houston methodist heart & vascular annual report 2013
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A proud trAdition of excellence, with A new nAme.the Methodist Hospital is now Houston Methodist Hospital. this new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.
thAt’s the difference between prActicing medicine And leAding it.
Leading Medicine: an Overview 3
deLivering Better OutcOMes 5
Breaking new grOund 11
Pursuing MedicaL discOveries 13
advancing technOLOgy 19
educating fOr tOMOrrOw 21
aBOut hOustOn MethOdist hOsPitaL 24
821
11
9
contents
3 DeBakey Heart & Vascular Center
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
Leading medicine: an overviewdeBakey Heart & vascuLar centerHouston Methodist DeBakey Heart & Vascular Center provides an interdisciplinary approach to patient care and research where cardiologists, cardiovascular surgeons, imaging specialists, cardiovascular anesthesiologists and intensivists deliver the most advanced medical and surgical solutions tailored for each patient.
At A GlAnce more thAn
ekGs
more thAn
heart transplants performed since 1968
open heart surgeries performed annually
750more thAn
more thAnclinicAl triAls currently under wAy
10070,000 10,0001,650 2,000
This extensive expertise and array of resources offer comprehensive care and treatment for the
world’s most complex cardiac disorders.
• Located in Houston Methodist Hospital in the Texas Medical Center®
• More than 125 physicians and 550 employees
• 10 operating rooms, 2 hybrid operating rooms, 9 catheterization labs, 176 acute-care beds,
58 ICU beds and 43 transplant beds
• Recipient of more than $3 million in research support annually from sources including
the National Institutes of Health and the American Heart Association
• Ranked No. 14 by U.S. News & World Report among the 600 best hospitals in the United States
for cardiology and heart surgery
electrophysioloGy procedures performed annually
procedures performed AnnuAlly in cAtheterizAtion lAbs
patients from across the u.s. and 19 countries chose the heart center for their cardiovascular care last year.
20,000more thAn
messAGe from the medicAl director
Dear Colleagues,
On behalf of all the physicians and staff of Houston Methodist DeBakey Heart & Vascular Center, I’m pleased to share with you some highlights of our accomplishments over the past year.
The world-renowned legacy of Dr. Michael E. DeBakey continues at Houston Methodist Hospital in the areas of clinical excellence, innovative research and advanced education. Superior patient care is the core objective of Houston Methodist Hospital, and the exceptional care we give all heart and vascular patients is evidenced by our volume and outcomes. However, the specialized treatments we offer to the very sickest cardiac patients from around the nation and the world sets our center apart.
In the past year, we’ve made great strides in the treatment of advanced heart failure, atrial fibrillation and valve replacement, including transcatheter aortic valve replacement, and cardiac sarcomas and other tumors. Many of these clinical advances are the result of, or the genesis for, a wide range of advanced research that is being led by several members of our faculty and staff. We believe the basic and clinical research that is taking place within the walls of Houston Methodist is leading cardiovascular medicine into the future.
Currently, there are five national or international clinical trials with principal investigators from Houston Methodist DeBakey Heart & Vascular Center. A highlight of 2013 was the establishment of the Department of Cardiovascular Sciences and the Center for Cardiovascular Regeneration, both led by internationally renowned researcher, John P. Cooke, MD, PhD.
Interconnected with the research and clinical care at Houston Methodist are technological advances, cross-industry collaborative projects, and advanced educational opportunities that continue to fuel the ideas and visions that will shape cardiovascular care in the future. From the Pumps & Pipes Conference, to the latest technology for training and research, to the newest applications in mobile computing devices, it’s clear that the visionary spirit of Dr. DeBakey is alive and well at Houston Methodist Hospital.
We invite you to explore the exciting developments in cardiovascular care, research and education in the following pages, and we welcome your feedback on how we can continue to support you and your patients.
Alan B. Lumsden, MDWalter W. Fondren III Distinguished Endowed ChairMedical Director, Houston Methodist DeBakey Heart & Vascular CenterChair, Department of Cardiovascular Surgery Houston Methodist Hospital, Houston, Texas
4 DeBakey Heart & Vascular Center
5
congenitAl heArt progrAm for Adults:An extension of cAre for childhood mirAclesTreating adults with congenital heart disease is a
rapidly growing field in cardiology. For the very first
time, patients with a congenital disease are surviving
to adulthood. Many of them had miraculous surgeries
as children that allowed them to survive and grow
up. In fact, there are now approximately 1.5 million
adults in the United States living with congenital
heart disease, which is more than the number of
children with congenital heart disease. While initial
surgical repairs on the children were successful,
a s a d u l t s , t h e s e patients stil l require ongoing
treatment because the surgical repairs sometimes
need revision. To address this new population of
patients, Houston Methodist has created the
Adult Congenital Heart Program. “Our program offers
a combination of medical therapy and prevention,
observation, transcatheter intervention, and surgical
repair, if required,” says Chun Huie Lin, MD.
“We can now transition these patients to an adult
setting where they were followed throughout
their childhood.”
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
“Most cardiovascular diseases develop later in life, and patients are exposed to heart disease for a decade or two. in contrast, patients with congenital heart disease have a lifetime of exposure, so they require a lifetime of highly specialized care that adjusts to their needs as they age, a reflection of these childhood successes.”
c. huie Lin, Md, Phd
DeBakey Heart & Vascular Center
new tools decreAse blood trAnsfusions up to 50 percent
A coordinated team approach to blood management at
Houston Methodist Hospital has led to a decrease in the
need for transfusions in certain cardiac surgical patients.
Through the efforts of the Patient Blood Management Advisory
Committee – chaired by Christopher Leveque, MD – cardiac
surgeons, cardiovascular anesthesiologists, and perfusion
personnel implemented several recommendations from the
Society for Thoracic Surgery with positive results. Blood use
decreased 40 to 50 percent for all component categories for
isolated CAB, aortic valve replacement and CAB, and valve
surgeries. The percent of patients not requiring blood
components increased approximately 10 percent in isolated
CABG surgery cases.
Other efforts to reduce blood use include pre-operative
identification of anemic patients using an ultraviolet device,
similar to pulse oximetry. Patients who are found to be anemic
are referred to a hematologist for treatment before surgery.
