Methodist Heart and Lung Institute 2021 Annual Report

Annual Report 2021

Contents

03

INTRODUCTION

• A Message from J Fernando Triana, MD ▸ 03 • Methodist Heart and Lung Institute Overview ▸ 04

• Who We Are ▸ 06 • Methodist Heart Network ▸ 08

10 12

36

PROGRAMS AND SERVICES

36

Cardiohospitalists

40

Cardiointensivists

44

Cardiac Anesthesia

46

Heart Failure

• Mechanical Circulatory Support ▸ 52

GENERAL CARDIOLOGY

NONINVASIVE CARDIOLOGY

• Heart Transplant ▸ 54

56

• Noninvasive Diagnostic Cardiology ▸ 12

Surgical Services

• Cardiovascular and Cardiothoracic Surgery ▸ 56 • Valvular Surgery ▸ 60

• Noninvasive Advanced Cardiac Imaging ▸ 16

• Aortic Surgery ▸ 62

20

66

Vascular Medicine

24

68

Cardiopulmonary Rehabilitation Services

72

Pulmonary and Critical Care

DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY

ELECTROPHYSIOLOGY

28 32

STRUCTURAL HEART DISEASE

ADULT CONGENITAL HEART DISEASE

2

• Clinical Heart Failure ▸ 48

• Extracorporeal Membrane Oxygenation (ECMO) ▸ 74 • Pulmonary Embolism Response Team (PERT) ▸ 80 • Interventional Pulmonology ▸ 84

90

CONCLUSION

A Message from J Fernando Triana, MD Physician Director Cardiac, Vascular, Pulmonary and Thoracic Service Lines It is my privilege to introduce the Heart and Lung Institute at Methodist Hospital of San Antonio. This annual report outlines the structure of our multiple specialized programs and highlights the complexity of the cardiovascular and pulmonary care we provide to the community that we serve. The mission of Methodist Healthcare is Serving Humanity to Honor God; our highest priority centers around not only caring for our patients with the utmost excellence but also expanding the range of our services that will allow us to best fulfill this mission.

Beginning with a brief historical perspective of our institution, we outline the multiple access points from which our patients enter into our system. Each of our clinical programs shares a narrative about the respective clinical field and offers a concise performance summary, represented by volume of encounters and procedures followed by indicators of quality outcomes.

The comprehensive group of individuals who constitute the human capital of the Methodist Heart and Lung Institute is the greatest strength of our institution.

Dan Miller, Chief Executive Officer of Methodist Hospital and Methodist Children’s Hospital, leads the planning and strategic approach to address our objectives. The continuous efforts from his team ultimately provide the platform for physicians, nurses, and technologists to deliver the most efficient clinical care.

Finally, the many facets of the COVID-19 pandemic were a constant presence in the background of every healthcare initiative in 2021. The high level of clinical care and program differentiation within the Methodist Heart and Lung Institute provided a unique position to help the most gravely affected patients: more than 5,000 patients affected by COVID 19 infection, several hundred ICU level care and requiring ventilatory support, nearly 100 patients undergoing ECMO support. Each one of our team members performed at heightened levels. We reached a stage of multidisciplinary work and mutual support that gave us strength during the arduous journey. The past two years have brought exceptional demands that we met with exceptional efforts. This unique and challenging time has enriched our souls and prepared us for the future.

On behalf of all the individuals of the Methodist Heart and Lung Institute, I present our annual report as I renew our pledge of continued devotion of our best efforts towards our mission.

3

Methodist Heart and Lung Institute Methodist Heart and Lung Institute, the center of cardiovascular and pulmonary care for Methodist Hospital, is proud to serve one of the largest areas in the continental United States. The institute serves San Antonio, South Texas, and neighboring counties, a 40,000-square-mile area that is larger than several states in the country. As the only quaternary-level hospital in the region, the institute is committed to being the epicenter of cardiovascular care for this large area and its 3+ million residents.

For the last two decades, Methodist Heart and Lung Institute has been on a steady trajectory toward two goals: first, to expand its services to cover every aspect of cardiovascular care, and second, to provide the highest level of quality. The institute has taken a programmatic approach to developing its services, focusing not only on the hospital-based services we provide but on making sure residents have multiple access points available and can move seamlessly between levels of care as needed. Next, the institute identified and developed services that, because of its size and clinical depth, Methodist Hospital is especially suited to delivering.

Today, the institute provides excellence at all levels.

From renowned multidisciplinary programs like heart 4

transplant and high-risk cardiac surgery, to strong clinical screening and diagnostic capabilities, to a broad network of access points, Methodist Heart and Lung Institute synchronizes clinical identification of patients and provision of care all along the continuum for a consistent, high-quality approach. This annual report highlights many of the institute’s highperforming programs.

Looking ahead, the institute will continue to achieve greater clinical differentiation, so it can serve this large population even more effectively. To that end, the institute constantly reviews the depth and extent of its clinical services, maintaining focus on the fundamentals while also pursuing leading-edge cardiovascular techniques and technologies.

Accolades • One of Healthgrades America's 100 Best Hospitals for Coronary Intervention™ in 2022 • One of Healthgrades America's 100 Best Hospitals for Critical Care™ in 2022 • Recipient of the Healthgrades Coronary Intervention Excellence Award™ for two years in a row (2021, 2022) • Named among the top 5 percent in the nation for cardiology services in 2022 • Named among the top 5 percent in the nation for coronary interventional procedures in 2022 • Named among the top 10 percent in the nation for coronary interventional procedures for two years in a row (2021, 2022) • Five-star recipient for coronary interventional procedures for two years in a row (2021, 2022) • Five-star recipient for treatment of heart attack in 2022 • Five-star recipient for treatment of heart failure in 2022 • Five-star recipient for defibrillator procedures in 2022 • Five-star recipient for pacemaker procedures in 2022

5

Who We Are Since 1963, Methodist Healthcare has continuously evolved to meet the growing needs of the greater San Antonio Community. Our commitment has never wavered in consistently improving the health and wellness of our community by “Serving Humanity to Honor God.”

RESEARCH & INNOVATION

ECONOMIC DEVELOPMENT

12,500

The Pediatric Blood & Marrow Stem Cell Transplant Program at Methodist Children’s Hospital is one of the

EMPLOYEES

as San Antonio’s second largest private employer

busiest programs in the nation.

The Live Donor Kidney Transplant (LDKT) Program of Methodist Hospital | Specialty and Transplant is a global leader in LDKT and has performed more procedures in the U.S. since 2009 than any other LDKT program. These efforts have successfully matched donors—many who remain anonymous—with approximately 2,000 patients suffering from End Stage Renal Failure to deliver the gift of life.

Methodist Healthcare is a national leader in robotic surgery, offering one of the most comprehensive programs in the country. 25 surgical robots, 175 surgeons, 6 locations and 4 national surgeon training programs - We continuously collaborate on emerging technologies and techniques to deliver enhanced surgical experiences that reduce hospital stays and shorten recovery time.

8

facilities

1,957 beds

with

and

3,475

physicians

serving 27 counties

$20,592,291 in property taxes

$12,714,862 in sales taxes

Hospitals:

Methodist Hospital Methodist Children’s Hospital Methodist Hospital | Specialty and Transplant Methodist Hospital | Northeast

$689,588,418 in total payroll

Methodist Hospital | Stone Oak Methodist Hospital | Metropolitan Methodist Hospital | Texsan Methodist Hospital South

FAST FACTS COMMUNITY INVESTMENT

1.5 Billion $756 Million

$

invested in capital expenditures over the past

in charity and indigent care in 2020

10 years

687,366

inpatients and outpatients served per year

346,435

ER visits per year

11,200+

births per year

METHODIST HEALTHCARE MINISTRIES IMPACT since its inception to improve wellness $1.2 donated of the least served through direct services, Billion grants, and community partnerships

225+

funded program sites

6

116

grant programs with more than

90 partners

$114.3 Million

planned for community health in 2021

Serving clinics supporting

400,000+ patients and clients

74

counties

Largest private funding source for uninsured and underinsured patients in South Texas.

Methodist Healthcare is a 50-50 co-ownership between Methodist Healthcare Ministries of South Texas, Inc. (South Texas’ largest nonpublic funding source of community healthcare for uninsured patients) and HCA Healthcare, the nation’s leading provider of healthcare services. This structure creates a unique partnership that ensures Methodist Healthcare Ministries continues to benefit the community by providing quality care to all and charitable care to those who need it.

The Ministries is a faith-based, nonprofit organization dedicated to creating access to healthcare for uninsured and low-income families through direct services, community partnerships, and strategic grantmaking in 74 counties across South Texas. Because of collaborative partnerships like this, Methodist Healthcare is able to bring medical, dental, and other health-related services to low-income families across South Texas. Methodist Healthcare Ministries reinvests 100 percent of its net revenue back into the communities it serves, making a significant positive social impact across the region.

Methodist Hospital is the flagship facility in San Antonio’s renowned South Texas Medical Center. Opened in 1963, the hospital has grown to be Methodist Healthcare System’s most comprehensive medical care facility, recognized as the largest and most preferred healthcare provider specializing in cardiovascular services, robotics, oncology, emergency medicine, orthopedics and women’s health. Beyond being known for creating exceptional patient experiences, Methodist Hospital maintains an award-winning reputation and has received several prestigious accreditations for clinical excellence, including best regional hospital for three consecutive years named by U.S. News and World Report.

Jane Appleby, md

Chief Medical Officer

Felicia De La Garza

Vice President of Cardiovascular Services

Lori Townsend

Chief Nursing Officer

Carlos Ochoa

Division Vice Presdient of Cardiovascular Services

Rachel Goldsmith

Chief Operating Officer

John Armour

Chief Financial Officer

Celeste Bryson

Vice President of Nursing, Critical Care

Negar Johnson

Chief Nursing Officer Methodist Children’s Hospital and Women’s Services

“I am humbled every day to see the difference that the Methodist Heart and Lung Institute makes in serving our community. For the last 20 years, we have established a legacy of advancing research, educating our community, and delivering world class patient care. 2021 in particularly stands out for the accomplishments our physician leaders were able to support in advancing care for our community.”

