FOCUS TOPIC CARDIOVASCULAR CARE
February 2018 >> $5 ON ROUNDS
Balancing the Yuck and the Yum Dr. Ted Wright joins WTH Cardiothoracic Surgery Center, looks to expand services Ask Ted Wright, MD, what would lure him away from a major academic medical center to West Tennessee and he will tell you Yuck and Yum. While he may be ﬁnding the right balance to work and family here, he isn’t the only one that will be beneﬁtting from the move. Read the story on page 3.
Lending a Hand, and a Heart, to Children Le Bonheur’s Commitment to Transplantation Is Richly Rewarded Umar Boston, MD, a pediatric cardiovascular surgeon at Le Bonheur Children’s Hospital, has done approximately 100 heart transplants on children. None of them was any more challenging than one he did almost a year ago. Read the story on page 5.
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JMCGH, only hospital in state offering CorPath GRX System for coronary artery disease By SUZANNE BOyD
Since the introduction of percutaneous coronary intervention 40 years ago, there has been an astonishing amount of advancement in the technology and devices used in the procedure and robotics are a big part of the trend. Today, many procedures that were once highly invasive are now being performed via minimally invasive techniques, with the added benefit of robotic precision and radiation protection. And West Tennessee is the first in the state to have this level of technology. Percutaneous coronary intervention (PCI) fixes blockages in heart arteries without the need for open surgery using catheters inserted through the blood vessels. Robotic-assisted PCI Heart Stent placement is commonly known as robotic PCI. Robotic-assisted PCI is a revolutionary new technology that allows a cardiologist to use a robotic (CONTINUED ON PAGE 4)
Cardiologist Dr. John Baker was instrumental in bringing the CorPath GRX System for the treatment of coronary artery disease to JMCGH
Get with the Guidelines: Blood Pressure Edition ACC, AHA Redeﬁne Hypertension By CINDy SANDERS
This past November, the American College of Cardiology and American Heart Association redefined the way clinicians and the public should think about ‘high’ blood pressure. After nearly three decades of decline, deaths from heart disease have been on the rise over the past couple of years. While there are multiple risk factors for cardiovascular disease, the good news is that a number of those risks are controllable, including decreasing blood pressure. Previously, stage 1 hypertension began at 140/90 mmHg. Now, patients with a blood pressure of 130/80 mmHg are considered to be hypertensive. Lowering the numbers has allowed clinicians to raise the warning flag sooner
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and institute lifestyle modifications and medication if warranted. “We’re getting aggressive in looking at how we define hypertension and making sure we’re not underselling blood pressure,” explained Walter Clair, MD, MPH, a nationally recognized expert in his field who leads Vanderbilt Heart in Nashville and holds national and regional committee appointments with the American Heart Association. “We’ve all agreed for years that blood pressure is normal if it is less than 120 over 80,” he said. However, Clair continued, hypertension experts have anticipated the guideline change for several years as the science has shown not only cause for increasing concern with a systolic number of 130 and diastolic measurement (CONTINUED ON PAGE 4)
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Balancing the Yuck and the Yum
Dr. Ted Wright joins WTH Cardiothoracic Surgery Center, looks to expand services By SUZANNE BOyD
Ask Ted Wright, MD, what would lure him away from a major academic medical center to West Tennessee and he will tell you Yuck and Yum. While he may be finding the right balance to work and family here, he isn’t the only one that will be benefitting from the move. As the newest cardiovascular surgeon to join West Tennessee Healthcare’s Heart and Vascular program, patients will benefit from the additional treatment modalities he brings with him that will expand the services offered right here in Jackson. Hailing from Ashbury Park, New Jersey which is on the Jersey Shore, Wright says according to his mother he declared he would be a doctor, and a surgeon no less, when she dropped him at the playground one day. When he went down the road, as he calls it, to Princeton for college, he took pre-med classes, applied to medical school and was accepted to University of Virginia Medical School. While in medical school, Wright was inspired by several physicians who impacted not only him personally but also influenced the path he would choose to follow. “I was inspired by these physicians who were skillful, thoughtful and respected. That was something I wanted to emulate,” he said. “They were educators and trainers of residents and patients. They were people who were looked up to. They were role models and people I identified with in school.” R. Scott Jones, MD, a surgeon at UVA inspired Wright to pursue surgery initially. “There is an immediacy to it,” said Wright. “There is a defined problem that you can fix, and lives are improved immediately; that was important to me.” Wright’s general surgery residency was completed in his home town at the hospital where his parents first met, Monmouth Medical Center. Another physician, Charles Sills who was a thoracic surgeon, inspired Wright to pursue cardiothoracic surgery. “I loved the anatomy of cardiothoracic surgery. There is a complex simplicity to it,” he said. “You can’t get around it, you can’t stop in the middle, you have to follow it to the end. There is a sports aspect to it, the pre-game, the game and the post-game. You can reflect on what you have done, which I think is good.”