Additionally, several post-operative methods to lessen iatrogenic
blood loss in the cardiovascular intensive care unit (CVICU)
are currently under evaluation. The lessons learned from
these efforts are now being shared with other specialties
throughout Houston Methodist by the educational efforts
of the Patient Blood Management Advisory Committee.
blood mAnAgement options for pAtients
EDWARDS, COLITTLETON, CO
JACKSON HOLE, WY
RENO, NV
UKON, OK
RIODOSO, NM
PHOENIX, AZ
SANTA BARBARA, CA
LOS ANGELAS, CA OKLAHOMA CITY, OK
KANSAS CITY, MO
ALBUQUERQUE, NMLEXINGTON, TN
MEMPHIS, TNSALLISAW, OK
ZWOLLE, LABATON ROUGE, LA
LAKE CHARLES, LAHMH
NEW ORLEANS, LA
MINNEAPOLIS, MN
DESMOINES, IOWA
WAUSAU, WI
ROSEVILLE, MI
BUFFALO, NY NEW PALTZ, NY
PHILADELPHIA, PA
CLEVELAND, OH
BENSON, NCFAYETTE, NC
COLUMBIA, SC
ATLANTA, GA
AUGUSTA, GATEXARKANA, ARK
Patients travel from across the U.S. for alternative blood management techniques as Houston Methodist is one of the few institutions to offer this unique treatment option.
6 DeBakey Heart & Vascular Center
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
The focus of the team is to address the needs of heart failure
patients with medical and mechanical interventions, either
as primary therapy or as a bridge to transplant. Houston
Methodist offers several unique strategies for mechanical
circulatory support as a bridge to heart transplantation.
These include the novel use of the left axillary intra-aortic
balloon pump that permits ambulation, Heartmate II LVAS,
HeartWare HVAD, Total Artificial Heart (TAH), and
the Thoratec PVAD coupled with the Heartmate II for
biventricular support.
Treatment options are evaluated by the team and weighted
for the greatest benefit versus risk for each patient. “At the
Houston Methodist DeBakey Heart & Vascular Center, we are
committed to pushing the field of heart failure research and
treatment forward in numerous ways,” says Jerry D. Estep, MD,
FACC, Heart Transplant and LVAD Program medical director.
“We pursue promising new ideas, but we also use novel
approaches with existing technology to improve outcomes for
heart failure patients that come to us from all over the world.”
shAred cAreAs heart failure therapies continue to improve, Houston
Methodist has seen significant increases in volume in both
heart transplants and LVAD patients, and many of these patients
come from across the nation and around the world.
Estep and his colleagues are creating innovative methods to
allow patients who have received heart failure interventions –
especially mechanical therapies – to be monitored post-procedure
by cardiologists at home.
“The goal is to create partnerships with providers from the region,
and eventually the world, during all three stages of LVAD care —
pre-intervention, intervention and long-term follow-up care,”
says Estep. “We believe this can become a model for best practice.”
To facilitate this effort, Houston Methodist hosted a Shared
Care Summit Meeting designed for physicians and mid-level
practitioners who are committed to treating LVAD patients
in their communities. The Advanced Heart Failure Team
provided real-world education using Houston Methodist’s
MITIESM lab for demonstrations with a current LVAD patient.
DeBakey Heart & Vascular Center7
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
setting new best prActices in AdvAnced heArt fAilure & trAnsplAntThe Advanced Heart Failure Team at Houston Methodist Hospital is a collaboration between the DeBakey Heart & Vascular Center and the J.C. Walter Jr. Transplant Center.
“houston Methodist is committed to pushing the field of heart failure research and treatment forward in numerous ways. we pursue promising new ideas, but we also create novel approaches with existing technology to improve outcomes.”
Jerry d. estep, Md, facc
24heArt trAnsplAnts in 2013
lvAd implAnts in 2013
54
dedicAted AdvAnced heArt fAilure physiciAn speciAlists10
24314
top10proGrAm AccordinG to the university heAlth consortium dAtA
evAluAtions performed And presented to the medicAl review boArd for AdvAnced heArt fAilure
dAys mediAn process lenGth from referrAl to medicAl review boArd presentAtion
5.3 % wAit list mortAlity rAte**lower than national srtr benchmark of 10.4%
85% 3-yeAr post-heArt trAnsplAnt pAtient survivAl*
*greater than national srtr benchmark of 83%
A promise from the heArt
When Timothy Lewis, 48, was admitted to Houston Methodist Hospital on December 3, 2013 with end-stage congestive heart failure, the cardiovascular team quickly determined that he required a transplant. Lewis, of Jackson, Miss., was implanted with an intra-aortic balloon pump to augment cardiac function while he was put on the donor list.
As his family kept vigil at the hospital, plans for an imminent family celebration were quickly re-evaluated. Lewis’s youngest child, Lolaycia, was planning her wedding for March 2014, and her father had promised to walk her down the aisle. But with transplant prospects uncertain, Lolaycia and her fiancé, Melmiah Walker, changed the wedding date and location. New date: December 22. New location: the chapel at Houston Methodist Hospital.
With nurses minding his equipment, Lewis made it all the way down the 40-foot aisle with Lolaycia, and he even managed a brief dance with her after the ceremony. “Because of the severity of my illness, I didn’t think I would be able to participate in this day,” Lewis said afterward. “I thank God for giving me the strength to walk her down the aisle.”
Fortunately, a heart became available soon after the wedding, and Lewis was transplanted on January 4, 2014. He’s now doing well and getting stronger by the day.
“Thankfully, Mr. Lewis has been free of rejection and free of infection,” said Houston Methodist cardiologist Jerry Estep, MD “We project that he will do well over the next several years.”
8DeBakey Heart & Vascular Center
DeBakey Heart & Vascular Center9
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
ecmo mortAlityrevAmped protocols reduce ecmo mortAlity 30 percent
This year the extracorporeal membrane oxygenation (ECMO) program at Houston Methodist Hospital
has seen a major improvement in mortality outcomes thanks to newly revamped protocols created by
a multidisciplinary team.
