rvmc - 2008 heart and vascular services outcomes report

8/14/2019 RVMC - 2008 Heart and Vascular Services Outcomes Report

1/56

YOURHEART

our commitment

HEARTANDVASCULAROUTCOMESREPORT


2/56


3/56

HEARTANDVASCULAROUTCOMES

ThecardiologistscardiothoracicsurgeonsandvascularsurgeonsfromRogueValleyMedicalCenterRVMCarepleasedtopresentthisinauguraleditionoftheHeartandVascularOutcomesReportThereportreviewstheactualvolumesandpatientoutcomesforeachcardiovascularprocedurecovers

newtechnologiesandprovidesanoverviewoftheentireheartandvascularprogramThisdatareflects

ourdedicationtotreatingawiderangeofcardiovasculardisease

AsphysiciansweallstrivetoprovidethebestpossiblecareforourpatientsSincetheinceptionofthe

cardiacprogramyearsagoatRogueValleyMedicalCenterwehavealwaysbelievedthatteamwork

amongphysiciansisessentialfordeterminingthebesttreatmentoptionforeachpatientWealsoaimfor

excellenceinallareasandtechniquessothatwecanachievethebestpossibleresultsOurperformance

improvementprogramprovidestimelyfeedbacksothatwecanmakecontinuousimprovements

Wehopeyoufindthisinformationinterestingandusefulandwelookforwardtoacontinuedcollaboration

withyousothattogetherwecanprovideyourpatientswiththebestpossibleoutcomes

ThephysiciansandsurgeonsoftheHeartandVascularCenteratRogueValleyMedicalCenter


4/56

OurMission

Asanteexiststoprovide

qualityhealthcareservicesina

compassionatemannervaluedby

thecommunitiesweserve

OurVision

Asantewillberecognizedformedicalexcellenceforoutstanding

customerserviceandasa

greatplacetowork

TheValuesin

WhichWeBelieve

Excellenceineverythingwedo

Respectforall

Honestyinallourrelationships

Servicetothecommunity

physiciansandeachother

Teamworkalways

TheHeartofRogueValleyMedicalCenter

Cardiac disease is the leading cause of death in Oregon and California. Fortunately, effective therapy is available.Rogue Valley Medical Center (RVMC), a part of the Asante fami ly, is a tax-exempt -licensed-bed facility created

by and for the people of southern Oregon years ago. It provides, and is nationally recognized for, highly specializedheart and vascular care in the region.

RogueValleyMedicalCenter

Opens

CardiacIntensiveCareUnitOpens

FirstCardiacCatheterization

LaboratoryOpens

FirstOpenHeartSurgery

FirstCoronaryBalloon

Angioplasty

PatientTowerConstructed

OtherTeamMembersphysician

assistantsnursestechnicianscliniciansetcTe first number represents the total number ofpeople working in that department. Numbers inparenthesis represent people with years or moreexperience in that particular field.

Operating Room ()

Cardiac Perfusionists ()

Cardiac Catheterization Laboratory

RVMC ()

CVISO ()Cardiovascular Recovery ()

Cardiac Intensive Care Unit ()

Heart Center ()

Nurse Educators ()

Cardiac Rehabilitation ()

Echocardiographers ()

Vascular Ultrasound ()

Stress esting ()

Cardiopulmonary ()

Clinical Quality Analysts ()

CardiacFacilitiesatRVMCCardiac Intensive Care Unit ( beds)

Heart Center ( telemetry beds)

Cardiac Catheterization Labs

outpatient labs at CardiovascularInstitute of Southern Oregon, LLC (CVISO)

inpatient labs at Rogue Valley Medical Center

Cardiovascular Recovery Unit

Operating Rooms for cardiovascular procedures

dedicated to open heart procedures

Te regions only endovascular angiographic suite

Imaging Department

Echocardiography

Stress Nuclear

Cardiac C

Physiciansallboardcertified Cardiologists

Cardiothoracic Surgeons

Vascular Surgeons

Anesthesiologists

Intensivists

Hospitalists


5/56


Table of ContentsCoronaryArteryDisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CardiacCatheterizationandCoronaryIntervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CardiovascularInstituteofSouthernOregonLLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MyocardialInfarctionTheASSETProgram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HypothermiaforCardiacArrestPatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EnhancedExternalCounterpulsation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DiagnosticElectrophysiologyStudies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IntracardiacAblation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DeviceImplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CardiacSurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CardiothoracicSurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CoronaryArteryBypassGra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ValveProcedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MinimallyInvasiveValveProcedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TransmyocardialRevascularization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VascularSurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ComprehensiveVascularCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AorticAneurysmRepair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CarotidEndarterectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CarotidStenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoninvasiveDiagnosticTesting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CardiacCT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CoronaryCalciumScore. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PreventiveCardiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CardiacRehabilitationProgram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CardiacEducators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HeartTransplantCare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