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take a look at the practice. “Life is a series of yum and yucks,” said Wright. “And you have to have find a balance of the two. As a husband and an older father of twin five-year-old boys, as well as a busy cardiothoracic surgeon, I knew I needed to find that balance. The opportunity in Jackson gave me that and so much more. Living in a community that is friendly and family oriented is a way to balance the yum and the yucks. What I found in Jackson was nice folks who were raising their families here, and a great tradition of heart surgery. I was also impressed by the number of physicians who came here out of training thinking that maybe this was just a springboard yet they are still here and so glad to be here.” Although Wright just joined the practice in early January, he has already brought a wealth of knowledge and experience to the practice. “We had a great multi-disciplinary meeting with cardiology,” he said, “and have identified some areas that we feel we can expand services, especially surgical treatment of atrial fibrillation and minimally invasive techniques. We will be able to provide cutting edge services that will mean patients aren’t having to travel out of town to get them. We are well poised to serve this community very well and I am looking forward to doing it.”
Dr. Ted Wright and his wife Saskia enjoy traveling with their ﬁve-year old twins, Oliver and Felix
After his residency, Wright headed to the University of Wisconsin for a fellowship in cardiothoracic surgery followed by a cardiopulmonary transplant fellowship at the University of California in San Francisco. He was recruited by a cardiovascular surgery practice in Lexington, Kentucky and headed to the Bluegrass
state. When the practice became a part of the University of Kentucky Medical Center, Wright had the opportunity to be a part of the residency training program in addition to his practice. One of the residents he had trained, Hetal Patel, MD, had joined a cardiothoracic practice in Jackson, Tenn. and Wright decided to
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Robotic Interventions, continued from page 1 console to navigate the heart arteries and place stents inside the blocked arteries to fix heart blockages with the potential for incredible precision. Jackson-Madison County General Hospital, is the only hospital in Tennessee to offer the CorPath GRX System for the treatment of coronary artery disease. The vascular robotic-assisted system offers interventional cardiologists robotic precision when controlling guide catheters, guidewires, balloons and stents during CorPath Robotic Angioplasty. Currently the hospital has two units in operation. Cardiologist John Baker, MD, of the Jackson Clinic, PC was instrumental in the technology coming to Jackson. “The equipment for robotic PCI has been present for seven to eight years, but recent advances in technology caused me to develop an increased interest,” he said. “The area that was of most interest was the ability to deliver increased precision over the manual techniques we already have been using. Dr. (Tommy) Miller and I traveled to New York Presbyterian Hospital/Columbia University to learn about and evaluate the technology. We realized this was something that could be beneficial to patients in West Tennessee. Our training included instruction on the use of the equipment as well as observing live cases. We also traveled to a research facility in upstate New York, where we were able to obtain hands-on training with the device in an animal lab.” The CorPath System is the first FDAcleared robotic platform designed for interventional cardiologists. It is composed of two functional subunits: the bedside unit
The Robotics Team at Jackson General Hospital is excited to be the only hospital in Tennessee to offer CorPath GRX System for the treatment of coronary artery disease.