- Dan Miller Chief Executive Officer

7

Methodist Heart Network For more than 55 years, Methodist Healthcare has delivered innovative and comprehensive heart, lung, and vascular care to patients of all ages. As the largest provider of cardiovascular services in South Texas, the healthcare system maintains an award-winning reputation and has received several prestigious accreditations for clinical excellence.

Methodist Heart is defined by our specialists’ collaborative approach to care and the access points we have built for our community. Our team has built a reputation for providing high quality and innovative cardiovascular care across an array of comprehensive services, from prevention, testing, and diagnosis to invasive treatment and complex surgery. Our numerous locations provide access to these services throughout South Texas.

METHODIST HEART LOCATIONS • Methodist Heart and Lung Institute at Methodist Hospital

SPECIALIZED CARE AT THE METHODIST HEART AND LUNG INSTITUTE COMPREHENSIVE PROGRAMS AND CENTERS • Aortic Center • Arrhythmia Center • Heart Failure Program • Structural Heart Program • Advanced Lung Center • Adult Congenital Heart Program • ECMO Program • Vascular Program • Lung Nodule Program Shock Team • Heart Transplant and Mechanical Support • Cardiopulmonary Rehab ADVANCED TECHNOLOGY AND RESEARCH PROGRAMS • Watchman

• Methodist Hospital | Metropolitan

• TAVR

• Methodist Hospital | Northeast

• ECMO

• Methodist Hospital | South

• VAD

• Methodist Hospital | Specialty and Transplant

• CTO

• Methodist Hospital | Stone Oak

• VAD

• Methodist Hospital | Texsan

• Robotics (Lung)

METHODIS

2020

200, CV O

90

17

Providers

Locations

20

322,849

Cardiac Subspecialties

8

Cardiac Procedures

2015-2019 (Medical, Procedural, Surgical)

Specialized Care at the Methodist Heart and Lung Institute •

Aortic Center

•

Cardio-Oncology Program

74,3 Total

20,5

Echoc

13,50

Stres Perfu

2020 AT A GLANCE

200,000

12,000

120

CV Office Visits

Cardiac Catheterizations

Providers

74,300

3,000

34

Total CV Patients

Coronary Interventions

Heart Transplants (2021)

20,500

1,200

26

Echocardiograms

Heart Surgeries

LVAD Placements

13,500

200

1 PURPOSE

Stress Tests Myocardial Perfusion

ECMO Cases

Methodist Heart

Cardiac, Vascular, Pulmonary & Thoracic Service Line Governance

CVPT SL Executive Committee CV Quality

SL Research

CV Integration

Physician Practice Work Group

CV Disease Work Group

Surgery Work Group CV, CT, AO

Cath PCI Work Group

Thoracic Pulmonary Work Group

Electro Physiology Work Group

Vascular Work Group

9

CARD Cardiology

Comprehensive cardiology, including diagnostic evaluation and treatment, is the foundation of Methodist Heart and Lung Institute’s broadbased structure of cardiovascular clinical excellence. Through our network of cardiologist and cardiovascular disease specialists, we provide services to the large San Antonio area, the large counties surrounding the city, and we outreach to the South Texas Communities that encompass more than 30 counties.

To access the people and the communities that we serve, we have entry points for ambulatory services that are focused on the noninvasive evaluation, the treatment or chronic conditions, and the long term follow up of patients. These ambulatory facilities are located within the city of San Antonio at multiple sites and also in nearby communities, including Boerne, Kerrville, Helotes, New Braunfels, and expanding to more distant areas such as Uvalde.

Through our ambulatory centers we are able to provide more than 120,000 meaningful contacts per year and within that number, 17,000 represent new contacts annually. The footprint of our cardiologists encompasses even a larger area that expands to Del Rio, Laredo, and West Texas.

CLINICAL CARDIOLOGY VOLUME 72,950

75,961

9,203-

9,494-

63,747-

66,467-

2019

30,997-

2020

New Patients 10

82,016

8,477-

2021 Follow Ups

Richard A. Baum, md Quality Chair Cardiovascular Division, Methodist Hospital A comprehensive cardiologist is the quarterback of the team, evaluating and ordering appropriate testing and diagnosing the patient. The cardiologist then advises the patient and makes sure the patient gets the appropriate care at the right time. The cardiovascular care provided by our team is patient-centric.

We’re known for our guideline-directed therapeutic approach. We pursue the right procedure for the right patient at the right time. When interventions are needed, we offer patients streamlined access to Methodist Heart and Lung Institute’s world-class cardiovascular services.

Looking ahead, we aim to continue growing, while engaging in community outreach to touch even more lives across South Texas.

The advances in the field of cardiovascular disease during the last four decades have surpassed many of the treatments and procedures that we saw in the previous half century. The obvious challenge with this rate of progression is the ability to maintain coordination and the appropriate level of communication between the different aspects that ultimately lead to the patient’s optimal treatment. One of the advantages of the Methodist Heart and Lung institute is the ability to integrate the efforts from many physicians in a relatively contained environment to ultimately provide the highest level of care.

CARD 11

NIDC

Noninvasive Diagnostic Cardiology

Methodist Heart and Vascular Institute’s noninvasive diagnostic cardiology team provides support for inpatient and outpatient noninvasive imaging, including vascular imaging, echocardiography, nuclear medicine, and positron emission tomography (PET).

12

13

NIDC

Noninvasive Diagnostic Cardiology The program is equipped with the latest hardware and technology available on the market, giving providers the best -available image quality while keeping patient experience and comfort top of mind. The team’s expertise spans a broad range of cardiovascular pathology, conducing assessments across the spectrum of the institute’s programs, from valvular heart disease to structural heart disease, cardio-oncology, extracorporeal membrane oxygenation (ECMO), and transplant. In 2020, the program incorporated vascular imaging as well, bringing additional specialized capabilities under a single umbrella.

In 2019, an amyloid imaging program was launched within nuclear medicine. Amyloid heart disease has historically been very difficult to diagnose and treat – there was no good therapy, and physicians had

to make the diagnosis with an invasive myocardial biopsy. Now, the institute’s nuclear medicine experts can make the diagnosis noninvasively using technetium pyrophosphate scintigraphy (PYP) scanning. Methodist Heart and Lung Institute is the only organization in San Antonio with PYP scanning capabilities.

In early 2022, the institute will unveil the latest PET capabilities, enabling unique perfusion imaging to examine myocardial blood flow and conduct other metabolic studies. These studies – which can only be done in a PET lab – represent a significant step forward in the institute’s noninvasive diagnostic capabilities. This means that the institute’s team will be able to diagnose coronary artery disease without an invasive cardiac catherization.

Randal White, md Nuclear Cardiology Providing the widest range of noninvasive diagnostic cardiology capabilities gives our patients easier, safer options for cardiovascular disease diagnosis. During COVID-19 in particular, our pharmacological profusion studies enabled us to continue providing diagnostic stress tests without increasing the risk of infection for patients or providers.

14

Rene Quiroz, md Medical Director, Noninvasive Diagnostic Cardiology Lab, Methodist Hospital and Methodist Healthcare The noninvasive lab offers unparalleled clinical breadth, supported by the latest technology.

We work hand in hand with all of the specialty programs at Methodist Heart and Lung Institute.

We are one of the busiest labs in HCA, completing more than 30,000 echocardiograms a year.

The imaging we provide forms the backbone of many of our specialty cardiovascular programs and services. Because the institute incorporates such broad and deep cardiovascular clinical complexity, our team has developed a correspondingly large area of specialization. Our volume, expertise, and equipment set us head and shoulders above other hospitals’ capabilities.

NON-INVASIVE DIAGNOSTIC PROCEDURES 44,090

42,373

5,981-

6,510-

9,218-

8,191-

28,891-

27,672-

2019 Vascular

46,220 6,7468,477-

30,997-

2020

2021

Nuclear

Echo

NIDC 15

NACI

Noninvasive Advanced Cardiac Imaging

When Methodist Heart and Lung Institute’s advanced cardiac imaging computed tomography (CT) and magnetic resonance imaging (MRI) program began in 2002, it was the first cardiac CT and MRI program in the region. Since its founding, the program has grown dramatically in the scope of services it provides. Today, the institute is the advanced cardiac imaging market leader in San Antonio and across most of South Texas.

16

17

NACI

Noninvasive Advanced Cardiac Imaging The institute’s state-of-the-art technological capabilities offer the most advanced images possible, enabling the department to support the complex imaging needs of programs like advanced heart failure, complex congenital heart disease, and cardiac transplant. The department’s current technology provides image capture as rapidly as 78 milliseconds, almost freezing cardiac motion. The high-speed CT systems can capture images of the entire heart, creating the appearance of a heart frozen in time or enabling movie-style images of a beating heart. The current generation of CT machines have dramatically lowered radiation doses as well.

The hospital’s five cardiac MRIs have dedicated cardiac imaging coils, offering high-end images using technology that is not available anywhere else in San Antonio. These MRI systems provide detailed imaging of the heart muscle to characterize the tissue for

CARDIAC CT VOLUME 5,247 4,232 2,824

2018

18

3,274

2019

2020

2021

infiltrative diseases such as amyloid, sarcoid, and tumors. They can even identify heart attacks as small as 5 grams.

The results of the institute’s advanced cardiac imaging services include precision diagnoses, risk stratification, and preprocedural imaging support.

In most cases, the CT scans can rule out coronary artery disease in seconds, so a patient can avoid an invasive procedure. For structural heart disease or electrophysiology, the program’s imaging can offer a detailed roadmap of the heart, cutting procedure time down significantly. The mission of the noninvasive advanced cardiac CT/MRI imaging program is to create detailed imaging and diagnoses that support cardiologists, interventional cardiologists, and cardiovascular surgeons in their life-saving work.

Michael J. Lane, md facr Chief of Radiology, Methodist Hospital and Methodist Children’s Hospital Medical Director, Advanced Cardiac Imaging, Methodist Hospital Chair-Elect, Methodist Healthcare Over the course of the program’s 20-year history, we’ve always been blessed with a great partnership between Methodist Healthcare and the department of radiology, enabling us to provide the most advanced, leading-edge equipment available to our patients. CT and MRI technology have changed dramatically and improved over time, much like all things in technology.