QualityOurApproach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PhysicianBiographies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ContactInformation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


6/56

CORONARYARTERYDISEASECORONARYARTERYDISEASE

RVMCcathlabcrew

CardiacCatheterizationandCoronaryIntervention

Cardiac catheterization facilities at Rogue Valley Medical Center (RVMC) were established in . Five catheterizationand angiographic laboratories are dedicated to state-of-the-art diagnostic coronary angiography, coronary interventions,

peripheral angiography and interventions, electrophysiologic procedures, and device implants. Board certification incardiology is required of all cardiologists. Cardiologists who perform coronary interventions are board certified ininterventional cardiology.

Expertise is maintained by focusing procedural experience within a small group of high-volume, experiencedinterventionalists whose complication rates and outcomes exceed national benchmarks. Coronary interventionalvolume for the institution and for each interventionalist exceeds volume recommendations established by theLeapfrog Group, Tomson Healthcare, and the American College of Cardiology. A proven record of satisfactoryoutcomes and active participation in quality improvement programs is mandatory for all physicians.

RVMC continues to adhere to the percutaneouscoronary intervention (PCI ) guidelines written and

recommended by the American Heart Association,the American College of Cardiology, and the Societyof Cardiac Angiography and Interventions. Teseguidelines are as follows:*

Operators perform at least procedures athigh-volume hospitals (more than proceduresper year) with on-site cardiac surgery.Operators and institutions should have outcomescomparable to those reported in contemporarynational data registries.For S-segment elevation myocardial infarction

(SEMI), emergent PCI should be performedby experienced operators who do more than elective PCI procedures per year and, ideally, atleast PCI procedures for SEMI each year.Ideally, these procedures should be conducted ininstitutions that perform more than elect ivePCIs per year and more than primary PCIprocedures for SEMI per year.

*SmithSCJrFeldmanTEHirshfeldJWJrJacobsAKKernMJKingSBIIIMorrisonDAONeillWWSchaffHVWhitlowPLWilliamsDOACC/AHA/SCAIguidelineupdateforpercutaneouscoronaryinterventionAreportoftheAmericanCollegeofCardiology/American

HeartAssociationTaskForceonPracticeGuidelinesACC/AHA/SCAIWritingCommieetoUpdatetheGuidelinesforPercutaneousCoronaryInterventionCirculation

Coronary

interventionalprogram

startedatRVMC


7/56


RVMCcardiovascularrecoverystaff

Thefiveinterventional

cardiologistsareboardcertified

inbothcardiovascular

diseaseandinterventional

cardiologyandprovide

around-the-clockcoverage

AnnualVolumeofDiagnosticCoronaryAngiograms

CombinedVolumeRVMCCVISO

AnnualVolumeofCoronaryInterventionalProceduresatRogueValleyMedicalCenter

TypeofStentUsed

Year BareMetalStent Drug-ElutingStent

CurrentUseofBareMetalStentsandDrug-ElutingStents


8/56


StentCourtesyofCordis

StentbetweenfingersCourtesyofCordis

WorkhorseballoonforangioplastyCourtesyofBostonScientific

Cuingballoonwithsurgicalbladesmountedontheballoon

CourtesyofBostonScientific

Diamond-coatedburrthatspinsatrevolutionsperminutetodrillthroughheavilycalcifiedlesions

CourtesyofBostonScientific

Intravascularultrasoundimagecross-sectionalviewofacoronaryartery

withaneccentricatheromatousplaqueCourtesyofVolcano

Awiderangeofdiagnostic

andinterventionalprocedures

areperformedatRVMC

infivestate-of-the-art

catheterizationlaboratories

cardiac

catheterizationshavebeenperformedatRVMCsince


9/56


Includescarotidangiographyrenalangiographymesentericangiographyupper-andlower-extremityangiographyandabdominalangiography