ECMO is an essential service to offer at a tertiary medical center like Houston Methodist, which has
extremely high volumes of transplant patients and patients with respiratory failure. Patients on ECMO
are the sickest of the sick, so the service tends to have a high mortality rate. However, ECMO is also
resource-intensive, so it is crucial that services are as efficient and effective as possible.
tAKing the teAm ApproAch
“In 2013, we completely revamped the ECMO program with our own protocols for anticoagulation,
patient selection, respiratory protocols, evaluation of venoarterial vs. venovenous ECMO, and other
crucial procedures,” says Brian Bruckner, MD, surgical director of the program.
Bruckner and John Fetter, MD, medical director of the program, put together a team that created a whole
new approach to ECMO care. With the team’s new protocols in place, ECMO mortality decreased from 85
percent to 51 percent, a remarkable improvement for patients in severe respiratory and cardiac distress.
expAnding physiciAn educAtion
Another new focus of the program is outreach and education to physicians at suburban feeder hospitals.
“Dr. Fetter and I provide education about ECMO, such as appropriate selection criteria and information
on how to quickly transfer patients,” Bruckner explains. The doctors are also conducting didactic
sessions in the MITIETM lab with mannequins to offer a hands-on experience for physicians. This is in
support of next year’s goal to expand the program.
the ecmo mortAlity rAte for houston methodist pAtients is 7% better thAn the nAtionAl AverAGe mortAlity rAte for Adult pAtients.
*Per the extra corporeal Life support Organization registry. houston Methodist hospital mortality rate is 51 percent compared to the national average of 58 percent.
Houston Methodist Hospital has the largest cardiac sarcoma program, and one of the largest primary heart tumor programs in the world.
The physicians at Houston Methodist were the first in the world to perform an auto-transplant for left atrial sarcoma,
an auto-transplant for left ventricular sarcoma, and bi-VAD replacement for cardiac sarcoma. In October of 2013,
physicians at Houston Methodist were also the first in the world to insert a total artificial heart in a patient with
a cardiac sarcoma diagnosis.
Although rare, cardiac tumors represent approximately one in every 500 clinical cardiac surgical cases. Approximately
75 percent of the tumors are benign, and of the remaining 25 percent that are malignant, approximately 75 percent
are sarcomas. It is important to note that most patients who are diagnosed with a malignant cardiac tumor are told
that there are no treatment options available.
Because of the low incidence, most cardiac surgeons have never seen a cardiac sarcoma. However, the cardiac tumor
program at Houston Methodist has treated approximately 300 patients with cardiac tumors, over half of those
being patients with primary cardiac sarcomas. Other diagnoses include myxoma, fibroelastoma, and paraganglioma.
building the Knowledge bAse for cArdiAc sArcomA
high volumes, treAtment options
At Houston Methodist Hospital, we are defining for the
world the most appropriate ways to evaluate and treat
patients with cardiac tumors. These patients are often
told they have no treatment options. The large clinical
volume has contributed to 44 peer-reviewed publications
and eight textbook chapters, in addition to dozens of
presentations and surgical demonstrations throughout
the world by the clinicians at Houston Methodist.
Additionally, Houston Methodist leads monthly tumor
boards, which also include MD Anderson Cancer Center,
the University of Michigan, Vanderbilt University and
Hadassah Hospital in Jerusalem.
“A malignant cardiac tumor is generally a dismal
prognosis,” acknowledges Michael J. Reardon, MD,
cardiovascular/thoracic surgeon at Houston Methodist.
“Survival for cardiac sarcoma patients with medical
therapy is between one and six months, and standard
surgical treatment is about 12 months. But we’ve moved
that survival rate out to about three years. Many patients
with cardiac sarcomas are at an age where they have young
families, so an improved prognosis can be a huge gift.”
“at houston Methodist hospital, we are defining for the world the most appropriate ways to evaluate and treat patients with cardiac tumors. these patients are often told they have no treatment options.”
Michael J. reardon, Md
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
DeBakey Heart & Vascular Center10
DeBakey Heart & Vascular Center11
retrogrAde Access: meeting in the middle to cleAr vesselsPatients with peripheral artery disease (PAD) often have vessels that have become so
hardened, normal endovascular techniques will not work. However, with a new
technique called retrograde access, surgeons enter arteries through the foot and
work upward.
“This procedure is not indicated for all patients with PAD,” explains Hosam El-Sayed,
MD, an endovascular surgeon with Houston Methodist. “It’s only used in complex
patients with heavily calcified arteries, which is common in people with severe diabetes.”
During the delicate procedure, surgeons access the blocked arteries both from the
foot and femoral artery, and meet in the middle. “Once that occurs, we can open the
vessels with a balloon or a stent,” says El-Sayed. “We can also shave the plaque to
increase patency of the vessels.”
Patients who receive an amputation below the knee for arterial occlusive disease
have a 25 percent one-month mortality rate. For the more extensive above knee
amputation, there is a 50 percent one-month mortality rate.
“retrograde access gives us another pathway to work through severely diseased arteries. we have saved the limbs of many patients who would have lost them just a few years ago.”
hosam el-sayed, Md
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
Certain pulmonary embolisms can now safely and effectively be treated with catheter-directed
thrombolysis combined with ultrasound, according to Alan B. Lumsden, MD, vascular surgeon
at Houston Methodist Hospital. “Recent trials have proved the safety and efficacy of using
catheter-directed thrombolysis in combination with ultrasound in resolving submassive
pulmonary emboli,” says Lumsden. “These are the emboli that show right heart strain in
an echocardiogram.”
At Houston Methodist, there is a multidisciplinary group of clinicians – including surgeons,
interventionalists, cardiologists and intensivists – who are focused on clarifying appropriate
clinical pathways for management of these patients. “When we are determining who needs
surgery versus who should be treated with thrombolytics, the catheter-directed thrombolysis will
give us another good option to offer our patients,” says Lumsden.
new thrombolysis method broAdens treAtment options
pioneering A new tool AgAinst renAl fAilureUntil recently, MRI angiography could not be performed on a patient with renal failure because
the gadolinium used for contrast is contraindicated in those patients. However, physicians at
Houston Methodist, in collaboration with Duke University, have pioneered the novel clinical
use of an FDA-approved iron agent for its imaging properties for the benefit of renal patients.
