Keyhole Bypass Surgery • Minimally Invasive/Keyhole Mitral Valve Surgery • MUGA Scan • Nuclear Stress Testing • Off Pump CABG/Beating Heart Surgery • Pacemaker Clinic • Pacemaker/Defibrillator Implantation • Preventive Cardiology • Thoracic Aortic Aneurysm Surgery • Tilt Table Testing • Treatment of Carotid Artery and Peripheral Artery Disease

• Excela Health Medical Group physicians may refer to any of our specialist through Allscripts.

• Non-EHMG physicians may refer by fax to these locations: • EHMG Cardiology - Latrobe Office: 724-539-6320 Fax: 724-539-6333 • EHMG Cardiology - Frick Office: 724-547-3858 Fax: 7245470737 • EHMG Cardiology - Norwin Office: 724-861-7939 • EHMG Thoracic Surgery and ALC - Greenburg/Frick/Norwin Office: 724-689-0520 Fax: 724-689-0522 • Excela Advanced Lung Center Office: 724-689-1440 Fax: 724-689-1442

Addresses for all locations available at ExcelaHealth.org

Awards and Accolades • American Heart Association “Get With The Guidelines” Gold Plus Award to both Westmoreland and Latrobe Hospitals • American Heart Association “Get With The Guidelines” Silver Plus Award to Frick Hospital

• U.S. News and World Report High Performing Hospitals, Heart Failure and COPD

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• American Heart Association “Get With The Guidelines” Heart Failure Quality Achievement Award

• Highmark Blue Cross Blue Shield Blue Distinction Center Plus for Cardiac Care

• Bronze Recognition through American Heart Association “Mission Lifeline” Award

• The Excela Advanced Vein Center is one of only seven IAC accredited vein center sites in the state of Pennsylvania.

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