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Heart & Vascular OutcomesGAGNON CARDIOVASCULAR INSTITUTE

Welcome

The Department of Cardiovascular Medicine at Morristown Medical Center,Overlook Medical Center and Newton Medical Center is leading the way ininnovative cardiovascular care in New Jersey. It encompasses the largestcardiovascular surgical program in New Jersey and nationally recognizedexpertise in each of cardiology’s major disciplines. We offer advancedindividualized team-based care for all forms of adult heart disease and areproud of our numerous awards and accolades, including recognition by U.S.News & World Report as one of the nation’s best hospitals for cardiology andcardiovascular surgery.

The center of the program is the Gagnon Cardiovascular Institute, a state-of-the-art heart hospital opened in 2009 on the Morristown Medical Centercampus. As highlighted in subsequent pages, this facility includes eightoperating rooms (two hybrid), five catheterization labs, threeelectrophysiology labs and advanced non-invasive imaging capability. Wealso have integrated programs for treating heart failure, heart disease inwomen, valvular heart disease, rhythm disorders and vascular disease.Through the partnership of our Advanced Interventional Therapies Programand Cardiovascular Surgical Program, we are one of only 20 programsnationally to offer all currently available catheter-based treatments for valvularheart disease (the SAPIEN® and CoreValve® valves for aortic stenosis and theMitraClip® for mitral regurgitation).

In addition to providing high quality care, optimizing the patient experience isalso a priority. From friendly greeters who meet patients at the front door toour exceptional group of physicians, nurses and allied health professionals,the Department of Cardiovascular Medicine is truly patient-centered.

Education is also part of our commitment. We offer a series of live and web-based programs for our professional and patient communities as well as livecase transmissions to professional society meetings and New Jersey’sLiberty Science Center. Our ACGME core cardiology fellowship and anadvanced imaging fellowship are training the next generation of cardiologists.

The Department of Cardiovascular Medicine also has a fully staffed researchdivision supporting both federally and industry-funded trials.

Excellence in all aspects of cardiovascular medicine and surgery is thehallmark of our program. I am proud to lead this exceptional team. Pleasetake a few minutes to read more about our program and its accomplishmentsand consider a personal visit as well.

Sincerely,

Linda D. Gillam, MD, MPH, FACC, FAHA, FASEChair, Cardiovascular MedicineAtlantic Health System

Heart and Vascular Outcomes 3

Exclusively published for Atlantic Health System475 South StreetMorristown, NJ 07962

Written, designed and produced by: Onward Publishing, Inc. 6 Bayview AvenueNorthport, NY 11768 631-757-8300

Photos: John Abbott and Titus Photographics

All charts based on internal data unless otherwise noted

y Overview_________________________4

y Cardiac Surgery __________________8

y Cardiac Rhythm Management ___10

y Advanced Interventional Therapies Center_________________12

y Advanced Heart Failure__________14

y Imaging _________________________16

y Valvular Heart Disease___________18

y Women’s Heart Program_________20

y Vascular Surgery ________________22

y Rehabilitation Services___________24

y Research and Education_________26

y The Patient Experience___________28

Table of Contents

Overview


Expert care is provided here by more than 700 board-certified cardiac and vascular care specialists,nurses and technologists. Clinical excellence correlates strongly with experience — more heartsurgeries are performed at Morristown Medical Center than at any other New Jersey hospital.

Gagnon Cardiovascular Institute’s services encompass the entire spectrum ofcardiac treatment and include:

y A catheterization laboratory that completesmore than 6,500 successful catheterizationsand angioplasties annually.

y The Cardiac Rhythm Management Program,which performs approximately 2,000 proceduresa year including ablation and device implantation.

y The Valve Program, whose surgeons performnearly 600 surgeries involving valvular repaireach year, placing Morristown Medical Center in the top two percent of all cardiac surgicalprograms in the United States in terms ofexperience. Gagnon Cardiovascular Institute isalso a leader in non-surgical approaches tovalve disease.

y Rehabilitative Medicine and Cardiac IntegrativeMedicine programs that help outpatients return totheir communities at lower risk of heart diseasethan before, reducing the risk of chronic events.

y The comprehensive Thomas E. Reilly HeartSuccess Program, which helps patients withheart failure manage their chronic diseasethrough a collaborative approach that includesboth MDs and APNs.

Gagnon Cardiovascular Institute is at the forefrontof research, working to develop new life-savingdiagnostic, medical, surgical and interventionaltreatments. Our goal is to prevent all types ofheart disorders and illnesses and to share ouradvanced knowledge with current and futurecardiac care professionals.

We employ the latest technologies, including 320-slice CT, percutaneous valve repair, epicardialablation and robotic surgery where appropriate. Inaddition, patients have the opportunity to accessthe newest treatments through the institute’sresearch programs and clinical trial participation.Comprehensive planning and care make for betteroutcomes at every level, even for high-riskpatients who, in other facilities, might not beconsidered candidates for some treatments.

Morristown Medical Center's Gagnon Cardiovascular Institute isrecognized as a national leader in the research and treatment of cardiacdiseases. Every aspect of the comprehensive cardiovascular services atthe Gagnon Cardiovascular Institute and the Charles L. Tice HeartCenter demonstrates a dedication to quality and a passion for advancingthe art of cardiac care to patients at Morristown Medical Center,Overlook Medical Center and Newton Medical Center.