PeripheralAngiographyVolume

Stroke MyocardialInfarction

Deaths

PeripheralAngiographyComplications

CardiacCatheterization/CoronaryAngiographyVolume

Nostrokemyocardialinfarctionordeathin

Includesarteriesofthearmsandlegsrenalarteriesmesentericarteriesandiliacarteries

PeripheralInterventionVolume

CVISOcathlabstaff

Physicianshowingcoronaryangiogramtopatientimmediatelyaerprocedure

CardiovascularInstituteofSouthernOregon

Te Cardiovascular Institute of Southern Oregon, LLC, (CVISO) opened in December and is a joint venture betweenRogue Valley Medical Center (RVMC); Cardiology Consultants, PC; Te Heart Clinic of Southern Oregon and Northern

California, PC; and Oregon Surgical Specialists, PC. Each year cardiologists and five vascular surgeons perform ahigh volume of diagnostic cardiac catheterizations, peripheral angiograms, and peripheral vascular interventions at CVISO.Located in a comfortable, state-of-the-art facility within the outpatient facilities of the Cardiovascular Institute on theRVMC campus, CVISO allows elective studies to be performed conveniently; total stays average just four hours.

Memberof

CardiovascularOutpatient

CenterAlliance


10/56


ASSETServiceArea

5

Chiloquin

Cave Junction

Gold Beach

Malin

PaisleyPort Orford

Dorris

Happy CampMontague

Tulelake

Bandon

Brookings

Coquille

Harbor

Lakeview

Myrtle CreekMyrtle Point

Redwood

Crescent CityYreka

MedfordAltamont

Ashland

Coos Bay

Grants Pass

Klamath Falls

Roseburg

C A L I F O R N I A

O R E G O N

RVMCRogue River

ASSETServiceArea

ASSETRegionalSupportServicesArea

MyocardialInfarctionTheASSETProgram

ASSE (Acute S-Segment Elevation Task Force) is a regional heart attack response team that coordinates the simultaneousactivation of paramedics, emergency departments, and the heart catheterization laboratory at RVMC for rapid

identification, triage, and treatment of S elevation myocardial infarction patients (severe heart attacks) throughoutsouthern Oregon and northern California. Te ASSE program has received national recognition for its dramatic reductionin death rates from heart attacks and is serving as a model for other programs in development across the country.

CorePartnershipHospitals

Ashland Community Hospital Fairchild Medical Center Providence Medford Medical CenterRogue Valley Medical Center Tree Rivers Community Hospital

CorePartnershipEmergencyServices

American Medical Response (AMR) Ashland Fire & Rescue Jackson County Fire District Medford Fire Department Mercy Flights Northern Siskiyou Ambulance Rogue River Fire District

ParticipatingHeartSpecialistsCardiology Consultants, PC Asante Cardiovascular and Toracic Surgeons