Therefore, Methodist Healthcare and radiology have made this a priority for our patients. Having the best possible imaging technology is critically important for cardiac imaging, because the heart is the most difficult part of the body to capture on a CT or MRI scan. The scanning technology must localize, scan, and reconstruct faster than the beating and rotating heart that moves with each breath.

Looking ahead, the advanced cardiac imaging program is rolling out coronary artery CT fractional flow reserve, a tool that uses artificial intelligence to help diagnose blockages in the coronary arteries before the individual has a heart attack. Another goal is to create a quality collaborative to train our CT technologists across Methodist Healthcare to use this elite CT technology, bringing the world-class quality available at Methodist Heart and Lung Institute to the entire Methodist Healthcare family. We strive to provide nothing less than the best complex imaging for our community and our patients.

NACI 19

DIC

Diagnostic and Interventional Cardiology

Most interventional cardiology programs offer diagnostic cardiac catheterizations and percutaneous coronary intervention (PCI).

Methodist Heart and Lung Institute’s interventional cardiology capabilities go beyond those of other San Antonio hospitals with particular expertise in complex PCI, including catheter-based interventions for chronic total occlusion (CTO) as well as cardiogenic shock management.

20

21

DIC

Diagnostic and Interventional Cardiology As the resuscitation center for the City of San Antonio, the institute sees a high volume of high-risk patients.

And whereas other centers may only offer open surgical procedures to treat CTO, the team at Methodist Heart and Lung Institute cares for these patients in the cardiac catheterization lab. The interventional cardiology suite is also the site of mechanical circulatory support (MCS) device implantation and management, including Impella and intra-aortic balloon pump (IABP).

To successfully treat so many high-risk patients, the institute employs a multidisciplinary “heart team” approach. To determine the best path forward for a specific patient, physicians from general cardiology, cardiac surgery, interventional cardiology, pulmonary and critical care, anesthesiology, and other subspecialties as needed come together to discuss the patient’s case, outline the risks and benefits of each treatment option, and reach a consensus on what is best for patient.

The heart team approach is robust and is applied across the institute’s specialty programs. That means that patients get the benefit of not just one doctor, but a dozen or more doctors, all bringing their particular expertise to the patient’s case and determining the right treatment option as a group.

CATH LAB PROCEDURES 4,574

1,469-

2,372-

1,758-

1,770-

2,787-

2,677-

2018

2019

4,635

4,497

3,871

1,659-

2,834-

2020

Diagnostic

2021 PCI

1 - PCI in-hospital risk adjusted mortality (all patients)

2.03

2.69

My R4Q Performance | 1

| 1.5

| 2

| 2.5

| 3

| 3.5

10th

25th

50th

75th

90th

4

3.03

2.34

1.71

1.32

US Hospital R4Q Performance Distribution for 2021-Q2

22

| 4

1.57 2019-Q3

1.88

2020-Q1

2.31

1.87

1.42 2019-Q4

2.59

1.37 2020-Q2

2020-Q3

Performance Trend

2020-Q4

2021-Q1

2021-Q2

Nandish Thukral, md Medical Director, Cardiac Catheterization Lab, Methodist Hospital Director, Complex PCI Program, Methodist Hospital At Methodist Heart and Lung Institute, we treat the sickest of the sick in the cath lab. Our highvolume, high-risk program draws patients from all over San Antonio as a shock resuscitation center and the number-one referral center for elective PCI patients who are too complex to be handled in other facilities.

Interventional cardiology sits at the nexus of many of our specialty cardiovascular programs at Methodist Heart and Lung Institute. Not only is the cath lab the site of many diagnoses, but it is often the site of treatment, from PCI to ECMO cannulation.

We were one of the centers for the national cardiogenic shock trial, and we’re now enrolling patients in the PROTECT IV trial, investigating the use of Impella in patients who are turned down for surgery and are undergoing high-risk PCI in the cath lab. These large, national trials speak volumes about our program’s quality, reputation, and outcomes.

DIC

23

EP

Electrophysiology

Arrhythmias affect an estimated five percent of the U.S. population and can range from innocuous to life-threatening. Methodist Heart and Lung Institute’s electrophysiology (EP) program has been providing specialized diagnostic and interventional electrophysiology procedures to patients in San Antonio for 25 years.

24

25

EP

Electrophysiology EP encompasses all heart rhythm disorders, and while some of these disorders can be managed by clinical cardiologists, more complex arrhythmias usually require EP participation in the patient’s care. The institute’s team of EP specialists perform diagnostic EP studies, radiofrequency (RF) ablation and cryoballoon ablation; pulmonary vein isolation; and device implantation for cardiac rhythm management, including pacemakers, implantable cardioverterdefibrillators, and cardiac resynchronization therapy to treat heart failure. The program’s experts also handle complex lead revision procedures with laser lead extraction, which they have been doing longer than anywhere else in South Texas.

The program stays on the leading edge with the most advanced mapping and ablation systems available to take care of the most complex arrhythmias including left atrial flutter and ventricular tachcyardia. As part of the CONVERGE trial, the institute offers convergent atrial fibrillation (AFib) ablation, a hybrid procedure to treat longstanding, persistent AFib. The program also has access to the newest implantable devices, such as leadless pacemakers, subcutaneous defibrillators, and implantable loop recorders. The program has continued to expand and now includes advanced AFib treatments, including Vein of Marshall ablation with ethanol infusion.

The WATCHMAN Flex™ device, for left atrial appendage occlusion, can be implanted to prevent stroke in patients who can’t tolerate anticoagulation therapies.

ELECTROPHYSIOLOGY PROCEDURES 1,887 1,638

1,457 490-

967-

2018

586-

531-

1,052-

1,052-

2019 EP Ablations

26

1,583

2020

742-

1,145-

2021 EP Procedures

David Pederson, md Director, Electrophysiology, Methodist Hospital Our full-service EP program offers the complete spectrum of specialized care for heart rhythm disorders of all kinds. We have pioneered EP techniques and technologies and have a string of “firsts” to our name: the first RF ablation procedure at Methodist Healthcare, the first leadless pacemaker implantation in San Antonio and the first lead extraction procedure in South Texas were all performed at Methodist Heart and Lung Institute.

Because of our high volume, we also have early access to new devices and technology. For example, because of our involvement in the WATCHMAN OPTION trial, and because of our reputation for safety and quality, we were one of the first three hospitals in the country to start implanting the WATCHMAN Flex device.

We’re continuing to expand our EP research program at the institute. For example, we’re poised to engage in clinical trials to study pulse-field ablation, which we expect to become the next leap forward in EP. Rather than destroying tissue with heat or cold, pulse-field ablation can pulse a specific frequency of energy to target only the heart’s endothelial cells – where the electrical problem is – leaving the rest of the tissue intact. We look forward to conducting pioneering research using this technology.

We are highly regarded in the region when it comes to level of complexity and breadth of service. We’re one of the country’s highest volume ablation centers, which makes a difference when it comes to patient safety and successful outcomes. We have nine dedicated EP specialists at the institute who focus exclusively on the field of EP, including the latest techniques and technologies – and our track record of great patient outcomes is the result of that specialization.

EP

27

SHD Structural Heart Disease

The Methodist Heart and Lung Institute’s structural heart program has been serving the needs of patients in San Antonio and South Texas since 2011.

Within six months of its debut, it became the highest volume structural heart program in San Antonio, and it has continued to grow ever since. The program began by specializing in transcatheter aortic valve replacement (TAVR). Today, the institute’s expert team offers the full range of open and minimally invasive procedures to repair or replace leaky or diseased aortic valves, mitral valves, and tricuspid valves as well as structural heart problems caused by adult congenital heart disease (ACHD), heart failure, and other conditions.

28

Bugle playing World War II veteran, Lyle Bird, was deemed too high risk for surgery but a very reasonable candidate for TAVR. “I’m feeling great. I got a new heart valve.

I’ll be back in the band soon. Life is Good.”

- Lyle Bird TAVR Patient

SCAN QR CODE TO WATCH VIDEO.

29

SHD Structural Heart Disease In 2021, the structural heart program will complete almost 500 TAVR procedures, putting Methodist Heart and Lung Institute among the top five percent nationwide in terms of volume. The institute is the designated TAVR facility for all of Methodist Healthcare.

The program has also expanded into the diseases effecting the mitral valve and the tricuspid valve, becoming one of the top centers for mitral clip and tricuspid clip procedures in the country over the last two years. Because of structural heart program’s size, physicians at the institute have been able to super-specialize in one type of valve or one type of procedure – giving patients access to the most highly specialized expertise available anywhere.

The structural heart program collaborates with other advanced programs across the institute, from EP and heart failure to aortic disease, ACHD,

and others. The team has many percutaneous and endovascular tools and devices at its disposal, which allows the institute’s physicians to solve problems in new ways. For example, the structural heart team recently used devices to successfully close off a pseudoaneurysm, which would not have been treatable using other minimally invasive techniques.

The program continues to pursue the development of new technologies to treat structural heart disease and related conditions.

The institute has become the referral hub for complicated structural heart procedures of all kinds, not only from Texas but from other states as well.

Its outreach extends from El Paso, to San Angelo, to Corpus Christi. Looking ahead, the program is committed to developing stronger ties with outlying communities and focusing in on healthcare disparities, making sure that all patients have access to the institute’s lifesaving care.

Daniel Donovan, md Co-Director Structural Heart Program

30

“Just as the past ten years have been exciting and challenging, the future of our structural heart interventions appears unlimited. Technology is proceeding rapidly. Our structural heart research program is very active and growing. With our team approach and remarkable support from Methodist Hospital, I am certain we will remain one of the premier structural heart programs in South Texas providing state-of-the art-care to our patients.”

Jorge Alvarez, md Director, Structural Heart Program, Methodist Hospital At Methodist Heart and Lung Institute, we offer a high-volume, high-quality, efficient center with easy access, all of which has made us a very favorable choice both for patients and for industry partners looking to find a launching site for new technologies.

The structural heart program functions as a concierge service for valvular disease and coronary disease. We have the full menu of therapies available, and we may take a hybrid approach that incorporates different procedures to achieve the best overall result.

