Houston Methodist Heart & Vascular Annual Report 2013

2013 Year in Review

Leading Heart & Vascular Care

A proud tradition of excellence, with a new name.

The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.

That’s the difference between practicing medicine and leading it.

Contents

9

Leading Medicine: An Overview

3

Delivering Better Outcomes

5

Breaking new ground

11

Pursuing Medical Discoveries

13

Advancing Technology

19

Educating for Tomorrow

21

About Houston Methodist Hospital 24

11

8

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Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Leading medicine: an overview DeBakey Heart & Vascular Center Houston Methodist DeBakey Heart & Vascular Center provides an interdisciplinary approach to patient care and research where cardiologists, cardiovascular surgeons, imaging specialists, cardiovascular anesthesiologists and intensivists deliver the most advanced medical and surgical solutions tailored for each patient.

This extensive expertise and array of resources offer comprehensive care and treatment for the world’s most complex cardiac disorders.

• Located in Houston Methodist Hospital in the Texas Medical Center®

20,000 more than

• More than 125 physicians and 550 employees • 10 operating rooms, 2 hybrid operating rooms, 9 catheterization labs, 176 acute-care beds, 58 ICU beds and 43 transplant beds

patients from across the U.S. and 19 countries chose the heart center for their cardiovascular care last year.

• Recipient of more than $3 million in research support annually from sources including the National Institutes of Health and the American Heart Association • Ranked No. 14 by U.S. News & World Report among the 600 best hospitals in the United States for cardiology and heart surgery

At a Glance

750 heart transplants performed since 1968

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DeBakey Heart & Vascular Center

more than

70,000 more than

ekgs

1,650 open heart surgeries performed annually

10,000 100

more than

clinical trials currently under way

procedures performed annually in catheterization labs

more than

2,000

electrophysiology procedures

performed annually

Message from the Medical Director Dear Colleagues, On behalf of all the physicians and staff of Houston Methodist DeBakey Heart & Vascular Center, I’m pleased to share with you some highlights of our accomplishments over the past year.

The world-renowned legacy of Dr. Michael E. DeBakey continues at Houston Methodist Hospital in the areas of clinical excellence, innovative research and advanced education.

Superior patient care is the core objective of Houston Methodist Hospital, and the exceptional care we give all heart and vascular patients is evidenced by our volume and outcomes.

However, the specialized treatments we offer to the very sickest cardiac patients from around the nation and the world sets our center apart.

In the past year, we’ve made great strides in the treatment of advanced heart failure, atrial fibrillation and valve replacement, including transcatheter aortic valve replacement, and cardiac sarcomas and other tumors. Many of these clinical advances are the result of, or the genesis for, a wide range of advanced research that is being led by several members of our faculty and staff. We believe the basic and clinical research that is taking place within the walls of Houston Methodist is leading cardiovascular medicine into the future.

Currently, there are five national or international clinical trials with principal investigators from Houston Methodist DeBakey Heart & Vascular Center. A highlight of 2013 was the establishment of the Department of Cardiovascular Sciences and the Center for Cardiovascular Regeneration, both led by internationally renowned researcher, John P. Cooke, MD, PhD. Interconnected with the research and clinical care at Houston Methodist are technological advances, cross-industry collaborative projects, and advanced educational opportunities that continue to fuel the ideas and visions that will shape cardiovascular care in the future. From the Pumps & Pipes Conference, to the latest technology for training and research, to the newest applications in mobile computing devices, it’s clear that the visionary spirit of Dr. DeBakey is alive and well at Houston Methodist Hospital.

We invite you to explore the exciting developments in cardiovascular care, research and education in the following pages, and we welcome your feedback on how we can continue to support you and your patients.

Alan B. Lumsden, MD Walter W. Fondren III Distinguished Endowed Chair Medical Director, Houston Methodist DeBakey Heart & Vascular Center Chair, Department of Cardiovascular Surgery Houston Methodist Hospital, Houston, Texas

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DeBakey Heart & Vascular Center

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Congenital Heart Program for Adults : An extension of care for childhood miracles Treating adults with congenital heart disease is a rapidly growing field in cardiology. For the very first time, patients with a congenital disease are surviving to adulthood. Many of them had miraculous surgeries as children that allowed them to survive and grow up. In fact, there are now approximately 1.5 million adults in the United States living with congenital

“Most cardiovascular diseases develop later in life, and patients are exposed to heart disease for a decade or two. In contrast, patients with congenital heart disease have a lifetime of exposure, so they require a lifetime of highly specialized care that adjusts to their needs as they age, a reflection of these childhood successes.”

C. Huie Lin, MD, PhD

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DeBakey Heart & Vascular Center

heart disease, which is more than the number of children with congenital heart disease. While initial surgical repairs on the children were successful, a s a d u l t s , t h e s e patients still require ongoing treatment because the surgical repairs sometimes need revision. To address this new population of patients, Houston Methodist h as create d th e

Adult Congenital Heart Program. “Our program of fers a combination of medical therapy and prevention, observation, transcatheter intervention, and surgical repair, if required,” says Chun Huie Lin, MD. “We can now transition these patients to an adult setting where they were followed throughout their childhood.”

Leading Medicine: An Overview Delivering Better Outcomes

JACKSON HOLE, WY

Breaking New Ground

MINNEAPOLIS, MN

WAUSAU, WI

Pursuing Medical Discoveries

BUFFALO, NY ROSEVILLE, MI

PHILADELPHIA, PA

DESMOINES, IOWA CLEVELAND, OH

RENO, NV

EDWARDS, CO

SANTA BARBARA, CA

BENSON, NC ALBUQUERQUE, NM PHOENIX, AZ

OKLAHOMA CITY, OK UKON, OK

FAYETTE, NC

LEXINGTON, TN MEMPHIS, TN

SALLISAW, OK

COLUMBIA, SC

RIODOSO, NM

ATLANTA, GA TEXARKANA, ARK

BATON ROUGE, LA LAKE CHARLES, LA

NEW ORLEANS, LA

Patients travel from across the U.S. for alternative blood management techniques as Houston Methodist is one of the few institutions to offer this unique treatment option.