Te Heart Clinic of Southern Oregon and Northern California, PC

ASSETProgram

MissionStatement

Tofacilitatetheaccurateandrapid

diagnosistreatmentandtransport

ofpatientswithacuteST-Segment

ElevationMyocardialInfarction

STEMIfromthroughouttheregion

totheRogueValleyMedicalCenter

cathlabforemergentPercutaneous

CoronaryInterventionPCI

cardiologistsandfour

cardiothoracicsurgeonsworktogether

toprovidecarearound-the-clock

Sevenparamedicunits

andfivehospitalsarecurrently

collaboratingintheASSETprogram


11/56


hours hours hours

Healthyheartmuscle

Deadheartmuscleiemyocardialinfarctionheartaack

MyocardialInfarctionTimeIsMuscle

Cross-sectionalimageoftheleventricleduringaninferiormyocardialinfarction

ActualCoronaryAngiogram

Blockedartery

Ballooninflation

Stentwithopenartery

CoronaryArteryStenting

Coronaryarteryatheroscleroticplaque

Ballooninflationresultsinstentdeployment

Balloonremovedstentmaintainsanopenartery

Low-profilestentandballoonadvancedacrossblockage

CORONARY ARTERY DISEASE


12/56


AllASSETPatientsn

minutesRVMCdoortoballoontime

RVMCn

Patientsbroughtdirectlytothecardiaccatheterizationlaboratorybyparamedics

Paramedicn

TransferfromReferringHospitaln

TimeinMinutesArrivalatRVMC

ASSETPatientsAverageMedianTimetoTreatmentforSTEMI

ParamedicTimeonScene

TimeatReferringHospital

ParamedicTransportTime

EmergencyDepartmentDoortoCardiacCathLabDoorTime

CardiacCathLabArrivaltoOpenArtery

PatientfirstevaluatedinRVMCEmergencyDepartmentASSETTeamnotified

AllASSETPatientsJanDecn


AllASSETPatientsJanDecn


AllASSETPatientsJunAugn

minutesRVMCdoortowiretime

AllASSETPatientsJunDecn

minutesRVMCdoortowiretime

TimeinMinutes

ArrivalatRVMC

ASSETPatientsAverageMedianTimetoTreatmentforSTEMI

TimeatReferringHospital

ParamedicTransportTime

EmergencyDepartmentDoortoCardiacCathLabDoorTime

CardiacCathLabArrivaltoOpenArtery


13/56


NationallyRecognized

An Approach to Shorten ime to Infarct ArteryPatency in Patients with S-Segment ElevationMyocardial Infarction

American Journal of Cardiology;:.

Brian W. Gross, MDKent W. Dauterman, MDMark G. Moran, MDodd S. Kotler, MDStephen J. Schnugg, MDPaul S. Rostykus, MD, MPH

Amy M. Ross, PhD, RN, CNSW. Douglas Weaver, MD

Acknowledgements:We thank Karen A. Bales, RN, BSN;Dr. Douglas Burwell; Dr. Nicholas Dienel;Dr. John Forsyth; Dr. Gary Foster; Dr. MichaelFugit; Dr. Mark Huth; Dr. Ken Lightheart; Dr. David Martin;Dr. Minor Mathews; Dr. Brian Morrison; Dr. Bruce Patterson; Dr. Eric Pena; Dr. Brad Personious;Dr. Richard Schaefer; Mercy Flights; American Medical Response; Ashland Fire & Rescue; Rogue RiverFire District; Northern Siskiyou Ambulance; Medford Fire Department; Jackson County Fire District #;Rogue Valley Medical Center and PCI team; Providence Medford Medical Center; Ashland CommunityHospital; Tree Rivers Community Hospital; Fairchild Medical Center; Jane Sawall, RN, CNS;Heather Freiheit, RN, BSN; and Jo Jacavone, RN, MS

patientstreatedatRVMCforSTEMI

fromJunethroughDecember

percentofpatientshadhospital

doortoballoontimeswithin

minutesinmakingASSET

oneoftheelitemyocardialinfarction

programsinthecountry

Primarypercutaneouscoronary

interventionisthemostcomplex

multidisciplinaryandtime-sensitivetherapeuticinterventioninthe

worldofmedicinetoday

Theprocess

ismeasuredinminutes

Theoutcomes

aremeasuredinmortality

Teamworkandsmooth

transitionsareessential

DrIvanRokos

STEMISystemsMay



14/56


Thestrengthoftheprogramisthecollaborativeeffortofalltheparticipantsonan

equalfootingEMScardiologistscathlabemergencydepartmentsandhospitals

PaulRostykusMDSupervisingPhysician

JacksonCountyEmergencyMedicalServices

WesawthebenefitimmediatelyItbroughtthemortalityratedownandkeptitdown

ItspreysimpleTheprogramworksItistherightthingtodoandwedoit

DaveMathewsJosephineCountyOperationsManager

AmericanMedicalResponseAMR

TheEMTsfeelgoodaboutthedramaticimprovementincaretheycanprovide

andtheyappreciatethetrusttheyvebeengivenbytheEmergencyDepartmentphysiciansandcardiologists

KenParsonsGeneralManager

MercyFlights

ASSETisagreatprogramWeareexceedinglypleasedThesearededicatedcrews

EveryoneisreadytogoEverybodywantsittosucceedThereisnowaitingatanystage

Thesystemissmooth

DougHowardMDEmergencyMedicine

ThreeRiversCommunityHospital


15/56


RVMCNationalRegistryofMyocardialInfarction

SimilarHospitals

ASSETServiceArea

STElevationMyocardialInfarctionIn-hospitalMortalityComparisonRVMCVersusOtherHospitals

HistoricalMyocardialInfarctionMortalityRates

GlenaRasmussen

Mrs. Rasmussen is an active dance instructorwho awoke at a.m. with severe chesttightness. After her husband brought her tothe Rogue Valley Medical Center EmergencyDepartment, a -lead electrocardiogramshowed an acute anterior S elevation

myocardial infarction. Emergent coronaryangiography revealed an occlusion in theproximal left anterior descending a rtery.Te artery was promptly opened with aballoon, and a stent was deployed. Her chestdiscomfort resolved, and she was dischargedhome three days later.