We have a range of valve options as well, enabling us to choose the best valve for the patient, rather than fitting the patient to the valve. Overall, we tailor the treatment plan to the individual’s needs in many ways, creating a solution that is easier for the patient, while maintaining excellent outcomes.

TAVR VOLUME

52-

242

40287-

190-

2018

406

327

62-

48-

344-

353-

2019

2020

TAVRS

401

Structural heart disease is advancing rapidly, and over the last decade, our program has been involved with research studies in order to keep a close eye on the future direction of these therapeutic options. We’re continuing to grow and expand the program as well, to maintain the highest level of quality and outcomes. We plan to further expand our program’s growth and research innovation in the future, while continuing to expedite patient care in an efficient manner.

2021

Mitral Valve

TAVR MORTALITY 1.60%

1.50%

1.40%

1.30%

1.20%

1.20%

1.20%

1.20%

1.00%

1%

0.80%

Another important focus area is continuing our heart team approach, a significant multidisciplinary collaboration among cardiovascular specialists from cardiology, cardiac imaging, cardiac surgery, pulmonary and critical care, interventional cardiology, and other disciplines.

0.60% 0.40%

0.50%

0.50%

2018

2019

Methodist Hospital in San Antonio is my home. I want every patient who comes through our doors to have the best possible experience.

0.20% 0.00%

MH Hospital

2020

2021

NCDR

SHD

31

ACHD Adult Congenital Heart Disease

Thanks to rapid advances in the field of cardiovascular medicine, many children who were born with congenital heart disease are not only surviving childhood, but are thriving well into adulthood. At the same time, ACHD presents unique, lifelong challenges for these patients.

Methodist Heart and Lung Institute’s ACHD program is designed to meet the specific needs of this patient population.

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ACHD Adult Congenital Heart Disease The ACHD program launched in 2016, and since then, it has grown to become one of the largest programs in Texas.

The program is one of only a few statewide – it’s the only program in South Texas. As such, it draws from a large referral area, from Lubbock, to Brownsville, to El Paso, and from other states as well.

The program brings together a multidisciplinary team of specialists, who work together to develop optimal management and treatment plans for this complex patient population. Subspecialists in ACHD team up with pediatric interventional cardiologists to perform procedures.

Additionally, the team partners with an ACHD surgeon, one of the few experts nationwide with subspecialty expertise in both pediatric and ACHD surgery.

Because ACHD patients frequently develop arrhythmias, the hospital’s adult electrophysiology (EP) team works closely with the institute’s ACHD experts to diagnose and treat rhythm disturbances. This enables the EP team to look through the lens of congenital heart disease when evaluating and treating these patients. Likewise, the institute’s cardiac radiology experts worked with the ACHD team to understand and meet ACHD-specific imaging needs using the leading-edge technology at their disposal.

adult hospitals under the same roof promotes interdisciplinary collaboration and streamlines the patient experience.

The program’s strong outcomes are the result of a deliberate focus on quality, tracked and measured with an analytics tool modified from adult cardiothoracic surgery. Since the program launched in 2016, it has had an outstandingly low surgical mortality rate.

Overall, Methodist Heart and Lung Institute’s ACHD program takes a multifaceted approach that understands the interplay between patients’ congenital heart disease diagnoses and their long-term cardiovascular health.

ADULT CONGENTIAL PATIENT VOLUMES

1,062 316-

Pankaj Madan, md Medical Director, Adult Congenital Heart program, Methodist Hospital 34

2018

1,020-

963-

872-

746-

Methodist Heart and Lung Institute is particularly well positioned to provide a comprehensive ACHD program because it is the site of a top quaternary care adult hospital with robust cardiovascular capabilities and the site of a world-class pediatric hospital. Having both pediatric and

361-

322-

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1,381

1,285

1,208

2019

New Patients

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2021

Existing Patients

Before we launched the ACHD program at Methodist Heart and Lung Institute, there was no ACHD specialty care program anywhere in South Texas. Serving this “orphaned” patient population requires expertise in both pediatric and adult cardiology. You need to understand the congenital conditions and the surgical repairs and medical management strategies that were used when these patients were children. You also need to understand the evolving impact of congenital heart disease

on a patient’s heart over time. Only with expertise in both disciplines can a physician identify, monitor, and treat the unique complexity of an ACHD patient.

Because our adult and pediatric hospitals are located in a single building, we can provide seamless care for both pediatric congenital heart disease and ACHD patients, without having to transfer them back and forth. For example, our team recently cared for a patient who had ACHD and was pregnant with her first child, who also had congenital heart disease. The mom needed a cardiovascular procedure while she was pregnant, which she received here, and her baby needed surgery shortly after birth, which the baby received here as well.

ACHD is an innovative and growing specialty with a burgeoning need. Our program is committed to helping to meet that need by training the next generation of ACHD specialists. Methodist Heart and Lung Institute provides training rotations for the largest Accreditation Council for Graduate Medical Education-accredited military cardiology fellowship program in the country, and we provide ACHD training as part of that program. We also train fellows from the University of Texas Health Science Center at San Antonio, giving them the opportunity to complete rotations in ACHD. We also engage in “fellow bootcamps,” bringing in fellows from programs across the state to gain experience and expertise in ACHD. Looking ahead, we plan to continue to push the envelope of what’s possible in ACHD. To give just one example, we have performed valve replacements on pregnant patients. We are continuing to boost our training and collaboration efforts, and we’re hiring more ACHD specialists to expand our capacity to care for this patient population.

As national center of excellence criteria are established, our program will pursue those designations. Our goal is to become a center of excellence in ACHD care for the entire state.

ACHD 35

CH

Cardiohospitalists

In a cardiac emergency, every minute counts. That’s one reason why a hospital’s door-to-balloon time has become such a prevalent quality measure. Methodist Heart and Lung Institute took an innovative approach to the task of expediting emergency cardiac care: adding an in-person, on-the-ground hospital bound cardiologist who is able to recognize acuity immediately and take patients directly to the cath lab to start lifesaving interventional procedures for acute myocardial infarction and other emergencies. In 2010, the cardio hospitalist program was born.

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CH

Cardiohospitalists There are two cardio hospitalists in the hospital at all times. One covers the emergency room (ER), while the other covers the hospital floors. In the ER, cardio hospitalists take care of any cardiac-related emergency that arises, working hand in hand with emergency medicine physicians and other hospitalists. The cardio hospitalists on the floor take care of patients who have already been admitted. Having dedicated cardiology specialists in the hospital at all times enables the cardiologists who are in clinic to focus on their patients in the office, rather than having to drop everything to help a patient having an emergency.

The cardio hospitalists help with patient throughput, moving patients to the right level of care and running multidisciplinary rounds. They also help to streamline the discharge process: instead of chasing down different cardiologists to sign off on every patient, the cardo hospitalist is there to make the determination.

The program has resulted in significant improvements in efficiency, including door-to-balloon times and other metrics. In recognition of the effectiveness of the new approach, the cardio hospitalist program received the highest award for innovation and care from the Texas Hospital Association (Bill Aston award 2013).

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Art Tontiplaphol, md Director, Telemetry Services, Methodist Hospital The standard approach to emergency cardiac care for a patient is to be transported by emergency medical services, be seen and evaluated by an emergency physician and cardiologist, then go to the cath lab. Each of these steps would be sequential rather than simultaneous. With a cardio hospitalist on site, the patient can go from EMS to the cath lab in the quickest possible time.

The role of the cardio hospitalist adds immense flexibility to the hospital. For example, during the height of COVID-19, the cardio hospitalists helped to take some of the pressure off the critical care pulmonologists and intensivists, who were flooded with COVID-19 patients in the intensive care unit (ICU). By managing hospitalized cardiac patients, the program also enabled practicing cardiologists who were in high-risk categories to shift to officebased work and stay out of the hospital (if desired) during COVID-19 surges.

This program is only possible because of the size of our cardiology practice, which is among the 10 biggest in the country outside of an academic program. We are proud to have reached a critical mass of cardiologists within our organization to be able to support a specialty program such as this one.

The cardio hospitalist program is also well positioned to support Methodist Heart and Lung Institute’s future growth. As the institute’s referral area continues to expand, the cardio hospitalists will facilitate hospital-based patient care. They will also be on hand to start innovative new programs as ideas develop.

CH

39

CI

Cardiointensivists

For more than 10 years, Methodist Heart and Lung Institute’s cardio hospitalist program has been improving care quality metrics as well as efficiency for cardiac patients in the ER and on inpatient units across the hospital. Building on that success, the institute is breaking new ground by bringing a similar concept to the cardiovascular ICU (CVICU). The institute launched its cardiointensivist program in January 2021, becoming one of a few such programs nationwide.

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CI

Cardiointensivists Cardiointensivists enable Methodist Heart and Lung Institute to provide extraordinarily differentiated critical care to heart patients. Pulmonary and critical care intensivists manage ICUs across the system and are experts in caring for all types of critically ill patients. When the patient has a cardiac-specific diagnosis like end-stage heart failure or is recovering from cardiac surgery, a cardiointensivist’s formal cardiac training enables highly customized, onsite cardiac care in the CVICU. Cardiointensivists fill several roles in the CVICU. They participate in multidisciplinary rounds each morning, discussing the plan of care for each patient in the CVICU. When surgical cases come out of the operating room (OR), the cardiointensivist is on hand to land the patient in the CVICU. In order to prepare for a successful handoff, cardiointensivists collaborate closely with cardiac surgeons who have patients scheduled for surgery. Working as part of the CVICU team, they constantly reassess patients and are available to react in a quick and efficient manner if the patient begins to decompensate.

To build this program, the team engaged in significant additional training in cardiac hemodynamics, Impella management, ECMO management, and critical care echocardiography, among other skills. They then conducted hands-on simulation training and began week-long rotations in the CVICU. The cardiointensivist program has contributed to Methodist Heart and Lung Institute’s low mortality rates and decreased CVICU length of stay (LOS). For example, CVICU LOS after coronary artery bypass graft surgery (CABG) or valve surgeries decreased from an average of 3.0 days to 1.5 days in 2021.

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Mauro Ortiz, md Chief of Cardiology, Methodist Hospital At Methodist Heart and Lung Institute, we are proud to offer our patients cardiointensivist care. There are a handful of cardiointensivist programs nationwide, and we are keeping pace with the latest systems of care in the country.