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DeBakey Heart & Vascular Center

A coordinated team approach to blood management at Houston Methodist Hospital has led to a decrease in the need for transfusions in certain cardiac surgical patients.

AUGUSTA, GA

ZWOLLE, LA

HMH

Blood Management Options for Patients New tools decrease blood transfusions up to 50 percent

LITTLETON, CO KANSAS CITY, MO

LOS ANGELAS, CA

NEW PALTZ, NY

Advancing Technology Educating For Tomorrow

Through the efforts of the Patient Blood Management Advisory Committee – chaired by Christopher Leveque, MD – cardiac surgeons, cardiovascular anesthesiologists, and perfusion personnel implemented several recommendations from the Society for Thoracic Surgery with positive results. Blood use decreased 40 to 50 percent for all component categories for isolated CAB, aortic valve replacement and CAB, and valve surgeries. The percent of patients not requiring blood components increased approximately 10 percent in isolated CABG surgery cases.

Other efforts to reduce blood use include pre-operative identification of anemic patients using an ultraviolet device, similar to pulse oximetry. Patients who are found to be anemic are referred to a hematologist for treatment before surgery.

Additionally, several post-operative methods to lessen iatrogenic blood loss in the cardiovascular intensive care unit (CVICU) are currently under evaluation. The lessons learned from these efforts are now being shared with other specialties throughout Houston Methodist by the educational efforts of the Patient Blood Management Advisory Committee.

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Setting new best practices in Advanced Heart Failure & Transplant The Advanced Heart Failure Team at Houston Methodist Hospital is a collaboration between the DeBakey Heart & Vascular Center and the J.C. Walter Jr. Transplant Center.

The focus of the team is to address the needs of heart failure patients with medical and mechanical interventions, either as primary therapy or as a bridge to transplant. Houston Methodist offers several unique strategies for mechanical circulatory support as a bridge to heart transplantation.

These include the novel use of the left axillary intra-aortic balloon pump that permits ambulation, Heartmate II LVAS, HeartWare HVAD, Total Artificial Heart (TAH), and the Thoratec PVAD coupled with the Heartmate II for biventricular support.

Treatment options are evaluated by the team and weighted for the greatest benefit versus risk for each patient. “At the Houston Methodist DeBakey Heart & Vascular Center, we are committed to pushing the field of heart failure research and treatment forward in numerous ways,” says Jerry D. Estep, MD, FACC, Heart Transplant and LVAD Program medical director.

“We pursue promising new ideas, but we also use novel approaches with existing technology to improve outcomes for heart failure patients that come to us from all over the world.”

Shared Care As heart failure therapies continue to improve, Houston Methodist has seen significant increases in volume in both heart transplants and LVAD patients, and many of these patients come from across the nation and around the world.

Estep and his colleagues are creating innovative methods to allow patients who have received heart failure interventions – especially mechanical therapies – to be monitored post-procedure by cardiologists at home.

“The goal is to create partnerships with providers from the region, and eventually the world, during all three stages of LVAD care — pre-intervention, intervention and long-term follow-up care,” says Estep.“We believe this can become a model for best practice.”

To facilitate this effort, Houston Methodist hosted a Shared Care Summit Meeting designed for physicians and mid-level practitioners who are committed to treating LVAD patients in their communities. The Advanced Heart Failure Team provided real-world education using Houston Methodist’s MITIEsm lab for demonstrations with a current LVAD patient.

“Houston Methodist is committed to pushing the field of heart failure research and treatment forward in numerous ways. We pursue promising new ideas, but we also create novel approaches with existing technology to improve outcomes.”

Jerry D. Estep, MD, FACC 7

DeBakey Heart & Vascular Center

24

54

heart transplants in 2013

85% 10 5.3 %

lvad implants in 2013 3-year post-heart transplant patient survival*

*greater than national SRTR benchmark of 83%

Dedicated Advanced Heart Failure Physician Specialists

Wait list mortality rate* *lower than national SRTR benchmark of 10.4%

243

14

10

top

program according to the University Health Consortium data

evaluations performed and presented to the Medical Review Board for advanced heart failure

days median process length from referral to medical review board presentation

A Promise from the Heart When Timothy Lewis, 48, was admitted to Houston Methodist Hospital on December 3, 2013 with end-stage congestive heart failure, the cardiovascular team quickly determined that he required a transplant. Lewis, of Jackson, Miss., was implanted with an intra-aortic balloon pump to augment cardiac function while he was put on the donor list.

As his family kept vigil at the hospital, plans for an imminent family celebration were quickly re-evaluated. Lewis’s youngest child, Lolaycia, was planning her wedding for March 2014, and her father had promised to walk her down the aisle. But with transplant prospects uncertain, Lolaycia and her fiancé, Melmiah Walker, changed the wedding date and location.

New date: December 22. New location: the chapel at Houston Methodist Hospital.

With nurses minding his equipment, Lewis made it all the way down the 40-foot aisle with Lolaycia, and he even managed a brief dance with her after the ceremony. “Because of the severity of my illness, I didn’t think I would be able to participate in this day,” Lewis said afterward. “I thank God for giving me the strength to walk her down the aisle.”

Fortunately, a heart became available soon after the wedding, and Lewis was transplanted on January 4, 2014. He’s now doing well and getting stronger by the day.

“Thankfully, Mr. Lewis has been free of rejection and free of infection,” said Houston Methodist cardiologist Jerry Estep, MD “We project that he will do well over the next several years.”

DeBakey Heart & Vascular Center

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Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

ecmo mortality Revamped protocols reduce ECMO mortality 30 percent This year the extracorporeal membrane oxygenation (ECMO) program at Houston Methodist Hospital has seen a major improvement in mortality outcomes thanks to newly revamped protocols created by a multidisciplinary team.

ECMO is an essential service to offer at a tertiary medical center like Houston Methodist, which has extremely high volumes of transplant patients and patients with respiratory failure. Patients on ECMO are the sickest of the sick, so the service tends to have a high mortality rate. However, ECMO is also resource-intensive, so it is crucial that services are as efficient and effective as possible.

TAKING THE TEAM APPROACH “In 2013, we completely revamped the ECMO program with our own protocols for anticoagulation, patient selection, respiratory protocols, evaluation of venoarterial vs. venovenous ECMO, and other crucial procedures,” says Brian Bruckner, MD, surgical director of the program.