Many patients come to our facility as rapid transfersfrom either an outlying acute care hospital’s emergencydepartment or an inpatient unit when a patient isdeemed to need a higher level of care or the specialtyservices offered by Gagnon Cardiovascular Institute.

A single call by either a referring physician or hospitalrepresentative to the Atlantic Patient Transfer Centersets in motion a variety of patient transfer coordinatingservices to achieve a safe and seamless transition in atimely fashion. These include targeted physician-to-physician consultation, updated communications ofpatient status en route to all involved clinicians, intakelogistics, and necessary insurance reviews andauthorizations. Teams of registered critical care nurses,on call 365 days per year, stand ready to assist referringdoctors and accompany patients. One phone call to877-441-4450 is all it takes to mobilize all parties andthe transport team can reach any location in New Jersey,by ambulance or helicopter, within 20 minutes if necessary.

Morristown Medical Center is also a Level I RegionalTrauma Center and a Stroke Center, which are servedby Atlantic’s 911 Mobile Intensive Care Unit. When a callinvolves a possible AMI or stroke patient, attendingparamedics are able to assess and send, via telemetry,the results of 12-lead electrocardiograms to the awaitingER, activating the STEMI team when appropriate to beready when the patient arrives. It’s one more essentialstep in making our door-to-balloon times well belownational norms.

Clockwise from top left: Morristown Medical Center, Gagnon Cardiovascular Institute, Overlook Medical Center,

Newton Medical Center


U.S. News & World Report has named MorristownMedical Center a “Best Hospital” in the country forCardiology and Heart Surgery. It’s the latest example ofour dedication to providing the highest quality medicalcare as well as the latest diagnostic and treatment toolsto our patients and their families.

The Society of Thoracic Surgeons(STS), which uses 11 separate qualitystandards in measuring cardiacsurgery performance at hospitalsthroughout the country, awardedMorristown Medical Center threestars, its highest rating. Only 14percent of participating institutionsachieve this high honor. For thelast decade, Morristown MedicalCenter’s mortality rates have beenstatistically lower than the STSnational database benchmark.

Beacon Award by the AmericanAssociation of Critical CareNurses. The Beacon Award for Excellence lauds NorthAmerican hospital units that employ evidence-basedpractices to improve patient and family outcomes. TwoGagnon Cardiovascular Institute units, the Cardiac CareUnit and Gagnon A, at Morristown Medical Center havereceived this honor. Only 166 units in the countryachieve the Beacon Award. Recipient of the BeaconAward since 2009, Morristown Medical Centers’Cardiac Care Unit has been recognized asdemonstrating continuous learning and effectivesystems to achieve optimal patient care.

Thomson Reuters Top 100 Hospitals forCardiovascular Care. After examining 970 hospitals,Thomson Reuters recognized Morristown MedicalCenter as a standout facility in the region. Analyzed inthe rating were clinical outcomes, patient safety andpatient satisfaction among persons diagnosed withheart failure, heart attacks or patients who underwentCABG or angioplasties.

Magnet Recognition by the American NursesCredentialing Center. Only six percent of all registeredhospitals in the US have achieved this prestigious statusto date. Morristown Medical Center has held this honorfor 12 years running, in recognition of the hospital’s

sustained support for educationand professional developmentamong its nursing staff and theconcomitant effect it has onnursing recruitment, retention andquality patient care. The Magnet

recognition also contributes toGagnon CardiovascularInstitute’s selection as aparticipant in major

clinical trials.

ACTION Registry® — Get withthe Guidelines™ 2009, 2010,2011 Gold Performance

Achievement Award, and 2012Platinum Performance AchievementAward conferred by the American

College of Cardiology Foundation/ American HeartAssociation. The award was made in recognition ofMorristown Medical Center’s adherence to currentnational guidelines for treatment of patients withcoronary artery disease, specifically high-risk STEMI andNSTEMI patients.

Gold Seal of Approval™ for a Ventricular Assist Device Program. Awarded by the Joint Commission in recognition that the hospital’s VAD program is patient-centered, comprehensive, well-developed and has met stringent standards of care. MorristownMedical Center is one of 60 hospitals nationwide toreceive this recognition. We implant approximately 10 LVADs annually.

Consumer Reports has given Morristown MedicalCenter a 3 star designation as a cardiac surgery programwith excellent coronary artery bypass outcomes.

RECENT ACCOLADES AND ACCOMPLISHMENTS

Cardiac Surgery

THE SOCIETY OF THORACICSURGEONS (STS) AWARDEDMORRISTOWN MEDICALCENTER ITS PRESTIGIOUS“THREE STAR AWARD.”

At MorristownMedical Center,successfulcardiac surgeryrelies on multipledisciplinescontributing tothe individualizedcare of ourpatients. Ourprogram is thelargest in NewJersey, withnearly 1,300surgicalproceduresperformed eachyear. The GagnonCardiovascular Institute at Morristown MedicalCenter offers a full range of open and minimallyinvasive heart surgeries, and is one of the fewprograms in the country that has grown eachyear over the last five years.

The growth of our program is largely attributableto an increase in valve surgery. Minimally invasivesurgical repair and replacement for the mitral andaortic valves is routine and combines the durableresults of conventional surgery with a fasterrecovery time, reduced pain and obviouscosmetic advantages over approaches usinglarger incisions. It will remain the destination ofchoice for most patients needing expert care forvalvular heart disease.