As we have been advancing our cardiac care at Methodist Heart and Lung Institute, we realized that there was a growing need for a consistent cardiology presence in the CVICU. With programs like advanced heart failure, aortic disease, and heart transplant at the institute, we care for the region’s sickest and most complex cardiac patients.

The program has established a firm foundation in 2021, and there are a number of exciting goals on the horizon. Looking ahead, we expect to see even further drops in CVICU length of stay. We are in the process of actively recruiting additional cardiointensivists and trained physicians, and we will visit the sites of other programs in order to share best practices.

CARDIAC ADMITS 5,914 5,741 5,418

2018

5,383

2019

2020

2021

CI

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CA

Cardiac Anesthesia The Methodist Heart and Lung Institute has a longstanding cardiac program. Over the last 15 years, the hospital’s anesthesia specialists have focused on adding additional physicians certified in cardiac anesthesia. All of the anesthesiologists who practice at the institute are double boarded in anesthesia and perioperative echocardiography.

This experience differentiates this group of physicians to deliver the highest level of expertise in cardiothoracic and vascular anesthesia.

Anesthesiologists are experts in perioperative medicine, holding them responsible for determining the safest plan of care for a patient through any given procedure. Specializing in cardiac anesthesia enables the team to practice at the full scope of the team’s certification, including transplant medicine, mechanical circulatory support, thoracic anesthesia, coronary artery bypass grafting, open valve replacement, vascular surgery, and structural heart surgery, including TAVR, WATCHMAN and MitraClip.

The institute’s cardiac anesthesiologists are at the forefront of new innovations and research, particularly new monitoring techniques or methodologies for interpreting monitor data. The cardiac anesthesiology team was pivotal in the institute’s recent expansion of the aortic surgery program. Looking ahead, the team will work with Methodist Healthcare to expand the institute’s vascular service line and future program development.

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Kristina Eng, md Division Medical Director, Anesthesia, Methodist Healthcare As cardiac anesthesiologists, our mission is to help Methodist expand the cardiovascular program while keeping patients safe. Our priority as anesthesiologists is to uphold safety and take care of patients in an evidence-based way. In the cardiac realm, that’s even more important because the stakes are higher and the patients are higher acuity.

As Methodist Heart and Lung Institute continues to grow, we will expand with them, while maintaining an excellent level of care.

CA

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Heart Failure Methodist Heart and Lung Institute’s Advanced Heart Failure and Cardiac Transplant program is much more than a heart transplant program. The hospital’s integrated, multidisciplinary team treats the entire disease process, from medical management for heart failure and pulmonary hypertension (PH) to mechanical circulatory support (MCS) including ventricular assist devices, ECMO, and Impella devices, all the way to heart transplant and post-transplant management.

The program brings together the strengths of multiple specialties into a single, unified program designed to treat the sickest of the sick. It is the only comprehensive advanced heart failure and cardiac transplant program in South Texas. It’s no surprise that Methodist Heart and Lung Institute earned a five-star rating in heart failure treatment from U.S. News and World Report in 2020/2021.

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Chandra Kunavarapu, md Medical Director, Advanced Heart Failure and Cardiac Transplant Program, Methodist Hospital While heart failure is a challenging disease to manage, patients’ struggles with heart failure and the impact it has on their families is what drives my desire to make a difference.

The field has advanced immensely in options of medical management and heart failure assist devices. It’s a privilege to be in a setting where we can provide these resources optimally. Our field is rapidly evolving, where now we have the possibility of a xeno heart transplant.

Over the years, as we have built new service lines and programs to better serve our patients and community, I have had the opportunity to work with some of the most caring and capable clinicians in our community, from physicians to nurses and specialists. I take great pride in how the multidisciplinary heart failure, ECMO and pulmonary teams work in coordination to provide excellence in care for our patients. Looking forward, our continued focus is program growth and new program development. Training the next generation of fellows and colleagues has been a privilege.

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CHF Clinical Heart Failure

Today, there are effective treatment options for advanced heart failure that can prolong not only survival but quality of life as well. Receiving treatment at a center that provides the full spectrum of services, as Methodist Heart and Lung institute does, is the key to a successful outcome. The program’s full-time staff of board-certified advanced heart failure and transplant cardiologists and surgeons make the program’s large patient volumes and quality outcomes possible.

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CHF Clinical Heart Failure

Because of the program’s longevity, comprehensiveness, volumes, and quality, the team is able to partner with the medical device industry to bring a wide range of devices to patients. As a result, Methodist Heart and Lung Institute has the largest selection of MCS devices available. The hospital is one of only 10 centers nationwide using the newest left ventricular assist device (LVAD) technology, for example. Additionally, the hospital’s expert team helped to write the protocols that govern the use of temporary support devices. The program was the origin of the hospital’s renowned ECMO program, and the hospital’s heart transplant volume in 2021 place it among the top quartile of centers in the nation.

Patient and family education is another strength of the program.

The team is committed to helping patients live well with this chronic disease, empowering them to take the necessary steps to deal with the disease effectively.

Overall, this multidisciplinary program seeks to treat a disease process, not just offer a therapy. Through a team-based approach, Methodist Heart and Lung Institute cares for patients across the full spectrum of end-stage heart and lung disease.

HEART FAILURE CLINIC REFERRALS 773

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625 373-

419-

324-

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301-

2019 Inpatient

50

2020

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2021 Outpatient

Michael Kwan, md Program Director, Advanced Heart Failure and Cardiac Transplant Program, Methodist Hospital Because Methodist Heart and Lung Institute is a comprehensive advanced heart failure center, we have the widest range of heart failure treatment options at our disposal – more tools in our toolbox, so to speak. Rather than offering several small, focused services in clinical heart failure, MCS, and heart transplant, we have rolled all of these capabilities into one program. By consolidating expertise in all of these areas, Methodist Heart and Lung Institute can offer patients unparalleled clinical depth and breath, with a seamless patient experience.

Going forward, we seek to continue increasing awareness in San Antonio and across South Texas of the range of therapies that are available through our program. We are proud to have maintained our excellent outcomes as the program has grown and expanded, and we have robust systems in place to enable us to continue maintaining top quality.

We are also dedicated to developing our PH program in partnership with our pulmonology colleagues. PH’s symptoms and disease process have important similarities to heart failure and are often confused with heart failure. Diagnostic imaging and therapeutic options for PH are highly specialized, and our team’s cardiologists and pulmonologists are certified in using them.

As a large, high-volume program, we are routinely invited to participate in device and pharmacologic trials. That means that we’re aware of cutting-edge technologies and new medications before they’re widely available. We can truly say that we have the widest range of treatment options for our patients. We also help to train the next generation of heart failure specialists, including cardiology, nurse practitioner, and pharmacy residents.

We remain on the forefront of end-stage heart and lung disease – not only by teaching, but by doing. Our unmatched experience sets us apart from every other center in Texas, and we look forward to continued growth on the horizon.

CHF

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Mechanical Circulatory Support MCS plays a key role in Methodist Heart and Lung Institute’s advanced heart failure and cardiac transplant program. The latest devices offer improvements to quality of life as well as survival and include portable and implantable options. MCS can help patients optimize cardiac function and provide a bridge to transplant.

The program’s volume and quality attract industry sponsored MCS device trials to Methodist Heart and Lung Institute. This gives the team more treatment options, enabling customized care for end-stage heart failure patients. The hospital’s current MCS capabilities include more left ventricular assisted device (LVAD) options than anyone else in South Texas. In January 2021, Methodist Heart and Lung Institute became the first in the nation to implant the newly designed cardiac mechanical pump, EVAHEART®2.

The MCS program engages with the interdisciplinary advanced heart failure and cardiac transplant team, collaborating closely with ECMO and cardiogenic shock specialists as well as cardiologists, intensivists, cardiac surgeons, and many others.

IMPELLA VOLUME 97

92 78

2019 52

2020

2021

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HT

Heart Transplant End-stage heart failure has one cure: a heart transplant. Yet a heart transplant is much more than a procedure; rather, it represents a point along a continuum of heart failure care and treatment. That’s why Methodist Heart and Lung Institute is committed to providing integrated, comprehensive care across the continuum for heart failure patients in San Antonio, South Texas, and beyond.

Methodist Heart and Lung Institute’s heart transplant program has been active since the mid1980s, at the dawn of the modern era of transplant that began with the introduction of effective anti-rejection medications. And over the past two years, Methodist Heart and Lung Institute’s heart transplant program has experienced tremendous growth, while maintaining is track record of excellence.

among the top 10 centers in the U.S. This year, the accumulated history of transplant of the heart transplant program exceeded 500.

Providing comprehensive care is critically important because these complex patients need a strong strategy to address their disease and take advantage of the optimal time window for heart transplant. If the program’s capabilities are not comprehensive, patients can lose the opportunity for a heart transplant. At Methodist Heart and Lung Institute, we can provide care from beginning to end, throughout the entire disease process. As the only comprehensive advanced heart failure and cardiac transplant program in South Texas, the program is committed to serving the region’s sickest patients.

In 2021, the program completed 35 heart transplants – the highest volume the program has seen in 20 years, and a rate that is higher than 75 percent of heart transplant centers in the U.S. At the same time, the program’s one-year survival rate is an outstanding 97 percent, placing the hospital

1 YEAR PATIENT SURVIVAL 120.00% 100.00% 80.00% 60.00%

91.50%

91.35%

91.77%

91.79%

91.46%

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91.88%

91.74%

74.92%

82.20%

88.18%

91.65%

91.11%

93.33%

93.75%

92.12%

89.17%

96.42%

40.00%

July 2014 - Dec 2016

Jan 2015 - June 2017

July 2015 - Dec 2017

Jan 2016 - June 2018

July 2016 - Dec 2018

Jan 2017 - June 2019

July 2017 - Dec 2019

Jan 2018 - Mar 2020

July 2018 - Dec 2020

0.00%

Jan 2014 - June 2016

20.00%

JUNE 2017

DEC 2017

JUNE 2018

DEC 2018

JULY 2019

JAN 2020

JULY 2020

JAN 2021

JULY 2021

JAN 2022 (P)

1 year pt survival

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SRTR

Masahiro Ono, md, phd Surgical Director, Heart Transplant and Mechanical Circulatory Support, Methodist Hospital In San Antonio and throughout South Texas, there is a significant need for advanced heart failure care, including MCS and transplant. But because donor hearts sustain damage during transportation time, the viable radius for organ donation has historically been very limited. As a result, demand for donor hearts exceeds supply – and some donor hearts that could have been used to save a life go unused because they are too far away. Across the U.S., about 60,000 people could benefit from a heart transplant. Yet, fewer than 3,000 heart transplants are performed each year.