Bruckner and John Fetter, MD, medical director of the program, put together a team that created a whole new approach to ECMO care. With the team’s new protocols in place, ECMO mortality decreased from 85 percent to 51 percent, a remarkable improvement for patients in severe respiratory and cardiac distress.

EXPANDING PHYSICIAN EDUCATION Another new focus of the program is outreach and education to physicians at suburban feeder hospitals.

“Dr. Fetter and I provide education about ECMO, such as appropriate selection criteria and information on how to quickly transfer patients,” Bruckner explains. The doctors are also conducting didactic sessions in the MITIETM lab with mannequins to offer a hands-on experience for physicians. This is in support of next year’s goal to expand the program.

THE ECMO MORTALITY RATE FOR HOUSTON METHODIST PATIENTS IS 7% BETTER THAN THE NATIONAL AVERAGE MORTALITY RATE FOR ADULT PATIENTS. *Per the Extra Corporeal Life Support Organization Registry. Houston Methodist Hospital mortality rate is 51 percent compared to the national average of 58 percent.

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DeBakey Heart & Vascular Center

Advancing Technology Educating For Tomorrow

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Building the knowledge base for cardiac sarcoma Houston Methodist Hospital has the largest cardiac sarcoma program, and one of the largest primary heart tumor programs in the world.

The physicians at Houston Methodist were the first in the world to perform an auto-transplant for left atrial sarcoma, an auto-transplant for left ventricular sarcoma, and bi-VAD replacement for cardiac sarcoma. In October of 2013, physicians at Houston Methodist were also the first in the world to insert a total artificial heart in a patient with a cardiac sarcoma diagnosis.

Although rare, cardiac tumors represent approximately one in every 500 clinical cardiac surgical cases. Approximately 75 percent of the tumors are benign, and of the remaining 25 percent that are malignant, approximately 75 percent are sarcomas. It is important to note that most patients who are diagnosed with a malignant cardiac tumor are told that there are no treatment options available.

Because of the low incidence, most cardiac surgeons have never seen a cardiac sarcoma. However, the cardiac tumor program at Houston Methodist has treated approximately 300 patients with cardiac tumors, over half of those being patients with primary cardiac sarcomas. Other diagnoses include myxoma, fibroelastoma, and paraganglioma.

“At Houston Methodist Hospital, we are defining for the world the most appropriate ways to evaluate and treat patients with cardiac tumors.

These patients are often told they have no treatment options.”

Michael J. Reardon, MD

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DeBakey Heart & Vascular Center

High Volumes, Treatment Options At Houston Methodist Hospital, we are defining for the world the most appropriate ways to evaluate and treat patients with cardiac tumors. These patients are often told they have no treatment options. The large clinical volume has contributed to 44 peer-reviewed publications and eight textbook chapters, in addition to dozens of presentations and surgical demonstrations throughout the world by the clinicians at Houston Methodist.

Additionally, Houston Methodist leads monthly tumor boards, which also include MD Anderson Cancer Center, the University of Michigan, Vanderbilt University and Hadassah Hospital in Jerusalem.

“A malignant cardiac tumor is generally a dismal prognosis,” acknowledges Michael J. Reardon, MD, cardiovascular/thoracic surgeon at Houston Methodist.

“Survival for cardiac sarcoma patients with medical therapy is between one and six months, and standard surgical treatment is about 12 months. But we’ve moved that survival rate out to about three years. Many patients with cardiac sarcomas are at an age where they have young families, so an improved prognosis can be a huge gift.”

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Retrograde access: meeting in the middle to clear vessels Patients with peripheral artery disease (PAD) often have vessels that have become so hardened, normal endovascular techniques will not work. However, with a new technique called retrograde access, surgeons enter arteries through the foot and work upward.

“This procedure is not indicated for all patients with PAD,” explains Hosam El-Sayed, MD, an endovascular surgeon with Houston Methodist. “It’s only used in complex patients with heavily calcified arteries, which is common in people with severe diabetes.”

During the delicate procedure, surgeons access the blocked arteries both from the foot and femoral artery, and meet in the middle. “Once that occurs, we can open the vessels with a balloon or a stent,” says El-Sayed. “We can also shave the plaque to increase patency of the vessels.”

Patients who receive an amputation below the knee for arterial occlusive disease have a 25 percent one-month mortality rate. For the more extensive above knee amputation, there is a 50 percent one-month mortality rate.

“Retrograde access gives us another pathway to work through severely diseased arteries.

We have saved the limbs of many patients who would have lost them just a few years ago.”

Hosam El-Sayed, MD

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DeBakey Heart & Vascular Center

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

New thrombolysis method broadens treatment options Certain pulmonary embolisms can now safely and effectively be treated with catheter-directed thrombolysis combined with ultrasound, according to Alan B. Lumsden, MD, vascular surgeon at Houston Methodist Hospital. “Recent trials have proved the safety and efficacy of using catheter-directed thrombolysis in combination with ultrasound in resolving submassive pulmonary emboli,” says Lumsden. “These are the emboli that show right heart strain in an echocardiogram.”

At Houston Methodist, there is a multidisciplinary group of clinicians – including surgeons, interventionalists, cardiologists and intensivists – who are focused on clarifying appropriate clinical pathways for management of these patients. “When we are determining who needs surgery versus who should be treated with thrombolytics, the catheter-directed thrombolysis will give us another good option to offer our patients,” says Lumsden.

Pioneering a new tool against renal failure Until recently, MRI angiography could not be performed on a patient with renal failure because the gadolinium used for contrast is contraindicated in those patients. However, physicians at Houston Methodist, in collaboration with Duke University, have pioneered the novel clinical use of an FDA-approved iron agent for its imaging properties for the benefit of renal patients.

“Ferumoxytol is primarily used to treat iron-deficiency anemia, and it’s specifically indicated for patients with chronic kidney disease and renal failure,” says Dipan Shah, MD, medical director of cardiac MRI at the DeBakey Heart & Vascular Center. “So we have pioneered the use of that iron-based agent for its imaging properties, and with that we are actually able to perform MR angiograms on patients with renal failure. As far as we know, only Houston Methodist and Duke are using ferumoxytol for this purpose.”