and the remote physician workspace. The bedside unit consists of the articulated arm, the robotic drive, and a single-use cassette in which devices including wires, balloons, and stents are loaded. The remote workspace consists of the interventional cockpit, which is surrounded by a radiation shield and houses the control console, angiographic monitors, hemodynamic monitors, and the x-ray foot pedal. In robotic PCI, a cardiologist sits at a robotic console and uses the controls to manipulate the wires to incredible degrees of precision allowing them to be passed into the chosen artery and through the area of
blockage. The system allows the operator to control and manipulate guide wires, balloons, and stents using a set of joysticks and touch screens while fluoroscopy provides image guidance. Axial and rotational motion are achieved by a mechanical transmission module. The balloon or stent can be guided both in a continuous motion using the joystick and in discrete highly sensitive small steps using the touch screen. The major benefits of robot-assisted PCI include improved operator safety and procedural precision, increased accuracy in stent selection and improved patient outcomes. “The procedure is performed in the
cath lab,” said Jeff Young, executive director of West Tennessee Heart and Vascular Center. “The system takes images at the cath table and sends them to the cardiologist who is in the cockpit. There are three screens that have real time images and still images. Tools built into the system and software allow those images to be layered to allow for more accurate marking of vessels and to set targets for advancing wires and stents.” “The procedure is possible on virtually any type of patient. Benefits to the patient are increased precision with which guidewires, balloon dilation catheters and stents may be placed with robotic control,” said Baker. “The physician however, has the benefit of being removed from the x-ray source resulting in reduced exposure to radiation. The potential for orthopedic injury to the physician is decreased because a lead apron is not required while doing the robotic procedure.” “This raises our program to a whole other level in technological advancements. To be the first and only hospital in the state to offer this shows our commitment to giving the best care possible to our patients,” said Emily Garner, RN, clinical manager for West Tennessee Heart and Vascular Center. “This is cutting edge technology that not Emily Garner only offers exact and precise treatment for the patient, but also helps prevent future negative effects to our physicians.”
Get with the Guidelines: Blood Pressure Edition, continued from page 1 above 80 but also a benefit from treatment. “Even when we can show a correlation between bad outcomes and hypertension, we still have to show that treatment is going to make a difference,” he said. With the science in place, these new numbers are the first change in blood pressure guidelines since 2003. Previously, patients with blood pressures between 120 and 139 systolic and/or a diastolic reading between 80-89 would have been classified as having ‘prehypertension.’ Now, anything greater than 120/80 is considered an elevated blood pressure. “It’s not ‘pre’ so we don’t say, ‘We’ll see you in a year,’” Clair said of the new trigger points. Instead, he continued, physicians should be intervening at that point and following up with patients more frequently to monitor improvement and sustainability. “Jumping all over it (hypertension) doesn’t mean you should necessarily start taking a drug for it,” he added in response to one concern some patients and physicians have voiced about the new guidelines. “But we begin to look more aggressively at cardiac risk factors … and you now have one, elevated blood pressure … so we should look at lifestyle, sodium intake, exercise, diet, smoking.” Realistically, Clair continued, lifestyle modification only achieves a decrease of about 11 millimeters of mercury so 4
someone with a blood pressure of 160/90 probably won’t move the needle enough with lifestyle changes alone. However, he pointed out, those defined as having elevated blood pressure and stage 1 hypertension could quite likely get numbers back in the normal range without requiring medication. He was quick to add that doesn’t mean lifestyle modifications aren’t critical for everyone at any stage of hypertension. “Many people think because they are taking these blood pressure medications and controlling their blood pressure, they don’t have to give up that frequent flyer card to McDonald’s … yes, you do,” he stated. “You still have to do all of the other cardiovascular risk modification steps to get the