John M. Brown III, MDChief of the Section of

Cardiovascular Surgery


Left to right: Steve Xydas, MD, John M. Brown III, MD,Christopher J. Magovern, MD, James Slater, MD

We are also recognized forbeing early leaders in thefield of percutaneous valvetherapy and offertranscatheter aortic valvereplacement with both theSAPIEN® and CoreValve®

devices. We have also beenearly adopters of theMitraClip® for mitral valverepair and we are about tobegin the SURTAVI trialwhich is comparingpercutaneous aortic valvetherapy in an intermediaterisk group. It has alreadybeen proven more effectivethan medical therapy in the

group of patients who are not candidates for surgery and hasbeen proven as effective as surgery in the high-risk group attwo years.

Our results with surgical revascularization continue to beexcellent. The duration of cross-clamp time is increasinglycorrelated with overall operative risk. Our cross-clamp timesare shorter than the national average and we feel thistranslates to a better patient outcome. Surgical volume is alsooften used as a marker for surgical results. Each of thesurgeons at Morristown Medical Center performsapproximately 300 heart surgeries a year. Our surgical resultscompare favorably with established national benchmarksdespite our comparatively high number of older patients withcomplicating co-morbidities. We expect that the need forsurgical revascularization will only increase in recognition of theearly results of the FREEDOM trial.

In addition to surgery for valvular heart disease and surgicalrevascularization with beating heart and MIDCAB procedures,Morristown Medical Center provides surgical devices for heartfailure, valve-sparing aortic root procedures, laser-guided leadextractions, robotically assisted MIDCAB procedures andtransmyocardial laser revascularization.

Grant V.S. Parr, MD, FACC,FACS, FCCP, FRSM(E)Physician-in-Chief

2006 2007 2008 2009 2010 2011 2012 LIKE STS

10%

8%

6%

4%

2%

0%

Morristown Medical CenterMitral Valve Repair Observed

Mortality (STS)

2007 2008 2009 2010 2011 2012

1,300

1,225

1,150

1,075

1,000

Morristown Medical Center All Open Heart Surgery Procedures

STS like group and total populationtaken from STS National ReportPeriod Ending 6/30/2012

Cardiac RhythmManagement

Under the directorship of Stephen Winters, MD, thecardiac rhythm management (CRM) program atMorristown Medical Center remains at the forefrontof established and investigative approaches to theevaluation and management of the most complexabnormal heart disturbances. The core group ofcardiac electrophysiologists, Jay Curwin, MD, RobertCoyne, MD, Jonathan Sussman, MD and TimothyMahoney, MD, perform more than 2,000 proceduresannually, including diagnostic electrophysiologyevaluations, catheter ablations and implantations ofrhythm control devices. The team has expertise inevaluating cardiac rhythm disturbances, from benignpalpitations to the most complex inherited arrhythmiasyndromes and channelopathies (e.g. long QTsyndrome, Brugada syndrome, catecholamine-dependent polymorphic ventricular tachycardia(CPVT), arrhythmogenic right ventricular dysplasia(ARVD)). A large focus of the program iscomprehensive treatment of syncope,bradyarrhythmias, heart block, supraventriculartachycardia, atrial fibrillation and flutter, ventriculartachycardia, ventricular fibrillation and riskassessment for sudden cardiac death. Physicianmembers of the program are all ABIM certified incardiac electrophysiology and are active in thedepartment’s training of cardiology fellows, medicalresidents, cardiovascular technologists and nurses.

The team has expertise in advanced ablationtechniques that include the use of radiofrequencyand cryoenergy for such complex rhythmdisturbances as ventricular tachycardia and atrialfibrillation, as well as supraventricular tachycardia.Ours was the first program in the state to utilizecryoballoon technology to cure atrial fibrillation, andwe are involved in an ongoing multicenter study toassess the “real-world” experience with catheterablation of atrial fibrillation. Our capabilities forablation of ventricular tachycardia include theconcomitant use of hemodynamic supportmodalities, along with endocardial, epicardial,transseptal and supra-aortic approaches.

EACH YEAR, WE PERFORMAPPROXIMATELY 2,000CRM PROCEDURES.


State-of-the-art electroanatomic mapping technology helpsmaximize procedural success while minimizing patient risk.

Our pacemaker and defibrillator (ICD) implantationcomplication rates are consistently at or below nationallypublished benchmarks. The group has been, and remainsextensively involved in, prospective trials of indications fornew technology and evolving utilization of these devices. Inaddition to participating in trials including MADIT, CABG-Patch, DEFINITE, and MADIT-RIT, our electrophysiologistshave been leading enrollers in two important ongoing NIHtrials (M2RISK, a trial aiming to define which patients benefitmost from ICDs post myocardial infarction in primaryprevention against sudden death, and RAID, which exploresthe benefit of ranolazine in preventing harmful shocks in ICDrecipients). The importance of the comprehensive on-siteand remote monitoring by our Pacemaker and DefibrillatorFollow-up Center, which ensures continuity of patient carewith over 11,000 evaluations per year, is ever more crucial inlight of recently recognized lead and device alerts. We workclosely with our cardiac surgical colleagues in providing leadextraction to appropriate patients.