DeBakey Heart & Vascular Center

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Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Research that forges a path to regenerative therapies: New faculty of clinician-investigators Since the earliest angioplasties, Houston Methodist Hospital has been an innovative leader in the field of cardiovascular medicine. The tradition continues today as the future of cardiac care moves beyond surgery and mechanical devices to the burgeoning field of regenerative medicine.

The fact that the human body can repair itself has been known for thousands of years. However, the research that will be required to unleash the full potential of stem cells and other regenerative therapies is still in progress. To that end, Houston Methodist Hospital has created the Center for Cardiovascular Regeneration within the Department of Cardiovascular Sciences at Houston Methodist Research Institute, all under the leadership of John P. Cooke, MD, PhD. Cooke is a world-renowned expert in fundamental and translational research in endothelial biology and vascular diseases. Before coming to Houston Methodist, Cooke held faculty positions at Harvard Medical School and Stanford University School of Medicine. Over the past 25 years, his primary work has been in developing therapeutic molecules to address atherosclerosis, angiogenesis and lymphangiogenesis, which has produced over 500 papers and 30 patents granted or pending.

As the Department of Cardiovascular Sciences Chair at Houston Methodist Research Institute, Cooke is the latest in a long line of world-renowned cardiovascular experts to conduct leading-edge research at Houston Methodist.

“The Department of Cardiovascular Sciences and the Center for Cardiovascular Regeneration are built on the noble tradition of cardiovascular investigation and patient care begun by Dr. DeBakey and continued by his clinical colleagues at Houston Methodist,” explains Cooke.

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DeBakey Heart & Vascular Center

“The department has a strong research focus and is providing an exceptional basic investigative effort that is continuing to distinguish Houston Methodist Hospital as a leader in cardiovascular sciences and care.” Although ongoing cardiovascular research at Houston Methodist includes imaging, intervention, electrophysiology and metabolism, a major thrust of Cooke’s work going forward is cardiac regeneration.

Focus on Regeneration “The mission of the Center for Cardiovascular Regeneration is to restore cardiovascular health by reversing cardiovascular aging and regenerating cardiovascular tissue,” says Cooke.

“I have great expectations that our work at Houston Methodist will have a tremendous impact on cardiovascular diseases in the near future and for years to come.”

Broadly speaking, research in cardiovascular regeneration includes investigations into processes that accomplish the following: • Restore the form or function of the cardiovascular system • Improve the contraction, relaxation or electrical conduction of the heart • Restore the distributive or nutritive properties of the blood or lymphatic vessels.

Cardiovascular regenerative therapies developed in the center may include small molecules, nucleic acid or protein-based agents, cell or tissue therapies alone or in combination with bioengineered matrices, nanotherapeutics, and medical devices.

“The Department of Cardiovascular Sciences builds on the noble tradition of cardiovascular investigation and patient care begun by Dr. DeBakey and continued by his clinical colleagues. Its efforts will be facilitated by the existing research strengths at Houston Methodist Research Institute.”

John P. Cooke, MD, PhD

Leaders in Research Accelerating discovery and delivery to patients

At Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.

More than 840 active clinical protocols $55 million TOTAL RESEARCH funding in 2013 See all the ways we’re leading medicine at hmleadingmedicine.com

Houston Methodist is pleased to announce Jack Wong, PhD, Yohannes T. Ghebremariam, PhD, and Nazish Sayed, PhD, as three new prestigious faculty members of the Department of Cardiovascular Sciences in collaboration with John P. Cooke, PhD (pictured).

DeBakey Heart & Vascular Center

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Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

$3.5 Million Grant to Test Innovative Atrial Fibrillation Treatments Physicians at Houston Methodist Hospital, led by cardiac electrophysiologist Miguel Valderrabano, MD, are advancing innovative clinical research on treatments for atrial fibrillation (AF) and prevention of AF-related strokes.

Below are a few research highlights

•

•

With a $3.5 million grant from the National Institutes of Health, Valderrabano is leading a consortium of hospitals in phase III clinical trials offering an innovative treatment with a minimally invasive procedure to treat AF by injecting alcohol through a balloon catheter into the Vein of Marshall. Preliminary trials of this procedure – the brainchild of Valderrabano – show promise that the alcohol procedure may have superior outcomes over current ablation procedures of the pulmonary veins.

Early trials of the alcohol procedure also show complete success in treating peri-mitral atrial flutter in AF patients, while traditional ablation procedures are approximately 65 percent successful. Additionally, alcohol infusion was shown to target nerves of the heart, not simply kill the muscle cells, which is a new therapeutic target.

“Houston Methodist Hospital is a high-volume center for AF treatment, so we participate in many national research projects in the development of new technologies.”

Miguel Valderrabano, MD

•

•

15

Strokes in AF patients can be caused by blood clots that collect in the left atrial vestigial appendage.

Valderrabano and his team are participating in a clinical study on the Watchman’s device, a plug that seals off the appendage, creating a non-pharmacological option for stroke prevention.

The team recently completed participation in a study on the Laser Heartlight device, an ablation catheter with an endoscopic balloon that allows direct visualization of the tissue being ablated. It uses a fiber optic light source and a laser dot to more precisely and quickly target vascular tissue for ablation.

DeBakey Heart & Vascular Center

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Transcatheter Aortic Valve Replacement Trials High Enrollers and Beyond

Europe in 2014. This valve is a single nitinol wire frame with a pericardial valve, which will allow the device to be recaptured, repositioned and redeployed if necessary.

Houston Methodist Hospital has been a leader in the research into TAVR technologies in the U.S. beginning with the CoreValve US Pivotal Trials. Neal Kleiman, MD and Michael Reardon, MD served as the local principal investigators. Reardon served on the national steering, publications and screening committees for the trial and was chair of the screening committee. These trials led to the approval of the first TAVR device in the U.S.

“This research has led to treatment modalities for inoperable patients who previously had no options whatsoever,” says Reardon. “Now we want to find out if TAVR is safe and efficacious for patients who may be operable but are at the high end of the risk scale.”