“Ferumoxytol is primarily used to treat iron-deficiency anemia, and it’s specifically
indicated for patients with chronic kidney disease and renal failure,” says Dipan Shah, MD,
medical director of cardiac MRI at the DeBakey Heart & Vascular Center. “So we
have pioneered the use of that iron-based agent for its imaging properties, and with that
we are actually able to perform MR angiograms on patients with renal failure. As far as we
know, only Houston Methodist and Duke are using ferumoxytol for this purpose.”
12DeBakey Heart & Vascular Center
DeBakey Heart & Vascular Center13
The fact that the human body can repair itself has been
known for thousands of years. However, the research that
will be required to unleash the full potential of stem cells
and other regenerative therapies is still in progress. To that
end, Houston Methodist Hospital has created the Center
for Cardiovascular Regeneration within the Department
of Cardiovascular Sciences at Houston Methodist Research
Institute, all under the leadership of John P. Cooke, MD, PhD.
Cooke is a world-renowned expert in fundamental and
translational research in endothelial biology and vascular
diseases. Before coming to Houston Methodist, Cooke
held faculty positions at Harvard Medical School and
Stanford University School of Medicine. Over the past 25
years, his primary work has been in developing therapeutic
molecules to address atherosclerosis, angiogenesis and
lymphangiogenesis, which has produced over 500 papers
and 30 patents granted or pending.
As the Department of Cardiovascular Sciences Chair at
Houston Methodist Research Institute, Cooke is the latest
in a long line of world-renowned cardiovascular experts
to conduct leading-edge research at Houston Methodist.
“The Department of Cardiovascular Sciences and the
Center for Cardiovascular Regeneration are built on the
noble tradition of cardiovascular investigation and
patient care begun by Dr. DeBakey and continued by his
clinical colleagues at Houston Methodist,” explains Cooke.
“The department has a strong research focus and is
providing an exceptional basic investigative effort that
is continuing to distinguish Houston Methodist Hospital
as a leader in cardiovascular sciences and care.” Although
ongoing cardiovascular research at Houston Methodist
includes imaging, intervention, electrophysiology and
metabolism, a major thrust of Cooke’s work going forward
is cardiac regeneration.
focus on regenerAtion
“The mission of the Center for Cardiovascular Regeneration
is to restore cardiovascular health by reversing cardiovascular
aging and regenerating cardiovascular tissue,” says Cooke.
“I have great expectations that our work at Houston Methodist
will have a tremendous impact on cardiovascular diseases
in the near future and for years to come.”
Broadly speaking, research in cardiovascular regeneration
includes investigations into processes that accomplish
the following:
• Restore the form or function of the cardiovascular system
• Improve the contraction, relaxation or electrical
conduction of the heart
• Restore the distributive or nutritive properties of the
blood or lymphatic vessels.
Cardiovascular regenerative therapies developed in the
center may include small molecules, nucleic acid or
protein-based agents, cell or tissue therapies alone or in
combination with bioengineered matrices, nanotherapeutics,
and medical devices.
reseArch thAt forges A pAth to regenerAtive therApies: new fAculty of cliniciAn-investigAtorsSince the earliest angioplasties, Houston Methodist Hospital has been an innovative leader in the field of cardiovascular medicine. The tradition continues today as the future of cardiac care moves beyond surgery and mechanical devices to the burgeoning field of regenerative medicine.
“the department of cardiovascular sciences builds on the noble tradition of cardiovascular investigation and patient care begun by dr. deBakey and continued by his clinical colleagues. its efforts will be facilitated by the existing research strengths at houston Methodist research institute.”
John P. cooke, Md, Phd
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
houston Methodist is pleased to announce Jack wong, Phd, yohannes t. ghebremariam, Phd, and nazish sayed, Phd, as three new prestigious faculty members of the department of cardiovascular sciences in collaboration with John P. cooke, Phd (pictured).
Accelerating discovery and delivery to patientsat houston Methodist, we are dedicated to defining the future of medicine. we engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.
Leaders in researcH
More than 840 active clinical protocols$55 million tOtaL researcH funding in 2013see all the ways we’re leading medicine at hmleadingmedicine.com
14DeBakey Heart & Vascular Center
DeBakey Heart & Vascular Center15
below Are A few reseArch highlights
• With a $3.5 million grant from the National Institutes of Health, Valderrabano is leading a consortium of
hospitals in phase III clinical trials offering an innovative treatment with a minimally invasive procedure to
treat AF by injecting alcohol through a balloon catheter into the Vein of Marshall. Preliminary trials
of this procedure – the brainchild of Valderrabano – show promise that the alcohol procedure may have
superior outcomes over current ablation procedures of the pulmonary veins.
• Early trials of the alcohol procedure also show complete success in treating peri-mitral atrial flutter in AF
patients, while traditional ablation procedures are approximately 65 percent successful. Additionally, alcohol
infusion was shown to target nerves of the heart, not simply kill the muscle cells, which is a new therapeutic target.
• Strokes in AF patients can be caused by blood clots that collect in the left atrial vestigial appendage.
Valderrabano and his team are participating in a clinical study on the Watchman’s device, a plug that
seals off the appendage, creating a non-pharmacological option for stroke prevention.
• The team recently completed participation in a study on the Laser Heartlight device, an ablation catheter
with an endoscopic balloon that allows direct visualization of the tissue being ablated. It uses a fiber
optic light source and a laser dot to more precisely and quickly target vascular tissue for ablation.
$3.5 million grAnt to test innovAtive AtriAl fibrillAtion treAtments Physicians at Houston Methodist Hospital, led by cardiac electrophysiologist Miguel Valderrabano, MD, are advancing innovative clinical research on treatments for atrial fibrillation (AF) and prevention of AF-related strokes.
“Houston Methodist Hospital is a high-volume center for AF treatment, so we participate in many national research projects in the development of new technologies.”
Miguel valderrabano, Md
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
trAnscAtheter Aortic vAlve replAcement triAlshigh enrollers And beyond
Houston Methodist Hospital has been a leader in the research
into TAVR technologies in the U.S. beginning with the CoreValve
US Pivotal Trials. Neal Kleiman, MD and Michael Reardon, MD
served as the local principal investigators. Reardon served on the
national steering, publications and screening committees for the
trial and was chair of the screening committee. These trials led
to the approval of the first TAVR device in the U.S.