full benefit. We continue to work to get that message out.” In addition to lowering the definition of high blood pressure, Clair said the new guidelines also reemphasized the correct way to take a blood pressure reading – making sure the person is seated correctly, using the proper cuff size, waiting a few minutes after the patient arrives in an exam room. “We kind of got a little lazy about checking blood pressure over the last few years,” he said. Technology, he added, can also be an important tool for getting an accurate read on blood pressure – particularly among a couple of specific groups. Mobile technology, Clair noted, eliminates ‘white coat hypertension,’ where patients experience a
jump in blood pressure simply by being in a medical setting. “We now have the capability to actually look at people’s blood pressure at home to see if they are really normal or not,” he said. “The other group is people who are suspected of having high blood pressure,” Clair continued. “Those people … believe it or not … actually have blood pressures that look pretty good, but it’s labile.” While they test normal at the physician’s office, they actually have elevated numbers at home or work. “We have these two extremes of people – those who might be over-diagnosed and those who might be missed.” The rising death rates underscore just how important it is to properly identify those at increased risk of heart disease. Additionally, Clair said, “We are worried the increase in childhood obesity is a precursor of another surge in cardiovascular disease.” He continued, “For many years in cardiology, we have been striving to be the #2 killer … it’s a credit to our colleagues in oncology that cardiac disease and stroke remain #1 killers of both men and women in the U.S.” Noting that being the leading cause of death isn’t a designation anyone wants, Clair said more aggressively monitoring and treating elevated blood pressure is one important step toward improving heart health. westtnmedicalnews
Lending a Hand, and a Heart, to Children Le Bonheur’s Commitment to Transplantation Is Richly Rewarded Umar Boston, MD, a pediatric cardiovascular surgeon at Le Bonheur Children’s Hospital, has done approximately 100 heart transplants on children. None of them was any more challenging than one he did almost a year ago. A baby was born with dextrocardiaheterotaxy syndrome with congenital heart block. In short, electrical activity was blocked between the upper and lower chambers of the heart. Also, the baby’s heart was malformed. In a normal heart, the apex of the heart points to the left and the major veins that go into it come from the right. In this baby, it was the opposite – the heart pointed to the right and the veins came in from the left. In addition, the function of the heart was extremely poor. This combination, Dr. Boston said, is uniformly fatal. “So we offered the mother two things,” the doctor said. “You can take your baby home and do nothing. Or we will go out on a limb and see if we can get the child to transplantation, knowing this is a very rare type of transplant that the baby would have to undergo.” The mother opted for a transplant. In surgery, the surgical team had to take a donor heart and place it in the opposite
PHOTO BY LISA BUSER COURTESY LE BONHEUR CHILDREN’S HOSPITAL
By RON COBB
Dr. Umar Boston with one of his transplant patients.
configuration than the baby’s previous heart had been in. “It’s one of the more complicated operations one can imagine or perform,” Dr. Boston said. “The child is now 10 months out from transplantation, and she’s prob-
ably done the best of any transplant that I’ve ever taken care of.” Dr. Boston is surgical director of the Heart Transplant and Mechanical Circulatory Program and surgical director of the Adult Congenital Heart Disease Program
at Le Bonheur. Two unfortunate events – a death and a hurricane -- played a big role in getting him to where he is today. Dr. Boston was born in the South American country of Guyana, and his family moved to Papua, New Guinea, when he was 5. The father, Derrick Boston, was a barrister in criminal law but was plagued by heart disease. He had his first heart attack at age 35 and died of another at age 42. What he needed was a bypass operation, but Dr. Boston said his father was reluctant to go to a doctor and believed he could rely on medication. “When you’re 11 and you see your father die of a heart attack, you question whether anything else could have been done,” Dr. Boston said. “My initial ambition to pursue medicine was certainly born out of the experience of having my father die at a very young age from cardiac disease.” Years later, after completing his cardiothoracic training at the Mayo Clinic, Dr. Boston was doing a fellowship at the University of Alberta in Edmonton when one of his mentors suggested he apply for a job at Tulane University. Dr. Boston was about to go to New Orleans for an interview when Hurricane Katrina hit. (CONTINUED ON PAGE 6)