Valve Clinic Leader

Houston Methodist was the high enroller for the CoreValve US Pivotal Trials, in both the extreme high-risk and high-risk patients, as well as for the neurologic sub-study. The CoreValve extreme risk arm was just presented at the Transcatheter (TCT) Conference and the FDA found the data impressive enough to consider market approval without a panel consideration.

Physicians at Houston Methodist are now leading research to determine if TAVR is a safe and effective alternative to surgical intervention for intermediate-risk patients. Reardon and Kleiman, are the local lead primary principal investigators. Reardon is the national surgical PI and serves on the national steering committee for the SurTAVI trial. At the heart of the next generation CoreValve system is the Evolute valve, with a re-engineered nitinol frame that leads to more constant radial force over the planned expansion range, and a re-engineered shape to aid in sealing paravalvular leak.

Next Generation Coming Soon Reardon is also the global surgical PI on the forthcoming REPRISE III study on Boston Scientific Corporation’s LotusTM Valve System, set to begin in the U.S., Australia, Canada, and

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DeBakey Heart & Vascular Center

Similar to tumor boards, complex clinical cases are shared at a biweekly valve conference. Cardiovascular surgeons, interventional cardiologists, imaging experts and nurse practitioners discuss diagnostic and patient management considerations. After the conference, a letter outlining the team’s consensus opinion for treatment is sent to the referring physician for review.

Houston Methodist is uniquely positioned to continue leading advances in valve repair and replacement for many reasons. A key factor has been the development of a world-class valve program that led to the creation of a valve clinic in 2009. “The valve clinic – based on the multidisciplinary concept of our transplant clinic – is a close collaboration between cardiologists and cardiac surgeons,” explains Stephen Little, MD, medical director of the valve clinic.

“Each patient is thoroughly prescreened, allowing us to schedule the appropriate diagnostic tests and physician appointments all on the same day. This expedites the analytics and decision processes considerably.” This clinic was one of the first of its kind in the nation, and is one reason that Houston Methodist has been a leader in TAVR clinical trials.

“The integrated, multidisciplinary heart team at Houston Methodist is the foundation of our successful efforts to provide world-class patient care,” says Reardon. “It also allows us to continue to lead the latest clinical research in valve repair and replacement.”

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Putting theories to the test: 2013 research highlights In the continued tradition of Dr. Michael DeBakey, the cardiologists and cardiovascular surgeons at Houston Methodist DeBakey Heart & Vascular Center regularly lead research in numerous trials. A few highlights are listed below.

Aastrom ixCELL DCM Stem Cell Trial

CardioKinetix Parachute Trial

Barry H. Trachtenberg, MD, is the principal investigator for this study designed to assess the efficacy, safety and tolerability of Ixmyelocel-T in heart failure (HF) caused by ischemic cardiomyopathy.

The purpose of the Parachute randomized trial headed by Neal Kleiman, MD, is to determine the safety and effectiveness of the Parachute® device versus optimal medical therapy in patients with HF due to ischemic heart disease.

• Ixmyelocel-T is a patient-specific, expanded multicellular therapy derived from bone marrow cells with a proven range of activities including repair and regeneration of ischemic tissue.

• HF following myocardial infarction (MI) occurs in more than 3.6 million patients in the U.S. After an anterior infarct, almost 60 percent show LV remodeling and HF symptoms.

• In this multicenter, randomized, double-blind, placebo-controlled study, Ixmyelocel-T is administered to end-stage HF patients via transendocardial catheter-based injections and the efficacy, safety and tolerability is compared with the placebo.

• The Parachute device is a catheter-based treatment developed for patients with left ventricular dilation after an anterior MI. This device is a partitioning membrane deployed within the compromised ventricle and isolates the malfunctioning portion of the ventricle.

Celladon CUPID-2b Trial The purpose of this multinational study headed by Arvind Bhimaraj, MD, is to test whether an experimental gene transfer agent called MYDICAR® helps improve clinical outcomes in subjects with HF. • SERCA2a protein deficiency in cardiomyocytes has been identified as a key cause for myocardial dysfunction in HF. SERCA2a is involved in maintaining Ca2+ homeostasis in myocardial cells and thus affects the relaxation and contraction of cardiomyocytes.

• In advanced HF patients, targeted SERCA2a enzyme replacement with MYDICAR may correct imbalances in Ca2+ cardiac metabolism resulting in improved cardiac function and clinical outcomes.

Abbott COAPT Trial Neal Kleiman, MD, is the principal investigator for the prospective, randomized, parallel-controlled, multicenter clinical evaluation of the MitraClip® device.

• MitraClip is a percutaneous device developed for the treatment of clinically significant functional mitral regurgitation.

• Results from previous studies show a significant clinical benefit with relatively low risk of excessive peri-procedural or long-term mortality with this device.

• The COAPT trial will provide new data on the safety and effectiveness of the MitraClip System specifically in symptomatic patients who are extremely high risk for mitral valve surgery.

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DeBakey Heart & Vascular Center

Thoratec Roadmap Trial ROADMAP study led by Jerry Estep, MD, and Brian Bruckner, MD, is a multicenter investigation to determine the safety and efficacy of using the Heartmate II (HM II)® Left Ventricular Assist System (LVAS) in moderately sick HF patients.

•

The study will evaluate and compare the effectiveness of HM II LVAD support with optimal medical management in ambulatory NYHA Class IIIB/IV HF patients who are not dependent on intravenous inotropic support and who meet the FDA-approved indications for HM II LVAD destination therapy.

• Data from this study will be valuable for defining patient selection strategies for LVAD support.

AbbotT Absorb III Trial Alpesh Shah, MD, is involved in the Absorb III trial which will assess the safety and effectiveness of the Absorb™ BVS System in comparison with commercially approved metallic drug eluting XIENCE stents.

• The Absorb Bioresorbable Vascular Scaffold (Absorb BVS) System is a temporary balloon- expandable scaffold that has been designed to revascularize obstructed coronary arteries.

• Unlike other commercially available coronary stents that are made of metal, the polymer in the Absorb BVS System is bioresorbable and becomes undetectable over time.

Abbott Excel Trial The primary hypothesis of this study is that treatment of left main stenosis and other significant coronary lesions with the XIENCE family stent system will result in non-inferior or superior rates of all-cause mortality, myocardial infarction or stroke compared to coronary artery bypass graft (CABG) surgery.