Houston Methodist was the high enroller for the CoreValve US
Pivotal Trials, in both the extreme high-risk and high-risk patients,
as well as for the neurologic sub-study. The CoreValve extreme
risk arm was just presented at the Transcatheter (TCT) Conference
and the FDA found the data impressive enough to consider
market approval without a panel consideration.
Physicians at Houston Methodist are now leading research to
determine if TAVR is a safe and effective alternative to surgical
intervention for intermediate-risk patients. Reardon and Kleiman,
are the local lead primary principal investigators. Reardon is the
national surgical PI and serves on the national steering committee
for the SurTAVI trial. At the heart of the next generation CoreValve
system is the Evolute valve, with a re-engineered nitinol frame
that leads to more constant radial force over the planned
expansion range, and a re-engineered shape to aid in sealing
paravalvular leak.
next generAtion coming soon
Reardon is also the global surgical PI on the forthcoming
REPRISE III study on Boston Scientific Corporation’s LotusTM
Valve System, set to begin in the U.S., Australia, Canada, and
similar to tumor boards, complex clinical cases are shared at a biweekly valve conference. cardiovascular surgeons, interventional cardiologists, imaging experts and nurse practitioners discuss diagnostic and patient management considerations. after the conference, a letter outlining the team’s consensus opinion for treatment is sent to the referring physician for review.
Europe in 2014. This valve is a single nitinol wire frame
with a pericardial valve, which will allow the device to be
recaptured, repositioned and redeployed if necessary.
“This research has led to treatment modalities for inoperable
patients who previously had no options whatsoever,” says Reardon. “Now we want to find out if TAVR is safe and efficacious for patients who may be operable but are at the high end of the risk scale.”
vAlve clinic leAder
Houston Methodist is uniquely positioned to continue
leading advances in valve repair and replacement for
many reasons. A key factor has been the development of
a world-class valve program that led to the creation of a valve
clinic in 2009. “The valve clinic – based on the multidisciplinary
concept of our transplant clinic – is a close collaboration
between cardiologists and cardiac surgeons,” explains
Stephen Little, MD, medical director of the valve clinic.
“Each patient is thoroughly prescreened, allowing us to
schedule the appropriate diagnostic tests and physician
appointments all on the same day. This expedites the
analytics and decision processes considerably.” This clinic
was one of the first of its kind in the nation, and is one
reason that Houston Methodist has been a leader in TAVR
clinical trials.
“The integrated, multidisciplinary heart team at Houston
Methodist is the foundation of our successful efforts to
provide world-class patient care,” says Reardon. “It also
allows us to continue to lead the latest clinical research in
valve repair and replacement.”
DeBakey Heart & Vascular Center16
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
putting theories to the test: 2013 reseArch highlights
AAstrom ixcell dcm stem cell triAlBarry H. Trachtenberg, MD, is the principal investigator for this study designed to assess the efficacy, safety and tolerability of Ixmyelocel-T in heart failure (HF) caused by ischemic cardiomyopathy.
• Ixmyelocel-T is a patient-specific, expanded multicellular therapy derived from bone marrow cells with a proven range of activities including repair and regeneration of ischemic tissue.
• In this multicenter, randomized, double-blind, placebo-controlled study, Ixmyelocel-T is administered to end-stage HF patients via transendocardial catheter-based injections and the efficacy, safety and tolerability is compared with the placebo.
cellAdon cupid-2b triAlThe purpose of this multinational study headed by Arvind Bhimaraj, MD, is to test whether an experimental gene transfer agent called MYDICAR® helps improve clinical outcomes in subjects with HF.
• SERCA2a protein deficiency in cardiomyocytes has been identified as a key cause for myocardial dysfunction in HF. SERCA2a is involved in maintaining Ca2+ homeostasis in myocardial cells and thus affects the relaxation and contraction of cardiomyocytes.
• In advanced HF patients, targeted SERCA2a enzyme replacement with MYDICAR may correct imbalances in Ca2+ cardiac metabolism resulting in improved cardiac function and clinical outcomes.
Abbott coApt triAlNeal Kleiman, MD, is the principal investigator for the prospective, randomized, parallel-controlled, multicenter clinical evaluation of the MitraClip® device.
• MitraClip is a percutaneous device developed for the treatment of clinically significant functional mitral regurgitation.
• Results from previous studies show a significant clinical benefit with relatively low risk of excessive peri-procedural or long-term mortality with this device.
• The COAPT trial will provide new data on the safety and effectiveness of the MitraClip System specifically in symptomatic patients who are extremely high risk for mitral valve surgery.
cArdioKinetix pArAchute triAl The purpose of the Parachute randomized trial headed by Neal Kleiman, MD, is to determine the safety and effectiveness of the Parachute® device versus optimal medical therapy in patients with HF due to ischemic heart disease.
• HF following myocardial infarction (MI) occurs in more than 3.6 million patients in the U.S. After an anterior infarct, almost 60 percent show LV remodeling and HF symptoms.
• The Parachute device is a catheter-based treatment developed for patients with left ventricular dilation after an anterior MI. This device is a partitioning membrane deployed within the compromised ventricle and isolates the malfunctioning portion of the ventricle.
thorAtec roAdmAp triAl ROADMAP study led by Jerry Estep, MD, and Brian Bruckner, MD, is a multicenter investigation to determine the safety and efficacy of using the Heartmate II (HM II)® Left Ventricular Assist System (LVAS) in moderately sick HF patients.
• The study will evaluate and compare the effectiveness of HM II LVAD support with optimal medical management in ambulatory NYHA Class IIIB/IV HF patients who are not dependent on intravenous inotropic support and who meet the FDA-approved indications for HM II LVAD destination therapy.
• Data from this study will be valuable for defining patient selection strategies for LVAD support.
Abbott Absorb iii triAlAlpesh Shah, MD, is involved in the Absorb III trial which will assess the safety and effectiveness of the Absorb™ BVS System in comparison with commercially approved metallic drug eluting XIENCE stents.
• The Absorb Bioresorbable Vascular Scaffold (Absorb BVS) System is a temporary balloon- expandable scaffold that has been designed to revascularize obstructed coronary arteries.
• Unlike other commercially available coronary stents that are made of metal, the polymer in the Absorb BVS System is bioresorbable and becomes undetectable over time.