To expand the viable travel distance for donor hearts in South Texas, our team is now beginning to use the TransMedics Organ Care System (OCS), a portable organ transportation system that minimizes damage to the donor organ during travel. Across the U.S. fewer than 20 transplant centers – all of them academic medical institutions – have this capability. We’re proud to offer it here at Methodist Heart and Lung Institute.

HEART TRANSPLANT VOLUME 32

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27

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Our future vision – for the advanced heart failure and cardiac transplant program, as well as Methodist Heart and Lung Institute’s cardiovascular programs as a whole – is to pursue even more alignment and collaboration. By growing all of the cardiovascular services lines in a consistent manner, we develop and maintain an ever-higher level of comprehensive care for people across South Texas.

2021

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CVCT

Cardiovascular and Cardiothoracic Surgery

Methodist Heart and Lung Institute’s cardiovascular and cardiothoracic surgery program is the largest and most comprehensive in South Texas, and the program’s capacity and capabilities are second to none.

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CVCT

Cardiovascular and Cardiothoracic Surgery The program’s eight cardiovascular and cardiothoracic surgeons perform coronary bypass surgeries, all facets of heart valve surgery including repairs and replacements, multiple valve operations, minimally invasive cardiac surgery, aortic surgery, high-risk cardiac surgeries, noncardiac thoracic surgeries, mechanical circulatory support surgeries, and heart transplants. The hospital is a regional referral center for organizations across all of South Texas.

cardiologists, intensivists, and a variety of cardiovascular subspecialists to discuss and develop the right treatment plan for each individual patient.

High-risk cardiovascular patient cases are reviewed in a weekly team meeting.

The program’s surgical outcomes are among the best in the region, as measured by the Society of Thoracic Surgeons, and exceed national quality benchmarks.

The Methodist Heart and Lung Institute’s interdisciplinary collection of programs work together and overlap with each other, ultimately enabling the team to make the best decisions and recommend the best treatments for patients with complicated cardiovascular problems.

The institute is renowned for its high-risk cardiac surgery capabilities. The foundation of its success with the highest risk patients is a multidisciplinary “heart team” approach. Cardiovascular and cardiothoracic surgeons collaborate with

CARDIOVASCULAR AND CARDIOTHORACIC SURGERY 294

279 271

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CABG

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AVR

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MVRR ■ 2018

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■ 2019

■ 2020

23

17

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CABG+AVR ■ 2021

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7

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R. Brent New, md Chief of Cardiovascular and Cardiothoracic Surgery, Methodist Hospital Division Medical Director, Cardiovascular and Cardiothoracic Surgery, Methodist Healthcare Methodist Heart and Lung Institute serves a huge geographical region, from the ocean in one direction to the border with Mexico in another. Methodist Hospital is by far the most comprehensive medical center in South Texas, and that designation comes with a significant responsibility to the South Texas communities we serve.

Our heart transplant program has been active for decades and has continued to grow throughout the COVID-19 pandemic. We have the largest ECMO program in Texas, and we offer multidisciplinary services in everything from aortic and valvular surgery to cardiogenic shock and heart failure.

Through all of our achievements, our abiding focus remains on collaborative, comprehensive care using the best of all of our talents, all of our programs, and all of the tools and technology at our disposal, in order to deliver comprehensive care with unmatched clinical depth and breadth while maintaining our best-in-class cardiac surgery outcomes.

CVCT 59

Valvular Surgery Patients with damaged or diseased heart valves can be treated in several ways. That’s why Methodist Heart and Lung Institute founded the South Texas Heart Valve Center a decade ago. The center’s goal is to evaluate patients with valvular heart disease and determine the best treatment option for them, whether that is a surgical heart valve repair or replacement, a minimally invasive surgery, or an endovascular structural heart procedure, such as a transcatheter aortic valve replacement (TAVR).

Methodist Heart and Lung Institute performs more valve surgeries than anywhere else in San Antonio. It’s one of the only hospitals in the city with mitral valve cases large enough to be considered as a high-volume center. The institute’s valvular surgery team performs traditional open valve replacement surgery as well as minimally invasive surgical valve replacements. Both surgical options yield strong results, and the minimally invasive approach enables the surgery to be completed using a few small incisions rather than a larger one. Recovery time is about two to three times shorter for a minimally invasive procedure.

Some patients may be candidates for an endovascular valve procedure as well. The institute’s valve experts work closely with structural heart cardiologists to discuss each patient’s case and engage in a patientcentered decision-making process, developing the optimal treatment plan as a team. Having the full range of surgical capabilities for valvular disease available results in the best treatment.

Methodist Hospital is equipped with two hybrid ORs for valvular surgery, structural heart, aortic disease, and other procedures benefitting from high-definition fluoroscopy in addition to state-of-the-art OR equipment.

In partnership with colleagues in the structural heart program and other programs within the institute, the valvular surgery team maintains a robust level of participation in clinical research. This gives the institute’s patients access to the newest devices and valves on the market, before they become widely available. One current area of research focus at the institute is investigating transcatheter mitral valve systems, which is a major area of growth and innovation in valvular surgery.

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James R. Garrison, md Surgical Director, Structural Heart Program, Methodist Hospital At Methodist Heart and Lung Institute, each patient benefits from cooperation and coordination between surgeons and cardiologists, who work together to evaluate the patient and determine what type of valve procedure is best.

The early detection of mitral valve disease – and early surgical repair of these valves – has the potential to prevent many serious heart problems from developing.

Mitral valve disease is currently undertreated. But with minimally invasive techniques and the good repair options that we have now, we can stop leaky mitral valves from causing damage to the heart over time.

We encourage general cardiologists and primary care physicians in the community to refer patients with heart murmurs to the South Texas Heart Valve Center for evaluation. By seeing these patients early, we can help to prevent the heart from failing in the future as the valve problem gets worse.

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AS Aortic Surgery

Methodist Heart and Lung Institute’s aortic surgery program debuted in 2019.

The program focuses on surgical management of diseases of the aorta, which fall into two main categories: aortic aneurysms and aortic dissection. The program was built based on the model of major academic centers and includes advanced practice providers and program coordinators to facilitate management of patients with aortic disease. The multidisciplinary program employs a team approach that results in customized treatment plans for each patient, from screening and surveillance to the latest endovascular, open, and hybrid surgical techniques.

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Retired Navy Seal, Aaron Kendle, was a ticking time bomb, never imaging an aortic aneurism could nearly claim his life. “We’re going into battle together. I want you on your game,” Aaron told Dr. de la Cruz going into his operation.

- Aaron Kendle Aortic Patient

SCAN QR CODE TO WATCH VIDEO.

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AS Aortic Surgery

Aortic dissections and ruptured aortic aneurysms are life-threatening events with a mortality rate greater than 50 percent nationwide. The key to improving patient outcomes is identifying patients who have aortic aneurysms before they begin to show symptoms, then monitoring their aneurysms for growth or other changes over time.

AORTIC PROGRAM VOLUME 2019

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REFERRALS 150

In a population of 2 million people, which is roughly the size of the population in the greater San Antonio area, about 2,000 individuals will have one or more aortic pathologies that need to be watched. The aortic disease team established the Methodist Aortic Center to identify and monitor individuals with aortic aneurysms of 3.5 or 4 cm. The center’s staff of nurses and nurse practitioners reach out to patients who have incidental findings of aortic disease during a test for another condition. Patients receive ongoing monitoring of their aneurysm, and the center also advises patients about lifestyle changes that could help prevent their aneurysm from getting larger, including blood pressure control and smoking cessation.

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SURGICAL CASES 48 128 130

NEW PATIENT VISITS 92 127

For those patients whose aortic aneurysms have grown to a dangerous size (5.5 cm or larger), Methodist Heart and Lung Institute’s aortic surgery program provides individualized treatment options.

Surgery is performed in the hospital’s state-ofthe-art cardiovascular OR and hybrid OR, which offer enhanced, high-definition fluoroscopy and multimodality imaging capabilities for endovascular procedures. Examples of complex open procedures include aortic root replacement and aortic arch replacement. Endovascular procedures include fenestrated endovascular stenting and branched endovascular stenting as well as traditional endovascular stenting.

Every patient benefits from Methodist Heart and Lung Institute’s true multidisciplinary approach to treating aortic disease. Aortic disease specialists 64

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CLINIC VISITS 151 376 640

collaborate with cardiac and vascular surgeons, cardiologists, interventional radiologists, pulmonary and critical care doctors, and other team members.

The specialists meet as a team to discuss each patient’s case and determine the best treatment plan for that individual. Each discipline has input, and the group works together to come up with a unified recommendation for the patient.

Kim de la Cruz, md Director, Aortic Surgery, Methodist Healthcare, HCA San Antonio Division With Methodist Heart and Lung Institute’s aortic surgery program and the Methodist Aortic Center, our hospital can respond to a significant need in the community.

Our program is unusual in that we treat the aorta in its entirety, from the root in the chest all the way down to the bifurcation in the pelvis. We are experts in the full range of endovascular and open aortic procedures, giving us the ability to tailor treatments and create individualized therapies based on the patient’s age, risk factors, comorbidities, goals, and values. We are on call 24 hours a day, seven days a week, 365 days a year to handle transfers and emergencies. Our goal is to do whatever we can to give the patient a longer, better quality of life.

As our program continues to grow, we aim to increase awareness of our capabilities within the community.

We also intend to expand our research participation to contribute to the body of knowledge about treating complex aortic pathology based on our clinical experience here at Methodist Heart and Lung Institute.

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VM Vascular Medicine

In January 2021, Methodist Healthcare launched its state-of-the-art vascular center. The center aims to provide comprehensive vascular care using a collaborative, patient-centered approach that engages colleagues across Methodist Heart and Lung Institute.