• Alpesh Shah, MD, and other investigators of the Excel trial will examine if the XIENCE PRIME stent, XIENCE V stent and XIENCE Xpedition stent are safe and useful treatments for left main stenosis when compared to CABG surgery.

• The stents are coated with polymers and the anti-proliferative drug Everolimus.

The Cardiovascular Imaging Institute at the heart center evaluates and diagnoses

27,000

more than

patients each year

Core Lab for Echocardiograms Houston Methodist DeBakey Heart & Vascular Center continues to advance the field of cardiovascular imaging with groundbreaking research, clinical implementation, and physician training in new, noninvasive procedures. As one of the largest and most experienced cardiovascular imaging facilities in the nation, the Cardiovascular Imaging Institute at the heart center evaluates and diagnoses more than 27,000 patients each year.

The echo laboratory has been actively involved in developing and applying echocardiographic techniques in the evaluation of cardiac function and valvular heart disease. The heart center has subsequently served as the Core Echocardiography Laboratory for several multi-center (and multi-national) trials, the largest of which include the SOLVD registry, the SOLVD trial echocardiographic sub-study, the COMET trial, and ACCLAIM. The lab has also served as a core lab for St. Jude’s Medical Center and Abbott Laboratories.

Accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories in the 1990’s, the laboratory is currently fully digital, equipped with eight off-line quantitative review stations (DigiView Image Management & Reporting System), and 2 EchoPAC Dimension stations.

“Photo courtesy of WHR Architects, Inc. © Aker/Zvonkovic Photography, Houston, Texas”

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DeBakey Heart & Vascular Center

Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Taking a Virtual Look inside the Human Body Using a computer to visualize inside the body is not a new concept.

But combining technologies in novel ways can inspire new approaches to treating patients.

Physicians at Houston Methodist are using a system from Translucent Medical that merges CT and MRI images with GPS technology. “The concept mimics the ‘stargazer’ apps, with a CT or MRI scan of the body as the ‘universe,’” explains Alan B. Lumsden, MD. “When the GPS sensors are activated, virtual visualization inside the body is possible.”

Currently, the Translucent technology is only used as a patient and family education platform. However, future applications are endless. For example, with GPS sensors on needles or catheters, physicians could use an MRI or CT scan to guide the insertion of needles and catheters into a patient without the need for radiation.

Using Google Glass Technology for Medical Procedures in Space Physicians at Houston Methodist have begun collaborating with NASA on innovative ideas for applying medical technology in space. One of those ideas has yielded a project using Google Glass technology to train astronauts on using ultrasound to diagnose problems that occur while the astronauts are in space.

The idea is for the doctor on the ground to see exactly what the astronauts are seeing. The physician can talk the astronaut through the procedure, give immediate feedback about how and where to hold the wand, and help diagnose based on the images on the ultrasound screen.

“There are so many applications for using Google Glasses in space, but one of the first we thought of is for training purposes,” says Zsolt Garami, MD, ultrasound expert at Houston Methodist.

“One of the only diagnostic imaging tools that can be used in space is ultrasound, so helping astronauts perform this procedure in orbit could be a huge asset in diagnosing a sick astronaut.”

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DeBakey Heart & Vascular Center

Pumps & Pipes creates flow of ideas Over the past seven years of the annual Pumps & Pipes Conference hosted by Houston Methodist Hospital, ideas and conversations have turned into funded research, peer-reviewed publications, and cross-industry collaborative projects that are solving real-world problems. Participants of the conference include representatives from the medical, energy and space fields. Below are a few highlights of the most interesting collaborative projects whose genesis is owed to Pumps & Pipes.

HeartBeat Simulator In a collaborative project between ExxonMobil and the Houston Methodist DeBakey Heart & Vascular Center, ExxonMobil engineers helped develop software for a flow loop heartbeat simulator for use in multi-modality imaging for cardiovascular devices. This has resulted in a number of funded projects and articles published in peer-reviewed journals. It has also allowed researchers at the heart center to assess a range of cardiovascular devices, ranging from heart valves to vascular grafts to heart-assist devices. The most unique use of this software is to use the flow loop in the MRI, which allows ver y accurate measurements of flows, flow streamlines and profiles through the devices, in addition to testing disease states such as aortic dissections.

Imaging Wellbore Flow Engineers at ExxonMobil have been interested in the artificial mitral heart valve, in particular the imaging capabilities used in patients that might be applicable to wells.

Energy engineers have been looking to determine the flow into complex wellbores that may be thousands of feet underground.

Researchers at the heart center created a scale model of a wellbore, put it into the MRI imaging equipment, and imaged it, producing remarkable results.

Pipeline Infection The major cause of oil spills in pipelines is triggered by biofilm inside the pipe that can severely damage the pipe.

It is difficult to find and treat. Medical and energy researchers are looking in two areas: 1) finding and t re at ing th e biof il m in exis t ing p ip e l ine s , and 2) designing pipelines that resist pipeline infection.

ENERGY-BASED MATERIALS FOR MEDICINE Numerous materials developed for energy applications are often referred to as “environmentally friendly,” which also can frequently mean “bio-compatible.” Early work on bio-compatibility testing is beginning on some of these energy industry materials for medical applications.

PUMPS & PIPES 7: Exploration The seventh annual Pumps & Pipes Conference, co-sponsored by NASA, ExxonMobil and the University of Houston, is designed to gather experts from aerospace, energy, medicine and academic research to develop new resources and technologies.

For information on this year’s event, visit pumpsandpipes.com.

DeBakey Heart & Vascular Center

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Leading Medicine: An Overview Delivering Better Outcomes

Breaking New Ground

Pursuing Medical Discoveries

Advancing Technology Educating For Tomorrow

Educating the Medical Professionals of today and tomorrow The DeBakey Institute for Cardiovascular Education and Training (DICET), the educational arm of the heart center, provides comprehensive education in cardiovascular disease. DICET continues to deliver state-of-theart training for cardiovascular professionals at every stage of their medical career.

21

VASA

Save A Life

Fellows’ Bootcamp

In May 2013, Houston Methodist hosted the Vascular Access Society of the Americas (VASA) Practicum Conference.