The program’s efforts extend to improving the clinical andfunctional states of patients with congestive heart failure.We have been active in investigational, as well asestablished electrode and pulse generator technology forcardiac resynchronization therapy (CRT) pacemakers anddefibrillators. In conjunction with the Thomas E. ReillyHeart Success program, our electrophysiologists are veryinvolved with monitoring and optimization of implanted CRT systems. We participate in investigations of advancedapproaches to the management of congestive heart failure such as LAPTOP, which evaluates the benefit oftranscatheter left atrial pressure recording systems to enable patient-directed care.

Along with leading edge facilities and technology, theprogram boasts fully dedicated nursing and technical staffs that delivers outstanding patient care. Ourelectrophysiologists welcome the opportunity to workclosely with our referring physicians in providing state-of-the-art evaluation and treatment of patients with cardiac rhythm abnormalities.

1998–2002 2003–2007 2008–2012

3,000

2,250

1,500

750

0

Gagnon Defibrillator Implants

1997–2000 2001–2004 2005–2008 2009–2012

1,200

900

600

300

0

Gagnon Catheter Ablation Procedures

2004–2006 2007–2009 2010–2012

500

375

250

125

0

Gagnon Biventricular Defibrillator Implants

2007 2008 2009 2010 2011 2012

150

120

90

60

30

0

Gagnon Atrial Fibrillation Ablation

Left to right: Robert Coyne, MD, Timothy H. Mahoney, MD, Stephen L. Winters, MD, Jonathan S. Sussman, MD, Jay H. Curwin, MD

The AdvancedInterventionalTherapiesCenter

The Advanced Interventional Therapies (AIT)Center at Morristown Medical Centerspecializes in the latest techniques for minimallyinvasive catheter-based treatment for complexcardiac diseases. This state-of-the-art facilityoffers the latest imaging modalities andtherapeutic technologies to treat patients withcomplex coronary, structural heart (includingvalvular diseases) and endovascular diseases.

The AIT Center, which includes more than 20expert interventional cardiologists is led by itsdirector, Maurice Buchbinder, MD, Professor ofMedicine, Stanford University School ofMedicine; Robert Kipperman, MD, Director ofStructural Heart Disease; Barry Cohen, MD,Medical Director of the Cardiac CatheterizationLaboratories and Jordan Safirstein, MD,Director of Radial Coronary Intervention.

Through our well-established and highlyregarded research program, MorristownMedical Center offers the latest technologies,often prior to approval for general use (through

Members of the Interventional Cardiology team: Robert Kipperman, MD, Vance Weber, MD, Derek Santiago, MD,Domenick Randazzo, MD, Barry Cohen, MD, Brian Feehan, DO, John Cosmi, MD, Paul DeRenzi, MD, Craig Rosen, MD, Benjamin Fusman, MD, Puneet Gandotra, MD. Additional physicians unavailable for photo.

THE ADVANCEDINTERVENTIONALTHERAPIES CENTER IS ALEADER IN OVER-THE-WIRE INTERVENTIONS.

IRB-approved trials). Studies include the latest stenttechnologies, including the use of drug eluting stents withbiodegradable polymer or other polymeric scaffolds,which are fully biodegradable. For patients at high-riskduring coronary interventions, hemodynamic supportedprocedures with the Impella™ system are also available.Morristown Medical Center was the first center in NewJersey to perform systemic cooling with the Artic Sun®

device in a patient following cardiac arrest to preservebrain function. Hypothermia is now the standard of carein treating such patients.

Morristown Medical Center was the first hospital in NewJersey to offer minimally invasive catheter-basedtreatment for mitral regurgitation with the MitraClip®

system and the first to perform transcatheter aortic valveimplantation/replacement (TAVI/TAVR) for patients withsevere aortic stenosis. The “Heart Team,” comprised ofour expert interventional cardiologists and cardiacsurgeons, works together with our nationally renownedechocardiographers and cardiac anesthesiologists intreating patients at “high” or “prohibitive risk” for opensurgical aortic valve replacement (AVR). Procedures cannow be approached via transfemoral, transapical, directaortic or subclavian access routes.

Patients with congenital heart disease such as atrialseptal defects (ASDs) are being treated routinely atMorristown Medical Center using catheter-basedtechniques. Our interventional cardiologists have alsoteamed up with our colleagues in neurology to treatselected patients with cryptogenic stroke whenassociated with a patent foramen ovale (PFO).

The latest endovascular techniques are also available forpatients with refractory hypertension. Under a researchprotocol with the ARDIAN System, we provide renaldenervation to help control otherwise drug-resistant

hypertension. Selectedpatients with severe carotidartery narrowing can betreated with stenting insteadof surgery.

Radial access for coronaryprocedures is growing underthe leadership of Dr. Safirstein,who has also instituted anannual education programentitled MARS: the Mid-Atlantic Radial Symposium.

Morristown Medical Centerhas been recognized as aleading STEMI center, rankedamongst the top institutions for care of heart attacksusing standardized core measures that compare toMorristown Medical Center to all other institutionsnationwide. A team of dedicated physicians, nurses andtechnicians are on call, ready to respond at every hour ofevery day throughout the year.


Barry Cohen, MD, Maurice Buchbinder, MD, and Robert Kipperman, MD

2010 2011 2012

6.8% 5.6% 8.8% 7.1% 13.6% 12.4%

5,000

4,000

3,000

2,000

1,000

0

Percent RadialArtery Approach

PCI

Gagnon Coronary Artery Procedures

Cath

Radial artery access is associated withfewer complications and a faster recovery.