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GrandRounds Kirkland Cancer Center Receives Recognition for High-Quality Cancer Care from Largest Oncology Society
JACKSON - Kirkland Cancer Center has been recognized by the QOPI® Certification Program (QCP™), an affiliate of the American Society of Clinical Oncology (ASCO®), as successfully completing a three-year certification program for outpatient hematologyoncology practices that meet nationally recognized standards for quality cancer care. QCP™ builds on ASCO’s Quality Oncology Practice Initiative (QOPI®). “We are thrilled to receive this certification from the QOPI® Certification Program, which reinforces our commitment to excellence for our patients at the Kirkland Cancer Center,” said Gina S. Myracle, Executive Director of the Alice and Carl Kirkland Cancer Center. In applying for certification, Kirkland Cancer Center participated in a voluntary comprehensive site assessment against clearly specified standards
that are consistent with national guidelines and was successful in meeting the standards and objectives of QCP™. “ASCO’s QOPI Certification demonstrates an oncology practice’s dedi-
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cation to providing high-quality care to patients with cancer,” said ASCO President Bruce E. Johnson, MD, FASCO. “The certification process is rigorous and by successfully completing it, providers put into practice their commitment to QOPI® analyzes individual prac-
tice data and compares these to more than 160 evidence-based and consensus quality measures. The information is then provided in reports to participating practices. Individual practices also are able to compare their performance to data from other practices across the country. Based on this feedback, doctors and practices can identify areas for improvement. To become QOPI® Certified, practices have to submit to an evaluation of their entire practice and documentation standards. The QCP™ staff and task force members then verify through an on-site survey that the evaluation and documents are correct and that the practices met core standards in areas of treatment, including: • Creating a safe environment— staffing, competencies, and general policy • Treatment planning, patient consent, and education • Ordering, preparing, dispensing, and administering chemotherapy • Monitoring after chemotherapy is administered, including adherence, toxicity, and complications • Treatment planning
Lending a Hand, continued from page 5 One of the surgeons at Tulane suggested he try Le Bonheur instead. He got the job, and felt fortunate about it. “People who are ‘crazy’ enough, or diligent or ambitious enough to pursue pediatric cardiac surgery – you study for 19 years after high school, and the surgical training is 12 years,” he said. “At the end of that there is no guarantee of a job. “The number of pediatric cardiac surgeons in the United States is roughly about 150. It’s a very, very highly specialized and highly competitive field. The year I was training there were about 30 of us who were doing some form of pediatric cardiac fellowship, and there were only three of us who got jobs.” He started at Le Bonheur as the junior surgeon along with two other surgeons, Dr. Chris Gilbert and Dr. Jeff Meyers. Within a year, Dr. Gilbert left for another job, and not long after that Dr. Meyers took a job in Boston. “This is a specialty where you need good mentorship during training and, even more important, after your training. So I was by myself and had to carry the cardiac program here at Le Bonheur for two or three years before I got some help. “It was trying times, I would say.” In 2012, Dr. Boston left Le Bonheur to go to Washington University in St. Louis. A big reason was that Le Bonheur’s heart program, in his mind, wasn’t at the level where it needed to be. “We did not have a heart transplant program,” he said, “and one of my big interests is in transplantation of children with congenital heart disease. Washington U. and St. Louis Children’s Hospital provided that opportunity. I didn’t leave Le Bonheur with any ill feelings. I really