DeBakey Heart & Vascular Center17
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
In the continued tradition of Dr. Michael DeBakey, the cardiologists and cardiovascular surgeons at Houston Methodist DeBakey Heart & Vascular Center regularly lead research in numerous trials. A few highlights are listed below.
core LaB for ecHocardiogramsHouston Methodist DeBakey Heart & Vascular Center
continues to advance the field of cardiovascular imaging
with groundbreaking research, clinical implementation, and
physician training in new, noninvasive procedures. As one
of the largest and most experienced cardiovascular imaging
facilities in the nation, the Cardiovascular Imaging Institute
at the heart center evaluates and diagnoses more than 27,000
patients each year.
The echo laboratory has been actively involved in developing
and applying echocardiographic techniques in the evaluation
of cardiac function and valvular heart disease. The heart
center has subsequently served as the Core Echocardiography
Laboratory for several multi-center (and multi-national)
trials, the largest of which include the SOLVD registry,
the SOLVD trial echocardiographic sub-study, the COMET
trial, and ACCLAIM. The lab has also served as a core lab
for St. Jude’s Medical Center and Abbott Laboratories.
Accredited by the Intersocietal Commission for the Accreditation
of Echocardiography Laboratories in the 1990’s, the laboratory is
currently fully digital, equipped with eight off-line quantitative
review stations (DigiView Image Management & Reporting
System), and 2 EchoPAC Dimension stations.
“Photo courtesy of whr architects, inc. © aker/Zvonkovic Photography, houston, texas”
the cArdiovAsculAr imAGinG institute At the heArt center evAluAtes And diAGnoses
27,000more thAn
pAtients eAch yeAr
Abbott excel triAlThe primary hypothesis of this study is that treatment of left main stenosis and other significant coronary lesions with the XIENCE family stent system will result in non-inferior or superior rates of all-cause mortality, myocardial infarction or stroke compared to coronary artery bypass graft (CABG) surgery.
• Alpesh Shah, MD, and other investigators of the Excel trial will examine if the XIENCE PRIME stent, XIENCE V stent and XIENCE Xpedition stent are safe and useful treatments for left main stenosis when compared to CABG surgery.
• The stents are coated with polymers and the anti-proliferative drug Everolimus.
DeBakey Heart & Vascular Center18
DeBakey Heart & Vascular Center19
tAKing A virtuAl looK inside the humAn body
Physicians at Houston Methodist are using a system from
Translucent Medical that merges CT and MRI images with
GPS technology. “The concept mimics the ‘stargazer’ apps,
with a CT or MRI scan of the body as the ‘universe,’” explains
Alan B. Lumsden, MD. “When the GPS sensors are activated,
virtual visualization inside the body is possible.”
Currently, the Translucent technology is only used as a patient
and family education platform. However, future applications
are endless. For example, with GPS sensors on needles or
catheters, physicians could use an MRI or CT scan to guide
the insertion of needles and catheters into a patient without
the need for radiation.
using google glAss technology for medicAl procedures in spAce
Physicians at Houston Methodist have begun collaborating with
NASA on innovative ideas for applying medical technology in
space. One of those ideas has yielded a project using Google
Glass technology to train astronauts on using ultrasound to
diagnose problems that occur while the astronauts are in space.
The idea is for the doctor on the ground to see exactly
what the astronauts are seeing. The physician can talk the
astronaut through the procedure, give immediate feedback
about how and where to hold the wand, and help diagnose
based on the images on the ultrasound screen.
“There are so many applications for using Google Glasses in
space, but one of the first we thought of is for training purposes,”
says Zsolt Garami, MD, ultrasound expert at Houston Methodist.
“One of the only diagnostic imaging tools that can be used in space
is ultrasound, so helping astronauts perform this procedure
in orbit could be a huge asset in diagnosing a sick astronaut.”
Using a computer to visualize inside the body is not a new concept. But combining technologies in novel ways can inspire new approaches to treating patients.
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
pumps & pipes creAtes flow of ideAsOver the past seven years of the annual Pumps & Pipes Conference hosted by Houston Methodist Hospital, ideas and
conversations have turned into funded research, peer-reviewed publications, and cross-industry collaborative projects that are
solving real-world problems. Participants of the conference include representatives from the medical, energy and space
fields. Below are a few highlights of the most interesting collaborative projects whose genesis is owed to Pumps & Pipes.
heArtbeAt simulAtorIn a collaborative project between ExxonMobil and the
Houston Methodist DeBakey Heart & Vascular Center,
ExxonMobil engineers helped develop software for a
flow loop heartbeat simulator for use in multi-modality
imaging for cardiovascular devices. This has resulted in
a number of funded projects and articles published in
peer-reviewed journals. It has also allowed researchers at
the heart center to assess a range of cardiovascular devices,
ranging from heart valves to vascular grafts to heart-assist
devices. The most unique use of this software is to use the
flow loop in the MRI, which allows very accurate
measurements of flows, flow streamlines and profiles
through the devices, in addition to testing disease states
such as aortic dissections.
imAging wellbore flowEngineers at ExxonMobil have been interested in the artificial
mitral heart valve, in particular the imaging capabilities
used in patients that might be applicable to wells.
Energy engineers have been looking to determine the flow into
complex wellbores that may be thousands of feet underground.
Researchers at the heart center created a scale model of a
wellbore, put it into the MRI imaging equipment, and imaged it,
producing remarkable results.
pipeline infectionThe major cause of oil spills in pipelines is triggered by
biofilm inside the pipe that can severely damage the pipe.
It is difficult to find and treat. Medical and energy
researchers are looking in two areas: 1) finding and
t reat ing the biof i lm in exis t ing pipel ines , and
2) designing pipelines that resist pipeline infection.
energy-bAsed mAteriAls for medicineNumerous materials developed for energy applications
are often referred to as “environmentally friendly,” which
also can frequently mean “bio-compatible.” Early work on
bio-compatibility testing is beginning on some of these
energy industry materials for medical applications.
PuMPs & PiPes 7: exploration
the seventh annual Pumps & Pipes conference, co-sponsored by nasa, exxonMobil and the university of houston, is designed to gather experts from aerospace, energy, medicine and academic research to develop new resources and technologies.
for information on this year’s event, visit pumpsandpipes.com.