While vascular surgery has always been part of Methodist Heart and Lung Institute, the center will add a higher level of coordination and follow-up for this complex patient population.

The program’s outpatient services include a vascular clinic as well as diagnostic testing and imaging including Doppler ultrasound and ankle-brachial index.

When treatment is needed, the vascular surgery team performs open surgical procedures as well as minimally invasive endovascular procedures to restore blood flow and minimize the life-threatening consequences of vascular disease.

Surgical treatments include aortofemoral bypass, aneurysm repair, and stent grafts. Endovascular procedures include diagnostic angiography, balloon angioplasty, atherectomy, and stent placement.

The vascular team works closely with other cardiovascular disciplines within the institute. Treatment plans are designed using a team approach in order to find the best option for each patient. The vascular center serves as a hub of coordinated care for individuals with vascular disease, with comprehensive care within a single center.

Methodist Heart and Lung Institute is one of the leaders in cardiovascular care in San Antonio and South Texas. The addition of coordinated vascular services enables the team to streamline patient access to the highly specialized cardiovascular experts at the institute.

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VASCULAR VOLUME Peripheral Total Surgical Total

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Hinan Ahmed, md, mba Medical Director, Vascular Center, Methodist Healthcare San Antonio has a high prevalence of peripheral arterial disease.

As a result, the city has had the ignominious designation of having the highest amputation rate in the country for the past three years.

Methodist Heart and Lung Institute has taken significant steps toward addressing the unmet need for vascular care with the launch of the vascular center. It is our hope that by enhancing vascular specialty services to San Antonio, we will be able to treat and reverse chronic limb-threatening ischemia, diabetic ulcers, and other conditions that can lead to amputation.

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CPRS

Cardiopulmonary Rehabilitation Services

The cardiopulmonary rehabilitation program at Methodist Hospital plays a key role in patients’ long-term outcomes, whether they have suffered a major cardiovascular event, like a heart attack, or have ongoing cardiac symptoms associated to a cardiovascular diagnosis. The goal of the program is to help patients safely improve their cardiovascular health, keeping them out of the hospital and increasing their compliance with treatment plans.

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CPRS

Cardiopulmonary Rehabilitation Services Although supervised exercise sessions are certainly part of the service, the cardiopulmonary rehabilitation program takes a comprehensive approach. The team assesses each patient’s basic activity level and works with each patient to identify behavior patterns that might represent barriers to engaging in healthy habits.

Next, the team develops an individualized treatment plan that incorporates nutritional and behavioral counseling as well as exercise to improve not only cardiovascular endurance but strength, balance, mobility, and flexibility. The program also tracks

patients’ vital signs, such as pulse, blood pressure, and weight, which can help providers to spot problems and intervene early. Program participants generally attend hour-long sessions three times a week for 12 to 24 weeks.

The program encourages referrals. The best time for a patient to start cardiopulmonary rehabilitation is 30 days after an event. Studies suggest that long-term compliance is better if patients engage in a rehab program during this window. However, patients can be referred to cardiopulmonary rehabilitation up to one year after an event.

CARDIAC AND PULMONARY REHAB EXERCISE SESSION VOLUME

PATIENT VOLUME 527 454

518

176-

142-

349

15,013

13,703

189-

12,000

108-

7,099 351-

312-

329-

241-

2018

2019

2020

Cardiac Rehab Admits

2021

2018

Pulmonary Rehab Admits

2019

2020

Cardiac Rehab

2021

Pulmonary Rehab

45 - Cardiac rehabiliation referral

80.5%

96.4

My R4Q Performance | 0

(742/922)

| 20

| 40

| 60

| 80

10th

25th

50th

75th

90th

8.4

55.6

87.3

96.9

99.4

95.2

94.8

| 100

US Hospital R4Q Performance Distribution for 2021-Q2

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92.6

87.7 81.1 70.2

2019-Q3

2019-Q4

2020-Q1

2020-Q2

2020-Q3

Performance Trend

67.8 2020-Q4

2021-Q1

2021-Q2

Manjusha Anna, md Director, Cardiopulmonary Rehabilitation, Methodist Hospital Our cardiopulmonary rehabilitation program is designed to support patients in making progressive improvements to their cardiovascular health. We see patients who have had major events like heart attacks, as well as patients who are experiencing symptoms as a result of heart failure, peripheral artery disease, or other cardiopulmonary conditions.

Patients experience faster recovery in general once they get into a supervised program. In addition, the chance that they will adhere to exercise and medication recommendations is much higher. We encourage our colleagues and community providers to enroll their patients in our program, to maximize the benefits of the patient’s medications or the intervention that the patient received.

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PCC

Pulmonary and Critical Care The pulmonary critical care intensivist program at the Methodist Heart and Lung Institute was the first program of its kind anywhere in San Antonio.

Now entering its second decade, the program has dozens of highly specialized physicians, including subspecialists in cardiovascular, burn and reconstruction, and neurocritical care., It covers over 240 ICU beds. The program has wellestablished care guidelines and pathways. This allows integration within other subspecialties and nursing, while conducting multidisciplinary rounding with cardiology, infectious disease, nephrology, and other specialties as needed.

Pulmonary services span over a range of lung diseases, most of which are highly prevalent in South Texas. They include lung cancer, pulmonary vascular disorders like pulmonary embolism and pulmonary hypertension, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis, among many others. Because the heart and lungs are so closely linked, many of the programs are multidisciplinary collaborations between the institute’s pulmonary critical care doctors and cardiovascular specialists.

The Advanced Lung Center has a robust lung nodule program for early detection of lung cancer, coupled with strong diagnostic and treatment capabilities that save lives. Methodist Healthcare has made big investments in the institute’s sleep medicine capabilities, giving the region’s residents access to the largest sleep laboratory in San Antonio (20 beds). The pulmonary embolism response team (PERT) is aggressively treating pulmonary embolism using a data-driven approach. The institute’s ECMO program is among the largest and most experienced in the nation.

All of these programs culminate in a wide range of treatment options for advanced lung disease.

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Jairo Melo, md Director, Pulmonary and Critical Care, Methodist Healthcare Co-Chair, Thoracic Service Line The key to our success – and to the success of Methodist Heart and Lung Institute as a whole – is that pulmonology and critical care services are fully integrated into each cardiovascular specialty program.

PCC

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ECMO

Extracorporeal Membrane Oxygenation Methodist Heart and Lung Institute’s ECMO program began in 2012 as a support structure for the heart transplant program. Since then, the ECMO program has grown significantly in response to regional need. ECMO performs some of the work of the heart and lungs, enabling patients who are in severe heart or respiratory failure to heal from acute injury or illness or to survive long enough to have a heart transplant, cardiac surgery, or other intervention.

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“The last thing I remember was telling my wife I loved her and that I was scared. At that point, I wasn’t sure if I was going to make it.”

- Justin Moreno ECMO Patient

SCAN QR CODE TO WATCH VIDEO.

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ECMO Extracorporeal Membrane Oxygenation ECMO is a specialized procedure that requires specific expertise across the team, from the nurses caring for the patient, to the specialists taking care of the pump, to the physicians, pharmacists, and other team members. For that reason, ECMO is not available at most hospitals, and Methodist Heart and Lung Institute’s program supports a large referral area as one of the only ECMO programs in Southwest Texas.

ECMO VOLUMES

148 51-

Today, Methodist Heart and Lung Institute’s ECMO program is the largest in Texas and one of the largest in the country. The hospital was among the first facilities nationwide to begin using ECMO, making Methodist Heart and Lung Institute one of the most experienced ECMO programs in the country.

The ECMO program is so robust in part because it leverages the multidisciplinary expertise and close collaboration of the team of physicians. Teams from the advanced heart failure program join cardiac surgeons, cardiologists, critical care, and pulmonary specialists to evaluate and assess each patient’s case and determine, together and in real time, the optimal treatment. As a result, Methodist Heart and Lung Institute excels at getting each patient to the right level of support.

The program reaches beyond the cardiovascular service line and outside the hospital’s walls to bring the lifesaving potential of ECMO to the greatest number of patients.

For example, the hospital partners with the San Antonio Fire Department to identify potential ECMO candidates for patients in cardiac arrest while they are in the field.

This enables the multidisciplinary team to be ready to treat the patient before the patient comes through the ER doors. The program is also working with other programs and service lines such as PERT, cardiothoracic surgery, and heart transplant.

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188

185

97-

2019

120-

118-

65-

70-

2020 VA

2021 VV

2021 SURVIVAL TO DISCHARGE PERCENTAGES 59%44%-

51%-

44%-

58%-

63%-

30%91%-

69%-

VV

50%-

VA

ECPR

Methodist Healthcare System

COVID

Total

Extracorporeal Life Support Organization

Chandra Kunavarapu, md Medical Director, ECMO Program, Methodist Healthcare As a medical director for the past 14 years, I’ve helped develop a multidisciplinary approach that our program utilizes that not only allows us to provide very advanced care for our acutely critical patients, but also gives us an opportunity do provide complex cardiogenic shock patients the path to potentially be listed and move forward with a heart transplant.

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ECMO Extracorporeal Membrane Oxygenation Looking forward, the program is positioned for further growth in several areas. For example, Methodist Heart and Lung Institute is developing a cardiogenic shock team, designed to work together to identify patients in cardiogenic shock, evaluate their needs, and determine the best available option, one of which may be ECMO. Working together with colleagues in critical care, advanced heart failure, cardiology, and cardiothoracic surgery, the program will support the institute’s ability to care for these patients.

Secondly, the program is continuing to strengthen the burgeoning relationship between PERT and the ECMO program. That means that a patient with a massive pulmonary embolism stands to benefit from

5,412

ECMO VOLUMES CASES VS DAYS 3,276

1,266 185

148

2019

2020

ECMO Cases

78

188

2021 ECMO Days

the same multidisciplinary team approach that the hospital applies to its advanced heart failure and aortic disease programs.

Thirdly, Methodist Heart and Lung Institute will serve as a source of knowledge and experience for hospitals across HCA, sharing the team’s experience and successes to support ECMO capabilities as they spread to more hospitals in the system.