2010 2011 2012

30

24

18

12

6

0

Gagnon Advanced Interventional Therapies

PFO/ASD

MitraClip®

TAVI Procedures

Valvuloplasty

Jordan G. Safirstein, MD

AdvancedHeart Failure

The Thomas E. Reilly Heart SuccessProgram, the advanced heart failure programbased at Morristown Medical Center, isnationally recognized as a leader in advancedheart failure treatment and mechanicalcirculatory support. Our program offers acomprehensive, multi-disciplinary andpersonalized approach to the management ofcomplex cardiovascular disease involvingspecialists at our institution. This care isprovided through a collaborative approachwith the patient’s referring physician in orderto optimize patient care. We are able to offeradvanced therapies for the treatment ofpatients with dilated, hypertrophic andinfiltrative cardiomyopathies as well aspulmonary hypertension

Our institution employs advanced cardiacimaging, including PET, CT, cardiac MRI and3D echocardiography to gain a detailed

THE ADVANCED HEARTFAILURE PROGRAM HASBEEN A PIONEER IN THEUSE OF MECHANICALASSIST DEVICES AS ADESTINATION THERAPY.


assessment of each patient’s cardiac condition. We canalso perform risk stratification through cardiopulmonarystress testing. The Thomas E. Reilly Heart SuccessProgram offers both established and investigationaltreatments for heart failure involving pharmacological,interventional and surgical approaches. We workcollaboratively with our electrophysiology, interventionalcardiology, cardiothoracic surgery and cardiacrehabilitation colleagues. Our program has aninnovative, nurse practitioner-driven approach toimproving care by optimizing heart failure treatmentregimens and pioneering the use of remote monitoringof patients through various pathways. As a result, at fivepercent, our 30-day readmission rates are among thelowest in the nation.

For patients with end-stage heart failure, the Thomas E.Reilly Heart Success Program can offer advancedtherapies beyond intravenous inotropes. MorristownMedical Center is one of the region’s leading advocatesfor the use of mechanical assist devices that havedramatically improved both the prognosis and quality oflife for patients with end-stage heart failure. We areamong the largest non-transplant centers in the nationto offer left ventricular assist devices either as a bridgeto transplant or as destination therapy for those who arenot transplant candidates. We offer the latest generationof LVADs that have been shown to offer greaterreliability and durability compared to older and largerdevices. Our LVAD program has received the Gold Sealof Approval™ from the Joint Commission. For thosewho have sustained acute cardiogenic shock, we alsohave the ability to offer short-term support with theAbiomed Impella®, Thoratec CentriMag® or ECMO.These devices allow us to support a patient until moredefinitive therapy can be safely offered.

HeartMate ll® Impella®

James Slater, MD, Marc Goldschmidt, MD andmembers of the Heart Success team.

Imaging

Imaging is essential for the evaluation andmanagement of patients with known orsuspected cardiovascular disease and theGagnon Cardiovascular Institute atMorristown Medical Center and OverlookMedical Center ensures that state-of-the-artequipment and expert imaging staff areavailable for all imaging modalities.

Cardiovascular Ultrasound andOptical Coherence Tomography

Our cardiovascular imaging equipmentincludes the newest generation Philips andGE systems with 3D transthoracic andtransesophageal capability. Offline analysis isavailable through Philips Q-Lab, Tomtec andGE EchopacTM systems. This ensuresoptimal evaluation of all patients, particularlythose with structural heart disease. 3Dechocardiography is an important tool forevaluating patients with valvular andcongenital heart disease and helps guidesurgical and percutaneous approaches totreatment. In addition to 3D, other advancedapproaches to evaluating left and rightventricular anatomy and function are alsoavailable including strain, strain rate, twistand torsion. These provide sensitive tools for identifying early ventriculardysfunction before a reduction in ejectionfraction occurs.

We also use intracardiac echo (ICE) inguiding transcatheter closures of PFOs andASDs, and Intravascular Ultrasound (IVUS)and Optical Coherence Tomography (OCT)in procedures where we need a detailed andaccurate measurement of lumen and vesselsize, plaque area and volume, or othertissue characterizations within a suspectcoronary artery. Imaging findings help usdetermine if an arterial lesion is stable or vulnerable.

OUR IMAGING DEPARTMENTIS LEAD BY NATIONALLEADERS IN THE FIELD.

Nuclear imaging

Nuclear imaging remains an essential tool in managingpatients with known or suspected coronary arterydisease. Morristown Medical Center has the capabilityto perform standard myocardial perfusion imaging aswell as PET scanning alone or in combination with CT(PET-CT). Together these studies can define coronaryanatomy, myocardial perfusion and function, thusfacilitating clinical decision-making.

Cardiac CT

CT plays an important role in delineating structuralabnormalities of the cardiovascular system and inidentifying and quantitating atherosclerotic disease.Gagnon Cardiovascular Institute has two GE 64-sliceCT scanners. In addition, we are the only cardiac centerin the region with the Toshiba 320 Multislice CT scanner.While 64-slice has been rightly regarded as a greatachievement in imaging, the new Toshiba scanner cangenerate large image “slices” in one second or less,wide enough to display most of the body’s organs witha single rotation of the gantry, a major advantage overearlier devices. This system provides the best cardiacand brain perfusion images available.