20DeBakey Heart & Vascular Center
DeBakey Heart & Vascular Center21
educAting the medicAl professionAls of todAy And tomorrow
vAsAIn May 2013, Houston Methodist hosted the Vascular Access
Society of the Americas (VASA) Practicum Conference.
This internationally attended conference offered two
and a half days of live procedure observations, hands-on
training labs for new technology, and lectures on the
latest techniques in vascular access procedures. Attendees
included physicians, surgeons, nurse practitioners, nurses,
allied healthcare professionals, and technicians from all
over the United States and beyond.
sAve A lifeIn collaboration with the Texas Arrhythmia Institute,
the American Heart Association, and the Houston
Texans, Houston Methodist held the annual one day
CPR and automated external defibril lator (AED)
training in June 2013 at the Texans’ training bubble at
Reliant Stadium. Taught in both English and Spanish,
a record-setting attendance of more than 1000 people
learned to save a life through this community event.
fellows’ bootcAmpIn August 2013, Houston Methodist held its fifth annual
CV Fellows’ Bootcamp for incoming vascular, cardiology,
cardiac surgery and interventional radiology fellows from
around the United States. More than 150 fellows in these
specialties from around the country learned basic techniques
and procedures in hands-on labs and attended lectures from
world-renowned faculty. As Bootcamp has expanded, the
heart center plans to offer its first Finishing School Conference
in May of 2014 for fellows who are now completing their
fellowships and moving into private or academic practice.
The DeBakey Institute for Cardiovascular Education and Training (DICET), the educational arm of the heart center, provides comprehensive education in cardiovascular disease. DICET continues to deliver state-of-the-art training for cardiovascular professionals at every stage of their medical career.
Leading Medicine: an Overview delivering Better Outcomes Breaking new ground Pursuing Medical discoveries advancing technology educating for tomorrow
methodist debAKey cArdiovAsculAr JournAl
Founded in 2005, the Methodist DeBakey Cardiovascular Journal
reports on leading-edge research, diagnoses and treatments in
cardiovascular disease. A peer-reviewed publication, the journal became
a citable source in 2009 on MEDLINE, the most comprehensive medical
information resource compiled by the U.S. Library of Medicine.
Recent topics include regenerative medicine in cardiovascular disease,
next-generation transcatheter aortic valve replacement, nanotechnology
in cardiovascular medicine, and a case series of reversible acute
cardiomyopathies associated with H1N1 influenza infection.
The journal considers manuscripts in the form of case reports,
reviews, clinical investigations and guest editorials that address
any aspect of cardiovascular disease. For a complete list of
submission guidelines or for an electronic version of the journal,
visit houstonmethodist.org/debakeyjournal.
METHODISTDeBAKEY CARDIOVASCULAR JOURNAL
Volume 9, Number 3 • Jul. – Sep. 2013 • Official publication of Houston Methodist DeBakey Heart & Vascular Center
Noncompaction cardiomyopathy. Severely enlarged left ventricle (LV) with LV ejection fraction of 29%. Prominent LV apical trabeculations are seen with a ratio of noncompacted to compacted myocardium of 2.5:1. Late gadolinium enhancement demonstrated contrast uptake within the trabeculations.
CARDIAC MRI
PAGE 123 Cardiac MRI for Myocardial Ischemia
PAGE 132 Cardiovascular Magnetic Resonance Imagingfor Assessment of Cardiac Thrombus
PAGE 137 Safety of MRIs in Patients with Pacemakersand Defibrillators
PAGE 142 The Role of Cardiac Magnetic Resonancein Valvular Heart Disease
PAGE 149 Role of Cardiac MRI in the Assessment ofNonischemic Cardiomyopathies
PAGE 156 Cardiac Magnetic Resonance in Adults withCongenital Heart Disease
PAGE 163 Cardiac MR for the Assessment of Myocardial Viability
PAGE 169 Redefining Myocardial Infarction: What is New in the ESC/ACCF/AHA/WHF Third Universal Definition of Myocardial Infarction?
PAGE 173 A Case of Reverse Transient Ischemic Dilatation
PAGE 174 Utility of Cardiac Computed Tomography for Assessment of Prosthetic Aortic Valve Dysfunction with Pannus Formation
PAGE 177 Dr. Phil’s Art Corner: Skyward
PAGE 178 Poet’s Pen: Smart Probe
PAGE 179 Superior Vena Cava Syndrome Associated with Metastatic Adenocarcinoma to the Heart: The Diagnostic Utility of Cardiac Resonance Imaging
PAGE 181 The Texas Medical Center: Building Blocks for the Future
PAGE 183 In Memoriam: Homer Liston Beazley, M.D.
PAGE 184 Essay: Conducting in Chaos
22DeBakey Heart & Vascular Center
Leading tHe Practice of medicine
MITIE offers multidisciplinary, hands-on learning opportunities
using advanced imaging systems and robotics. Surgeons and other
health professionals are able to continually refine and acquire new
skills that allow them to perform at optimal levels throughout
their careers. Using procedural laboratories and sophisticated simulation
tools, our research programs are focused on the development and
assessment of emerging technologies and technical skills to improve
the care of patients through less-invasive therapies. At MITIE, the finest
researchers and clinicians are building on our legacy of ingenuity and
accelerating the discovery and delivery of better care and better cures.
With the recent installation of its new hybrid imaging suite, MITIE
now offers a training environment that mimics our clinical hybrid
suite at Houston Methodist. This new suite in MITIE is used strictly
for research, education, and training purposes to help improve
techniques and train others on hybrid procedures. Hybrid surgical
suites that can accommodate open cardiovascular surgery,
endovascular procedures, and combinations of both are quickly
becoming the standard of care across the nation. However, few
medical centers have a state-of-the-art hybrid suite with the
newest technologies available. The new training suite will help to
educate teams from around the world on cutting edge procedures
and techniques for years to come.
Houston Methodist Hospital is one of the few institutions that
operates such a unique enterprise. Working in conjunction with
Siemens, a world leader in providing health care products for image-
guided procedures, the new hybrid suite in MITIE has opened up
numerous training and research possibilities that could only have
been imagined a few years ago.
The heart center collaborates with the Houston Methodist Institute for Technology, Innovation & Education (MITIEsm) for the majority of its hands-on training programs.