This internationally attended conference offered two and a half days of live procedure observations, hands-on training labs for new technology, and lectures on the latest techniques in vascular access procedures. Attendees included physicians, surgeons, nurse practitioners, nurses, allied healthcare professionals, and technicians from all over the United States and beyond.

In collaboration with the Texas Arrhythmia Institute, the American Heart Association, and the Houston Texans, Houston Methodist held the annual one day CPR and automated external defibrillator (AED) training in June 2013 at the Texans’ training bubble at Reliant Stadium. Taught in both English and Spanish, a record-setting attendance of more than 1000 people learned to save a life through this community event.

In August 2013, Houston Methodist held its fifth annual CV Fellows’ Bootcamp for incoming vascular, cardiology, cardiac surgery and interventional radiology fellows from around the United States. More than 150 fellows in these specialties from around the country learned basic techniques and procedures in hands-on labs and attended lectures from world-renowned faculty. As Bootcamp has expanded, the heart center plans to offer its first Finishing School Conference in May of 2014 for fellows who are now completing their fellowships and moving into private or academic practice.

DeBakey Heart & Vascular Center

Methodist DeBakey Cardiovascular Journal Founded in 2005, the Methodist DeBakey Cardiovascular Journal reports on leading-edge research, diagnoses and treatments in cardiovascular disease. A peer-reviewed publication, the journal became a citable source in 2009 on MEDLINE, the most comprehensive medical information resource compiled by the U.S. Library of Medicine.

Recent topics include regenerative medicine in cardiovascular disease, next-generation transcatheter aortic valve replacement, nanotechnology in cardiovascular medicine, and a case series of reversible acute cardiomyopathies associated with H1N1 influenza infection.

The journal considers manuscripts in the form of case reports, reviews, clinical investigations and guest editorials that address any aspect of cardiovascular disease. For a complete list of submission guidelines or for an electronic version of the journal, visit houstonmethodist.org/debakeyjournal.

Volume 9, Number 3 • Jul. – Sep. 2013 • Official publication of Houston Methodist DeBakey Heart & Vascular Center

METHODIST DeBAKEY CARDIOVASCULAR JOURNAL

Noncompaction cardiomyopathy. Severely enlarged left ventricle (LV) with LV ejection fraction of 29%. Prominent LV apical trabeculations are seen with a ratio of noncompacted to compacted myocardium of 2.5:1. Late gadolinium enhancement demonstrated contrast uptake within the trabeculations.

CARDIAC MRI PAGE 123 Cardiac MRI for Myocardial Ischemia

PAGE 173 A Case of Reverse Transient Ischemic

Dilatation

PAGE 132 Cardiovascular Magnetic Resonance Imaging

for Assessment of Cardiac Thrombus

PAGE 174

PAGE 137 Safety of MRIs in Patients with Pacemakers

and Defibrillators

Utility of Cardiac Computed Tomography for Assessment of Prosthetic Aortic Valve Dysfunction with Pannus Formation

PAGE 142

The Role of Cardiac Magnetic Resonance in Valvular Heart Disease

PAGE 177 Dr. Phil’s Art Corner: Skyward

PAGE 149

Role of Cardiac MRI in the Assessment of Nonischemic Cardiomyopathies

PAGE 179 Superior Vena Cava Syndrome Associated

PAGE 156 Cardiac Magnetic Resonance in Adults with

Congenital Heart Disease

PAGE 163 Cardiac MR for the Assessment of

Myocardial Viability

PAGE 169

Redefining Myocardial Infarction: What is New in the ESC/ACCF/AHA/WHF Third Universal Definition of Myocardial Infarction?

PAGE 178

Poet’s Pen: Smart Probe with Metastatic Adenocarcinoma to the Heart: The Diagnostic Utility of Cardiac Resonance Imaging

PAGE 181 The Texas Medical Center: Building Blocks

for the Future

PAGE 183 In Memoriam: Homer Liston Beazley, M.D. PAGE 184 Essay: Conducting in Chaos

DeBakey Heart & Vascular Center

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Leading the Practice of Medicine The heart center collaborates with the Houston Methodist Institute for Technology, Innovation & Education (MITIEsm) for the majority of its hands-on training programs.

MITIE offers multidisciplinary, hands-on learning opportunities using advanced imaging systems and robotics. Surgeons and other health professionals are able to continually refine and acquire new skills that allow them to perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools, our research programs are focused on the development and assessment of emerging technologies and technical skills to improve the care of patients through less-invasive therapies. At MITIE, the finest researchers and clinicians are building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.

newest technologies available. The new training suite will help to educate teams from around the world on cutting edge procedures and techniques for years to come.

patient satisfaction

Houston Methodist Hospital is one of the few institutions that operates such a unique enterprise. Working in conjunction with Siemens, a world leader in providing health care products for imageguided procedures, the new hybrid suite in MITIE has opened up numerous training and research possibilities that could only have been imagined a few years ago.

82%

With the recent installation of its new hybrid imaging suite, MITIE now offers a training environment that mimics our clinical hybrid suite at Houston Methodist. This new suite in MITIE is used strictly for research, education, and training purposes to help improve techniques and train others on hybrid procedures. Hybrid surgical suites that can accommodate open cardiovascular surgery, endovascular procedures, and combinations of both are quickly becoming the standard of care across the nation. However, few medical centers have a state-of-the-art hybrid suite with the

houston mitie At A Glance More than

6,300

learners in 2013

26 23

Surgical specialties from across the world

DeBakey Heart & Vascular Center

40,000

More than

learners since inception

ranks as 84th percentile

71% 73% State Wide Average

National Average

*In a recent federal survey, 82% of Houston Methodist patients reported they would recommend the hospital to others. This compares to the statewide average of 71% and the national average of 73%.

heart center at a glance

32 20,000 1,153

square feet of education and research space

Houston Methodist Patients

courses in 2013

learners in 2013

See all the ways we’re leading medicine at hmleadingmedicine.com

HOUSTON METHODIST hospital Leading Medicine yesterday, today and tomorrow At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City.

Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list.

For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list.

Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.