MRI

Magnetic resonance imaging is the gold standard forevaluating infiltrative cardiomyopathies and evaluatingmyocardial viability/fibrosis. Led by cardiovascular MRIexperts, our MRI program is the busiest and mostrobust in the state.

Electro-Anatomical Mapping

Similar in concept to a GPS system, the CARTO 3system creates a magnetic field that pinpoints cathetersin 3D space during electrophysiology procedures,thereby facilitating ablations.


ValvularHeartDisease

The Valve Center at Morristown MedicalCenter offers state-of-the-art, evidence-based evaluation and management ofpatients with valvular heart disease. Ourteam approach includes expert non-invasivecardiologists, interventional cardiologists andcardiovascular surgeons as well ascolleagues in integrative medicine andrehabilitation medicine, all committed to theappropriate use of resources including non-invasive testing.

WE ARE ONE OF ONLY 20CENTERS IN THE U.S. TOOFFER ALL AVAILABLECATHETER-BASEDAPPROACHES FOR VALVEREPAIR AND REPLACEMENT.

We medically manage our patients until evidence-basedtriggers for further intervention are met, taking advantage ofour access to new imaging techniques that are no morecostly than less-advanced approaches. When surgicalintervention is indicated, we have the most experiencedopen-heart surgery program in the state of New Jersey.Morristown Medical Center surgeons perform more open-heart surgeries than any other facility in New Jersey, havesome of the lowest mortality rates and achieve patientsatisfaction scores in the 90th percentile. Our CardiovascularSurgery and Cardiology Programs are ranked 38 in thecountry in the most recent U.S. News & World Report andour Cardiovascular Surgery Program is one of only 14percent nationally that have received three stars, the highestrating offered by the Society of Thoracic Surgeons (STS).

For patients who are at high risk for surgery, we are one ofonly 20 centers in the nation to offer all available catheter-based approaches for valve repair and replacement: theFDA-approved SAPIEN® aortic valve and two investigationaldevices, CoreValve® (aortic valve) and MitraClip® (mitralvalve). The Valve Center coordinates patient testing andevaluation, including valve expert board certified cardiologistsand cardiothoracic surgeons in the discussion of treatmentoptions. Quality is continuously monitored through structure,process and outcomes measures, including those metricsthat assess quality of life.


MitraClip® system, employed by GagnonCardiovascular Institute cardiologists to

help reduce mitral regurgitation (MR).

SAPIEN® Transcatheter Heart Valve Replacement

CoreValve® Transcatheter Aortic Valve Replacement

2010 2011 2012

40

30

20

10

0

Gagnon TAVI Procedures Volume

We offer the latest in transcatheter aorticvalve implantation (TAVI), including theCoreValve® and SAPIEN® valve.

Offering comprehensive, gender-optimizedcare to women from early adulthood throughreproductive years, menopause and advancedage is the mission of the Women’s HeartWorking Group and its programs atMorristown, Overlook and Newton medicalcenters. Claire Boccia Liang, MD, director ofthe Women’s Heart Program, works with ateam of cardiologists to provide advanced carein the treatment of coronary artery disease,valvular heart disease, peripartumcardiomyopathy, heart failure, rhythm disordersand congenital heart disease in women.Primary and secondary prevention of heartdisease is an essential component of theprogram. Our team of nationally recognizedcardiac surgeons specializes in the minimallyinvasive treatment of heart disease andongoing surveillance of congenital diseases ofthe aorta.

Women’sHeartProgramWE STRIVE TO PROVIDETHE BEST CARDIAC CARE,TAILORED FOR THE NEEDSOF WOMEN.

Claire Boccia Liang, MD with members of the Women’s Heart Program and patients.


Comprehensive care comes through collaboration with ourcolleagues in Obstetrics and Gynecology, PediatricCardiology and Integrative Medicine, whose servicesinclude dietary counseling, smoking cessation, exercisephysiology and wellness coaching for women who areknown to have, or are at high risk for, developingcardiovascular disease.

Linda Gillam, MD, MPH, chair of the Department ofCardiovascular Medicine and the Gagnon CardiovascularInstitute, is a national leader in women’s heart health andadvanced echocardiography imaging and the treatment ofvalvular heart disease. She has initiated and strengthenedour ongoing relationships with several nationalorganizations that promote patient education andadvocacy for women with heart disease.

The Women’s Heart Program has become a member ofthe WomenHeart National Hospital Alliance and Dr. Gillamis the Chair of 2013 American Heart Association’s GardenState Go Red for WomenTM Luncheon, one of the largestevents held nationwide on behalf of the Go Red for Women Campaign.

The Gagnon Cardiovascular Institute at Morristown MedicalCenter has a longstanding partnership with the Morristown,NJ Chapter of Mended Hearts, a national organization ofheart disease survivors who offer hope and supportthrough, among other activities, in-hospital visits to thoserecently experiencing heart disease for the first time. Finally,the Woman’s Association of Morristown Medical Center isproviding resources to construct a Women’s ResourceCenter within the main atrium of the GagnonCardiovascular Institute at Morristown Medical Center. Theresource center will provide visiting women with a physicalspace for “drive by” access to resources, which will helppromote improved heart health.

Our Women’s Heart physicians are dedicated todiagnosing heart disease by the most effective meanspossible, ensuring that radiation exposure is minimized.