Houston MetHodist Patients
71% 73%
Patient satisfaction
rAnks As 84th percentile
stAte wide AverAGe
nAtionAl AverAGe
82%
*In a recent federal survey, 82% of Houston Methodist patients reported they would recommend the hospital to others. This compares to the statewide average of 71% and the national average of 73%.
see all the ways we’re leading medicine at hmleadingmedicine.com
houston mitie At A GlAnce
heArt center At A GlAnce
squAre feet of educAtion And reseArch spAce
40,000courses in 2013
leArners in 2013
321,15326 surgical specialties
from across the world
20,000more thAn
leArners since inception
6,300leArners in 2013
more thAn
DeBakey Heart & Vascular Center23
fast facts73Operating rooms
1,119Licensed Beds(824 operating beds)
1,862affiliated Physicians
6,101employees
8,150international Patient encounters (from 90 foreign countries)
36,310inpatients in 2013
61,043emergency room visits in 2013
301,478Outpatient visits in 2013
At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list. For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list. Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.
HOustOn MetHOdist HOspitaL Leading Medicine YesterdaY, tOdaY and tOMOrrOw
FORTUNE is a registered trademark of time inc. and is used under license. from FORTUNE Magazine, february 3, 2014 ©2014 time inc. FORTUNE and time inc. are not affiliated with, and do not endorse products or services of, Licensee.
DeBakey Heart & Vascular Center25
heArt center leAdership & teAm memberscArdiologistsGuha Ashrith, md mohammed Attar, md christie m. ballantyne, md nabil s. baradhi, md colin m. barker, md Arvind bhimaraj, md douglas r. bree, md John martin buergler, md sarma s. challa, md su min chang, md clement A. defelice, md Amish s. dave, md timothy k. doyle, md stanley m. duchman, md Jerry d. estep, md mark John hausknecht, md thomas e. hong, md robert G. hust, md John c. isaac, md matteethra c. Jacob, md sonia Jacob, mdmasroor khan, mdAmin h. karim, md neal s. kleiman, md sanjay kunapuli, md karla m. kurrelmeyer, md George c. li, md c. huie lin, mdkevin A. lisman, md stephen h. little, md John J. mahmarian, md faisal nabi, md sherif f. nagueh, md vijay nambi, md nadim nasir Jr., md craig m. pratt, md miguel A. quiñones, md Albert e. raizner, md michael e. raizner, md
tapan G. rami, md manuel reyes, md howard s. rubin, md david samuels, md monica G. sanchez-ross, mdGeorge schroth, md Alpesh r. shah, md dipan shah, md Gopi A. shah, md hue-the shih, md stuart l. solomon, md cyril b. tawa, md barry h. trachtenberg, mdGuillermo torre-Amione, md valentina ugolini, md miguel valderrábano, md brian walton, md htut k. win, md william l. winters, md david yao, mdnadim m. zacca, md william A. zoghbi, md
intensivistsJohn fetter, md faisal masud, md iqbal ratnani, md kamlesh b. thaker, md divina tuazon, mdfaisal uddin, md saleem A. zaidi, md Asma zainab, md
cArdiovAsculAr surgeonsulises baltazar, md Jean bismuth, md brian bruckner, md mark davies, md hosam el-sayed, md
richard c. Geis, md Jimmy frank howell, md Javier lafuente, mdGerald m. lawrie, md richard w. lee, md matthias loebe, md Alan b. lumsden, md charles h. mccollum, md imran mohiuddin, md George p. noon, md Jacobo nurko, md walter o’hara, md eric peden, md mahesh k. ramchandani, md basel ramlawi, md michael J. reardon, md dewei ren, mdwade r. rosenberg, md scott scheinin, md erik suarez, mdmichael sweeney, md uttam tripathy, md hartwell h. whisennand, md
cv Anesthesiologistsmohamad Abdalla, md, Addnidal m. Abdel-rahman, md nicolas Athanassiou, md Jessica brown, md Ghazala butt, md Jane carter, md James carter, md diane Gibson, md elizabeth herrera, md saras karri, md, Add Gary monteiro, md, AddJoseph naples, md hany samir, md karanbir singh, md luis velez-pestana, md zbigniew wojciechowski, md
investigAtors in bAsic or clinicAl reseArchArvind bhimaraj, mdJean bismuth, mdbrian bruckner, mdGerd brunner, phdsu min chang, mdJohn p. cooke, md, phdAmish dave, mdmark davies, mdmichael A. donovanhosam el sayed, mdmark entman, mdJerry estep, mdnikolaos frangogiannis, mdzsolt Garami, mdyohannes Ghebremariam, md dale hamilton, mdcraig hartley, phdsandra haudek, phdron hoogeveen, phdstephen r. igopeter Jones, mddirar khoury, phdneal kleiman, md karla kurrelmeyer, mdchun h. lin, mdstephen little, mdmatthias loebe, mdAlan lumsden, mdJohn mahmarian, mdfaisal masud, mdlloyd h. michael, phdJoel morrisett, phdsherif nagueh, mdryan neal, mderic peden, mdhenry pownall, mdmiguel quinones, mdAlbert raizner, md
mahesh ramchandani, mdtapan rami, mdbasel ramlawi, mdmichael reardon, mdAnilkumar k. reddy, phdnazish sayed, phddaryl schulz, mdAlpesh shah, mddipan shah, mdstuart solomon, mdGeorge taffet, mdGuillermo torre-Amione, md, phdbarry trachtenberg, mdJoAnn trial, phdmiguel valderrabano, mdwing tak Jack wong, phd
AdministrAtiondavid p. bernard vice President
michael A. donovan director of education
sarah homer director of clinical Operations
pauline todd director of research
tammy plumb administrator, cardiology/cardiovascular services
rick talbot administrator, anesthesia/ cvicu services
sofia perchesBusiness development specialist
Gabriela morenoBusiness development specialist
the heart center physician leadership team, from left to right: dr. Miguel a. Quiñones, dr. Joseph naples and dr. alan B. Lumsden
houston Methodist hospital6565 fannin street houston texas 77030 houstonmethodist.org/debakeyheart
Leading Medicine YesterdaY, tOdaY and tOMOrrOw.at houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.