Jeffrey DellaVolpe, md Program Director, ECMO Program, Methodist Healthcare Methodist Heart and Lung Institute’s ECMO program’s mission is simple: we take care of our community’s sickest patients. It’s a mission that we fulfill by working as one team: our physicians, nurses, providers, and administrators all focus on providing the highest level of cardiac care to our patients, and that commitment translates into the ECMO program’s strength. The multidisciplinary work that takes place when we put one of our patients on ECMO is extraordinary. As a result, we have saved a tremendous number of lives.

Our facility’s capabilities are an important example of the ways in which Methodist Heart and Lung Institute pursues clinical depth and differentiation at a level that is unmatched anywhere in San Antonio and the South Texas region. Drawing on our team’s clinical expertise in noninvasive cardiology, interventional cardiology, advanced heart failure, critical care, and cardiac surgery, we have put systems in place that are specifically geared toward ECMO patients. This enables us to arrive at the best possible treatment decision for each patient, setting the stage for excellent outcomes.

In short, Methodist Heart and Lung Institute’s ECMO program is a shining example of our world-class care, delivered by our team of world-class providers, with robust systems in place to take care of every patient, no matter what that patient’s level of complexity is.

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PERT

Pulmonary Embolism Response Team Methodist Heart and Lung Institute’s PERT was established in 2018 to address PE, a life-threatening condition that can occur without warning. The Centers for Disease Control and Prevention estimate that as many as 100,000 people in the U.S. die from deep vein thrombosis and pulmonary embolisms each year. The morbidity and mortality rates are dramatic. For example, sudden death is the first symptom of a PE about 25 percent of the time.1 Many of the people with PE are younger adults with no significant history of cardiovascular disease.

1

U.S. Centers for Disease Control and Prevention. Data and Statistics on Venous Thromboembolism. Retrieved from

https://www.cdc.gov/ncbddd/dvt/data.html. Accessed December 7, 2021.

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PERT

Pulmonary Embolism Response Team Despite the condition’s prevalence and seriousness, there is a lack of standardized protocols and evidence-based best practices nationwide. There are several reasons for this. First, PE presents in a wide variety of ways, potentially delaying diagnosis. Second, treatment options for PE vary, from medical treatment with anticoagulants for submassive PE all the way to ECMO for massive pulmonary embolization. The solution to these challenges is the development of standard protocols based on reliable data. PERT’s dataset will help to create national guidelines for risk stratification and standard treatment protocols.

Methodist Heart and Lung Institute is taking a leadership role in improving standardization and protocols for PE care. The approach to patients with pulmonary embolisms begins with a standardized assessment of the basic clinical variables of each patient who is admitted to the hospital with this condition. Next, the team uses a scoring system to determine each patient’s clinical risk and best treatment option. Finally, PERT tracks the patient throughout hospitalization and after discharge, collecting outcomes and readmission data.

Methodist Heart and Lung Institute’s pulmonary and critical care team has large patient volumes, rendering the hospital’s patient data especially useful for researchers.

Whereas other facilities may only see a handful of PEs a year, our program sees 200-300 a year.

Additionally, Methodist Heart and Lung Institute has a robust ECMO program, giving the hospital the capability to care for patients with massive PE. Our system of care interacts with the ECMO team, informing them of any patient who presents with a PE. Working as one multidisciplinary team, PERT and ECMO experts follow each patient from admission to discharge.

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Charles Burch, md Director, Cardiovascular Intensive Care Unit (CVICU), Methodist Hospital PE is a common, dangerous condition that is garnering national attention. One particular challenge of treating this condition is that it can be difficult to diagnose. Time to diagnosis and time to treatment are important indicators of whether a given patient will survive a PE. Having well-organized, standard diagnostic and treatment protocols in place can significantly improve outcomes for patients with PE, while also decreasing readmission rates.

In 2022, the PERT team will expand our program to examine data across Methodist Healthcare.

This will enable us to determine the best systemwide approach to PE diagnosis and treatment.

We aim to continue making improvements to our dataset, enabling us to extract more sophisticated and detailed information that will inform protocol development.

Our vision is that PE identification and treatment will become as standardized, and as successful, as heart attack care is today.

The database we are creating of PE patients across the Methodist Healthcare system will become the basis of a model for effective PE management at HCA hospitals nationwide.

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Interventional Pulmonology

As a full-service center, the Advanced Lung Center at Methodist Heart and Lung Institute treats a range of lung diseases, from emphysema, pulmonary hypertension, and chronic obstructive pulmonary disease to central airway disease, pleural disease, and tracheal stenosis. A large part of the team’s work in interventional pulmonology involves managing lung cancer.

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Retired Police Officer, John Underwood, was diagnosed with two types of lung cancer. “I promised my daughters I was going to beat it [cancer], and no doubt in my mind I’m going to.”

- John Underwood Lung Cancer Patient

SCAN QR CODE TO WATCH VIDEO.

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IP

Interventional Pulmonology Lung cancer is still the number-one cancer killer in the U.S., and 60 percent of lung cancer diagnoses are made when the cancer has reached an advanced stage, where treatment options are more limited.

Nationwide – and certainly in South Texas – early detection of lung cancer can save lives. With new diagnostic technologies and effective earlystage treatments, the outlook for lung cancer is more positive than ever – if it is caught early on. Improving early detection is a main focus of Methodist Heart and Lung Institute’s interventional pulmonology program.

The Advanced Lung Center at Methodist Heart and Lung Institute brings together a robust lung nodule program with leading-edge diagnostic technology and state-of-the-art treatment options, resulting in the only well-integrated, comprehensive lung cancer program in San Antonio and South Texas at large. This program has two main pillars: the lung nodule screening and surveillance program and the lung cancer program.

Most early lung cancer diagnoses come from CT scans that identify incidental findings during a scan for an unrelated issue in the chest or abdomen. The center uses software to scan patients’ electronic medical records for those findings and route the information to dedicated patient navigators, who contact each patient or their physician to offer the center’s lung nodule screening program. Most early lung cancer diagnoses that Methodist Heart and Lung Institute is making come as a result of the lung nodule program.

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Napoleon Puente, md Director, Pulmonary Endoscopy, Methodist Hospital Co-Director, Lung Cancer Program and The Advanced Lung Center When it comes to improving survival for lung cancer, early diagnosis is hugely important.

Good early detection capability starts with a lung nodule program, so patients who are at high risk of developing lung cancer don’t get lost in the community.

We’re very motivated; we view early detection of lung cancer as a labor of love. We have strong, collaborative relationships with thoracic surgeons and oncologists, which enables us to provide tightly coordinated care to our patients.

Everyone on the team is engaged in helping patients – we’re excited that we’re able to provide the South Texas community the services that are needed to save lives.

Our future goals include expanding the lung cancer program to reach more patients in the local community and replicating the program across other HCA hospitals, both within the San Antonio region and nationwide. We’ll continue working with partners to develop and explore new interventional pulmonology technologies.

We’ll also be participating in clinical trials to test new treatment modalities for lung lesions, such as RF ablation and microwave for patients who are not surgical candidates.

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Interventional Pulmonology When patients come to the lung nodule clinic, they receive detailed evaluation of their lung nodule, including follow-up monitoring as needed. Patients also receive information on how to reduce their lung cancer risk, including smoking cessation counseling.

The second pillar is the lung cancer program, which begins with robust diagnostic capabilities. center’s state-of-the-art-diagnostic capabilities include endobronchial ultrasound and navigational bronchoscopy. In 2019, the center added robotic bronchoscopy to its menu of diagnostic services.

Methodist Heart and Lung Institute was the second site anywhere in Texas to get robotic bronchoscopy technology, and it remains the only facility in San Antonio to have it.

Using these advanced tools, the interventional pulmonology team is able to target lesions that were previously impossible to reach. Being able to go after lesions that are 6 or 8 mm – rather than waiting until they are 1 to 2 cm – enables patients to be treated up to six months earlier, increasing the chance of a cure.

Early detection, efficiency, and a great patient experience set the center apart from other programs. Identified patients are scheduled for the lung nodule clinic right away, and the interventional pulmonologists perform procedures two days a week. That means that patients can be evaluated, have the necessary diagnostic procedures and biopsy, and start treatment on a faster timeline than anywhere else.

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Ali Abedi, md Medical Director, Lung Cancer Program, Methodist Hospital Co-Director, Interventional Pulmonology, Methodist Hospital Although we certainly treat other lung diseases, from emphysema and pulmonary hypertension to central airway disease, pleural disease, and tracheal stenosis, a large part of our work in interventional pulmonology is managing lung cancer.

Our lung cancer diagnostic procedures have increased tenfold over the last two years, leading to twice as many lung cancer surgeries over the same period of time. That means that many more people are getting their lung cancer diagnosed and treated at an earlier stage. Our expedited treatment timeline means that patients can go from the initial identification of a lung lesion to treatment and cure in one month or less, rather than two to three months at other programs.

Our dedicated lung cancer navigators play an important role, coordinating each patient’s care throughout treatment. During twice monthly multidisciplinary tumor boards, we discuss each lung cancer patient’s case and develop integrated treatment plans customized for each patient. This results in big advantages for patients: from the moment we identify them to the moment we have a treatment plan in place, everything is seamlessly coordinated and managed step by step.

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As we conclude this comprehensive overview of our cardiovascular programs, I am truly grateful and honored to work alongside the devoted individuals who have made our mission possible. Our clinical performance and our level of success is a testament to the partnerships and relationships we’ve built with physicians and hospitals in our area.

Over the past couple of years when collaboration was essential for best performance, our teams reached new heights. Looking ahead, our promise is to provide continued medical advancements throughout the depth and breadth of our clinical offerings. One fundamental aspect of our structure is our continued desire to evaluate and improve our systems of care at all levels. Innovation and quality are at the forefront of everything we do, and we will only continue to advance because of the medical leadership we have and through the partnerships we’ll build in the future.

This is an exciting time for the Methodist Heart and Lung Institute as it expands its mission of providing excellent cardiovascular and pulmonary care on a world-class level.

I welcome your feedback including suggestions, inquiries, and corrections.

Fernando Triana, MD Physician Director Cardiac, Vascular, Pulmonary and Thoracic Service Line

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