Advanced echocardiographic, nuclear, MRI and CTimaging are all available to assist in the evaluation andmanagement of patients with structural and ischemic heartdisease. Microvascular disease is a particular diagnosticand treatment challenge fully embraced by our Women’sHeart physicians and our Advanced InterventionalTherapies Center offers state-of-the-art catheter-basedtechniques for the diagnosis of this form of ischemic heartdisease.

The Cardiac Rhythm Management program at MorristownMedical Center’s Gagnon Cardiovascular Instituteimplements gender-tailored care for cardiac rhythm inwomen. It does so by offering in-depth counseling towomen regarding issues as complex as the safety ofintracardiac defibrillator shock during pregnancy, to thoseas common as the concordant pattern seen between risingprogesterone levels and arrhythmia frequency in womenwith supraventricular tachycardia. Gender-optimized care isalso provided for women with valvular heart diseasethrough the Morristown Medical Center Valvular HeartProgram.

Working together with the Divisions of Pediatric Cardiologyand High Risk Obstetrics, Women’s Heart Programphysicians offer comprehensive care to women withcongenital heart disease who require ongoing care andgenetic counseling, both anticipatory to and duringpregnancy.

Minimizing cardiac symptoms and cardiovascular eventsduring menopause is a priority for women in our program.The Women’s Heart Program works closely with theAtlantic Health Menopause Center to offer comprehensiveservices to women at this critical juncture in their physicaland emotional health.

Morristown Medical Center’s vascularspecialists treat problems of the aorta andperipheral vessels with the same “wholesystem” care that their cardiologist colleaguesbring to problems within the heart. Ourvascular physicians offer a wide range ofvascular surgery techniques that includecatheter-based interventions, carotid stenting,and in the case of severe peripheral arterialdisease (PAD), revascularization procedures,based on nonsurgical and surgicalapproaches to restore leg artery patency.

We perform approximately 150 proceduresfor aneurysms annually, the majority of themabdominal aortic aneurysms (AAAs); withMorristown Medical Center being the highestvolume center in New Jersey and among thehighest in the country. Hybrid therapies,

VascularSurgeryMORRISTOWN MEDICALCENTER PERFORMS MOREABDOMINAL ANEURYSMREPAIRS THAN ANY OTHERHOSPITAL IN NEW JERSEY.


which represent more of a revolution than an evolution incardiovascular therapies, bring together interventionalcardiologists, cardiac surgeons, vascular surgeons, andother clinical experts in a single hybrid operating room tooffer a complete, collaborative solution to what used torequire staged treatments and the moving of patientsfrom one suite to another over time. The two dedicatedhybrid suites at Gagnon Cardiovascular Institute allow forvascular imaging, implanting stents and open-heartsurgery as needed within the same sterile setting. Thismakes the procedure extremely efficient for physiciansand for patients who undergo far less physical stressthan in conventional staged treatments.

Morristown Medical Center was among the first hospitalsin the country to construct such a space and to install theSiemens Artis Zeego® medical imaging system, whichmakes this possible. The Zeego is particularly valuable inhelping repair aneurysms that require both surgical andinterventional endovascular components to be doneconsecutively. The Zeego’s robotic multi-axis C-arm givessurgeons extraordinary flexibility in maneuvering theimaging system to get a clear 3D picture of the patient’sendovascular anatomy and to deploy the appropriatestent from almost every angle without moving the patient.While our vascular specialists treat all levels of vascularrepair, technical advances like the Zeego allow us to treatmore complex disease cases and older patients withbetter outcomes than were possible in the past. Inaddition to advanced imaging techniques used in theoperating room, Morristown Medical Center providesvascular ultrasound imaging in its ICAVL-accredited lab.

Kevin James, MD, Medical Director, Vascular Lab

Rehabilitation Services

NATIONALLY CERTIFIED BYTHE AMERICAN ASSOCIATIONOF CARDIOVASCULAR ANDPULMONARY REHABILITATION.


The cardiac rehabilitation program of the GagnonCardiovascular Institute at Morristown Medical Center andOverlook Medical Center is a state-of-the-art programdesigned to help patients with heart disease recover fasterand return to a full, productive life.

The Phase I program starts with early ambulation 1-2 dayspost open-heart surgery, myocardial infarction, or otherinvasive procedure, and continues throughout the hospitalstay. It educates patients and their families aboutcardiovascular disease and risk factor modification inpreparation for the initial return to the activities of daily living.Phase II is a medically supervised, outpatient, monitoredexercise program, which takes place over 12 weeks and 36visits. Candidates for this program include those who havehad a heart attack, coronary artery bypass surgery, cardiacvalve surgery, angioplasty and/or intracoronary stentplacement or ongoing stable angina. Phase II’s mainobjective is a rebuilding of patient cardiovascular andmuscular endurance, improved flexibility, and facilitation of areturn to work and daily living. Proper exercise principles,nutritional counseling, stress management and other aspectsof a healthy lifestyle are also taught.

Our program is nationally certified by the AmericanAssociation of Cardiovascular & Pulmonary Rehabilitation, amark of top quality standards. Cardiologist directed, the staffis comprised of critical care registered nurses, cardiovasculartechnologists, exercise physiologists and a clinical dietician.

Gagnon Cardiovascular Institute at MorristownMedical Center, Overlook Medical Center andNewton Medical Center is at the forefront ofcardiovascular research, working to developnew life-saving cardiology treatments. Weparticipate in dozens of clinical trials each year,including those that are federally and industry-funded. These national and international studiesenhance our physicians' familiarity withpromising advancements in interventionalcardiology, electrophysiology, cardiac surgery,vascular surgery, cardiac imaging and clinicalcardiology. The result: improved outcomes forour patients.