FAST FACTS 73 Operating Rooms

1,119

Licensed Beds (824 operating beds)

1,862

Affiliated Physicians

6,101 Employees

8,150

International Patient Encounters (from 90 foreign countries)

36,310 Inpatients in 2013

61,043

Emergency Room Visits in 2013

301,478

Outpatient Visits in 2013

FORTUNE is a registered trademark of Time Inc. and is used under license.

From FORTUNE Magazine, February 3, 2014 ©2014 Time Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of, Licensee.

Heart Center Leadership & Team Members Cardiologists Guha Ashrith, MD Mohammed Attar, MD Christie M. Ballantyne, MD Nabil S. Baradhi, MD Colin M. Barker, MD Arvind Bhimaraj, MD Douglas R. Bree, MD John Martin Buergler, MD Sarma S. Challa, MD Su Min Chang, MD Clement A. DeFelice, MD Amish S. Dave, MD Timothy K. Doyle, MD Stanley M. Duchman, MD Jerry D. Estep, MD Mark John Hausknecht, MD Thomas E. Hong, MD Robert G. Hust, MD John C. Isaac, MD Matteethra C. Jacob, MD Sonia Jacob, MD Masroor Khan, MD Amin H. Karim, MD Neal S. Kleiman, MD Sanjay Kunapuli, MD Karla M. Kurrelmeyer, MD George C. Li, MD C. Huie Lin, MD Kevin A. Lisman, MD Stephen H. Little, MD John J. Mahmarian, MD Faisal Nabi, MD Sherif F. Nagueh, MD Vijay Nambi, MD Nadim Nasir Jr., MD Craig M. Pratt, MD Miguel A. Quiñones, MD Albert E. Raizner, MD Michael E. Raizner, MD

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DeBakey Heart & Vascular Center

Tapan G. Rami, MD Manuel Reyes, MD Howard S. Rubin, MD David Samuels, MD Monica G. Sanchez-Ross, MD George Schroth, MD Alpesh R. Shah, MD Dipan Shah, MD Gopi A. Shah, MD Hue-The Shih, MD Stuart L. Solomon, MD Cyril B. Tawa, MD Barry H. Trachtenberg, MD Guillermo Torre-Amione, MD Valentina Ugolini, MD Miguel Valderrábano, MD Brian Walton, MD Htut K. Win, MD William L. Winters, MD David Yao, MD Nadim M. Zacca, MD William A. Zoghbi, MD

Intensivists John Fetter, MD Faisal Masud, MD Iqbal Ratnani, MD Kamlesh B. Thaker, MD Divina Tuazon, MD Faisal Uddin, MD Saleem A. Zaidi, MD Asma Zainab, MD

Cardiovascular Surgeons Ulises Baltazar, MD Jean Bismuth, MD Brian Bruckner, MD Mark Davies, MD Hosam El-Sayed, MD

Richard C. Geis, MD Jimmy Frank Howell, MD Javier Lafuente, MD Gerald M. Lawrie, MD Richard W. Lee, MD Matthias Loebe, MD Alan B. Lumsden, MD Charles H. McCollum, MD Imran Mohiuddin, MD George P. Noon, MD Jacobo Nurko, MD Walter O’Hara, MD Eric Peden, MD Mahesh K. Ramchandani, MD Basel Ramlawi, MD Michael J. Reardon, MD Dewei Ren, MD Wade R. Rosenberg, MD Scott Scheinin, MD Erik Suarez, MD Michael Sweeney, MD Uttam Tripathy, MD Hartwell H. Whisennand, MD

CV Anesthesiologists Mohamad Abdalla, MD, ADD Nidal M. Abdel-Rahman, MD Nicolas Athanassiou, MD Jessica Brown, MD Ghazala Butt, MD Jane Carter, MD James Carter, MD Diane Gibson, MD Elizabeth Herrera, MD Saras Karri, MD, ADD Gary Monteiro, MD, ADD Joseph Naples, MD Hany Samir, MD Karanbir Singh, MD Luis Velez-Pestana, MD Zbigniew Wojciechowski, MD

Investigators in Basic or Clinical Research Arvind Bhimaraj, MD Jean Bismuth, MD Brian Bruckner, MD Gerd Brunner, PhD Su Min Chang, MD John P. Cooke, MD, PhD Amish Dave, MD Mark Davies, MD Michael A. Donovan Hosam El Sayed, MD Mark Entman, MD Jerry Estep, MD Nikolaos Frangogiannis, MD Zsolt Garami, MD Yohannes Ghebremariam, MD Dale Hamilton, MD Craig Hartley, PhD Sandra Haudek, PhD Ron Hoogeveen, PhD Stephen R. Igo Peter Jones, MD Dirar Khoury, PhD Neal Kleiman, MD Karla Kurrelmeyer, MD Chun H. Lin, MD Stephen Little, MD Matthias Loebe, MD Alan Lumsden, MD John Mahmarian, MD Faisal Masud, MD Lloyd H. Michael, PhD Joel Morrisett, PhD Sherif Nagueh, MD Ryan Neal, MD Eric Peden, MD Henry Pownall, MD Miguel Quinones, MD Albert Raizner, MD

Mahesh Ramchandani, MD Tapan Rami, MD Basel Ramlawi, MD Michael Reardon, MD Anilkumar K. Reddy, PhD Nazish Sayed, PhD Daryl Schulz, MD Alpesh Shah, MD Dipan Shah, MD Stuart Solomon, MD George Taffet, MD Guillermo Torre-Amione, MD, PhD Barry Trachtenberg, MD JoAnn Trial, PhD Miguel Valderrabano, MD Wing Tak Jack Wong, PhD

ADMINISTRATION David P. Bernard Vice President Michael A. Donovan Director of Education Sarah Homer Director of Clinical Operations Pauline Todd Director of Research Tammy Plumb Administrator, Cardiology/ Cardiovascular Services Rick Talbot Administrator, Anesthesia/ CVICU Services Sofia Perches Business Development Specialist Gabriela Moreno Business Development Specialist

The heart center physician leadership team, from left to right: Dr. Miguel A. Qui単ones, Dr. Joseph Naples and Dr. Alan B. Lumsden

Houston Methodist Hospital 6565 Fannin Street Houston Texas 77030

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW. At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.

houstonmethodist.org/debakeyheart