wanted to build a transplant program.” In 2015, he got that chance. Le Bonheur upgraded its commitment and brought Dr. Boston back. “During the time I was gone, there was a change in plan,” he said, “and the direction was ‘OK, if we’re going to be a top-notch program, we need to provide all these services.’ They saw what the future of cardiac surgery was looking like.” While he was in St. Louis, Dr. Boston said, Le Bonheur sent him four to six transplant patients each year. But then the hospital demonstrated its commitment by hiring Dr. Jeffrey A. Towbin, who, Dr. Boston said, “is one of the big names in cardiomyopathy and transplantation in the country.” Dr. Towbin is now co-director of the Heart Institute at Le Bonheur. Upon Dr. Boston’s return, he said, “we knuckled down, built the infrastructure and obtained the resources that are required to start a heart transplant program.” “By October 2016 we did our first heart transplant,” Dr. Boston said. “By December 2016 we had performed two heart transplants and had put in two mechanical devices. And in 2017 we really exploded and did 12 transplants, probably some of the more complex heart transplants that we can do.” Donor hearts come primarily from remote sites within a 500-mile radius of Memphis, which encompasses a population of 92 million people. “The donor heart doesn’t last forever,” Dr. Boston said. “So within 20 years a baby will require another heart. I wouldn’t say transplantation is a cure. It provides a better quality of life for the child. Hopefully, with the development of advanced therapies, the donor heart may last longer.” westtnmedicalnews
GrandRounds • Staff training and education • Chemotherapy orders and drug preparation • Patient consent and education • Safe chemotherapy administration • Monitoring and assessment of patient well-being. QOPI and the QCP are projects dedicated to innovative quality improvement programs. For more information, please visit: http://www.instituteforquality.org/qopi-qcp.
West Tennessee Healthcare Welcomes New Cardiothoracic Surgeon JACKSON West Tennessee Healthcare welcomes Dr. Ted Wright to the leading cardiothoracic surgery team in the region. Dr. Wright joins the Cardiothoracic Surgery Center, located at 27A Medical Center Drive. Dr. Wright was most Dr. Ted Wright recently with the University of Kentucky Medical Center
PUBLISHER Pamela Z. Harris email@example.com
in Lexington, KY. He graduated from Princeton University and attended medical school at the University of Virginia School of Medicine. “We are extremely fortunate to have someone with Dr. Ted Wright’s skill and extensive experience, practicing in our community. He will be an outstanding addition to what is already one of the leading heart programs in the region,” said Darrell King, Vice President, West Tennessee Medical Group. “I am confident that Dr. Wright will be well received by our patients in Jackson and West Tennessee.”
Dr. Wright brings his expertise in the surgical treatment of atrial fibrillation to our patients. Specifically, he is skilled in new minimal access approaches which can treat this common heart rhythm problem with less discomfort and faster recovery. As the only clinic in the area with surgeons who provide open heart surgery procedures, the physicians and the staff at the Cardiothoracic Surgery Center work daily with patients to provide the best outcomes and return them to a healthy life. West Tennessee Healthcare is proud to have cardiovascular sur-
geons from some of the top heart programs in the country providing state-ofthe-art service and expertise.
New Director of Rehabilitation Named at Baptist Union City UNION CITY - Andrew Jackson has been named director of rehabilitation at Baptist Union City. He fills the position left vacant by Denise Johnson, who retired after 42 years of service.
Heart Disease is the number one cause of death.
Don’t become a statistic
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11 Board Certified Cardiologists Front row (left to right): Dr. Shahzad Shah, Dr. Antwan Robinson, Dr. James H. Crenshaw, Jr., Dr. Sandra V. Dee, Dr. Jason C. Cherry, Dr. Kelly D. Green Back row (left to right): Dr. Chibuzo Nwokolo, Dr. Abdul Rashid, Dr. John W. Baker, Dr. Joseph Okolo, Dr. Michael O. Osayamen,
700 West Forest Avenue | Suite 300 | Jackson, TN 731.422.0213 | Mon-Fri 8am-5pm
First and Only in Tennessee to implement the Corindus Vascular Robotics CorPathÂŽ GRX System. The only FDA cleared medical device to bring robotic-assisted precision to coronary angioplasty procedures while protecting medical professionals from radiation exposure occurring in hospital catheterization laboratories.
Tomorrowâ€™s Cardiac Care Here Today Robotic Precision in Positioning Stents
More Safety and Comfort for Patients
Published on Feb 8, 2018