Research andEducation

STAYING AT THE FOREFRONTOF CARDIOVASCULARRESEARCH MEANS BETTEROUTCOMES FOR OURPATIENTS.

Members of the Gagnon Cardiovascular Institute research team.


Our physicians regularly present their clinical findings andtreatment techniques at well-regarded regional, nationaland international cardiac conferences. In sharing clinicalresults with national and international leaders in cardiology,our doctors train the next generation of cardiac experts,underscoring our reputation as a highly respected centerfor cardiovascular research.

Morristown Medical Center has comprehensive teachingprograms for cardiology fellows, medical residents andmedical students. Gagnon Cardiovascular Institute alsohas a robust program of educational seminars, offeringCME-award programs for physicians and other medicalpersonnel several times a year. We provide transmission

of surgical andinterventional cases to professional societymeetings and offerwebinars on a variety of subjects. We areparticularly proud of our cardiac classroomtransmissions to theLiberty Science Center(at right). Our well-attended Friday grandrounds presentationstypically featurenationally recognizedspecialists.

The Department of Cardiovascular Medicine is committedto quality assessment and improvement with activities thatinclude a number of local initiatives as well asparticipation in the national registries of the AmericanCollege of Cardiology (NCDR) and Society of ThoracicSurgeons. Mark Blum, MD, leads our GagnonCardiovascular Institute quality team.

Mark A. Blum, MD

CARDIAC CLASSROOM-LIVE!

From the first incision to the last suture, middle andhigh school students have, for the past 10 years, hadthe opportunity to watch open heart surgery at aninteractive theater suite within Liberty Science Center,Jersey City, New Jersey. The two-hour long program,offered twice a week during the school year, featuresinteractive videoconferencing with a MorristownMedical Center surgical suite. It provides students witha front-row seat to cardiac surgery in real time.Students are encouraged to ask questions and to holdin their hands surgical tools just like those seen on thescreen, as surgeons, perfusionists, anesthesiologists,nurses and other specialists describe what ishappening to the patient before them. As theyproceed, team members talk informally about theconsequences of coronary disease and the role ofsmoking, nutrition, exercise, other risk factors in waysthat are intended to engage students to think abouttheir own habits while exposing them to the drama andpotentials of science.

Research Coordinator Christine Ciprich with patient who hasundergone transcatheter aortic valve implantation

The Patient ExperiencePROVIDING THE BEST QUALITYCARE MEANS CARING FORTHE WHOLE PATIENT.


High-tech, high-touch, high quality and innovation sumsup the care provided to patients treated at MorristownMedical Center’s Gagnon Cardiovascular Institute. Thefive-story, 230,000-square-foot building, which opened in2009, is dedicated to meeting and the challenges ofadult heart and vascular diseases. Everything about theGagnon Cardiovascular Institute experience is designedto make an inherently stressful time more transparent,patient-centered, caring and supportive for patients andtheir families.

The Gagnon Cardiovascular Institute facilities have eightsurgical rooms, two of which are hybrid, five cardiaccatheterization labs, and three EP labs, any of which canbe staffed and in service 24/7. Other features include 14cardiac recovery bays for post-anesthesia care, eightcardiovascular intensive care rooms, 18 CCU beds and28 cardiac access bays. All are equipped with thenewest diagnostic, monitoring and treatment equipment.Our staff and programs are focused on ensuring that ourpatients and their families are holistically supported andcared for. Nationally known cardiologists, cardiac andvascular surgeons, and electrophysiologists lead our careteams, assisted by outstanding nurses and technicianswith advanced cardiovascular training.

Gagnon Cardiovascular Institute patients also appreciatethe Institute’s welcoming accommodations. Award-winning interiors include 106 private and 46 semi-privaterooms as well as family lounges that provide thecomforts of a first-class hotel within a hospital setting.Gagnon Cardiovascular Institute’s patient satisfactionscores consistently rank in the high 90th percentiles.

Gagnon Cardiovascular Institute understands that whatpatients do at the end of their hospital stay is asimportant in their recovery as the cardiac services weprovide. To assist our patients, as well as serve high-riskpatients, Morristown Medical Center also offersintegrative medicine outpatient services. These servicesprovide patient support, organized around a heart-healthy action plan in four key areas: nutrition and weightloss, physical activity, stress relief, and emotional well-being. Located in a spacious spa-like facility within theInstitute, and available to the public, services includeindividual and group sessions in yoga, Pilates,meditation, cranial sacral therapy, massage,acupuncture, healthful cooking classes, smokingcessation training and other programs.

For More Information:

Women's Heart Program 973-971-8811

Advanced Interventional Therapies/ Valve Center 973-971-7001

Cardiac Surgery 973-971-7300

Non-Invasive Imaging 973-971-5110

Morristown Medical Center100 Madison Avenue Morristown, NJ 07962

Phone: 973-971-5000

Overlook Medical Center99 Beauvoir Avenue Summit, NJ 07901

Phone: 908-522-2000

Newton Medical Center175 High Street

Newton, NJ 07860

Phone: 973-383-2121

For one of New Jersey’s elite cardiac specialists,Call 1-888-4AH-DOCS or visit atlantichealth.org

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