Imbacktoteachingtap

dancingandIfeelgreat

ClinicalPracticeGuidelinesAHCPRPublicationNo-

s ASSETProgramatRVMCn

s s

HistoricalNationalHospitalMortalityRatesforSTElevationMyocardialInfarctionHeartAack

Amortalityrateisamongthe

lowestreportedinthenation



16/56


RVMCcardiopulmonaryandEECPstaff

HypothermiaforCardiacArrestPatients

Cardiac arrest (ventricular fibrillation) results inimpaired blood flow to the brain. A prolonged cardiacarrest (more than five minutes) can cause brain damage(anoxic encephalopathy). On occasion the heart canbe stabilized, but the patient remains unresponsivedue to inadequate cerebral perfusion. Inducingmild hypothermia to a core body temperature of degrees C via an external cooling blanket reducescerebral metabolism and edema and increases thelikelihood of making a meaningful neurologic recovery.Tis treatment has been proven to save one additionallife for every seven patients treated and is currentlyrecommended by the American Heart Association.At Rogue Valley Medical Center, patients were

treated from November through December. Six patients survived, and only one requiredrehabilitation care.

CourtesyofAbboNorthwesternHospital

SourceTheHypothermiaaerCardiacArrestStudyGroupNewEnglandJournalofMedicine

Hypothermia Normothermia

Survival

Days

CumulativeSurvivalintheHypothermiaandNormothermiaGroups

GregWard

Tis elementary school teacher was drivinghis car when he went into cardiac arrest. His-year-old son stopped the c ar, called --,and provided chest compressions untilparamedics arrived. Tey found Mr. Wardin ventricular fibrillation and promptlyconverted him to sinus rhythm. His -leadelectrocardiogram showed normal Ssegments and pre-excitation. Mr. Ward wasunresponsive with decerebrate posturing andGlasgow Coma Scale . Due to his anoxicbrain injury, the hypothermia protocol wasinitiated and he was cooled to degrees C.Over the next week, he made a dramaticand complete neurologic recovery. He was

diagnosed with Wolff-Parkinson-WhiteSyndrome (AV reentrant tachycardia) andunderwent successful radiofrequency ablationof his left lateral accessory pathway. He isnow back to teaching full-time and studyingto be a school principal.

Idonthavetotakemedicationand

Ihavegainedallmystrengthback

Ivebeengivenacleanbillofhealth


17/56


Approvedbythefederal

FoodandDrugAdministration

FDAandMedicare

percentimprovementindistance

thatcanbewalkedinsixminutes

DuringanEECPtreatmentthepatientscalvesandthighsarewrappedwithcompressivecuffsthatareinflatedanddeflatedaccordingtothecardiaccycleThisresultsinimproveddiastoliccentralaorticpressureandincreasedcoronaryperfusionpressure

LargeReduction

inUse

SlightReduction

inUse

Unchanged Worse

ChangeinNitroglycerinUsen

OneYearLaterAtCompletionofTherapy

ChangeinChestPainn

OneYearLaterCompletionofTherapy

GoodImprovement

SlightImprovement

Unchanged Worse

EnhancedExternalCounterpulsation

For patients with debilitating chronic angina notamenable to coronary revascula rization (stent orbypass surgery), enhanced external counterpulsation(EECP) is a well-tolerated, atraumatic, noninvasiveprocedure that can reduce the symptoms of anginapectoris, presumably by increasing coronary bloodflow to ischemic areas of the heart.

Te EECP device uses a series of compressive cuffswrapped around the patients calves, thighs, andbuttocks and synchronizes their inflation and deflationto the cardiac cycle. During diastole the cuffs inflatesequentially from the calves proximally, resultingin augmented diastolic central aortic pressure and

increased coronary perfusion pressure (when coronaryartery flow is maximal). Rapid and simultaneousdecompression of the cuffs at the onset of systole reducesthe systolic pressure and the cardiac workload.

Although the mechanism at work is unclear(possibly improved collateral flow), studies haverepeatedly shown that to percent of patientsexperience the following results:

Reduced frequency and intensity of chest painIncreased exercise toleranceReduced need for antianginal medications(such as nitroglycerin)Improved sense of well-being and quality of l ife

Patients typically undergo one-hour sessionsover a seven-week period and should first be evaluatedby a cardiologist. Tere have been patients sincethe program was established in .

ARRHYTHMIAS


18/56

ARRHYTHMIASARRHYTHMIAS

RobertJones

Mr. Jones retired from a package deliveryservice due to progressive fatigue and theinability to do his work. He was diagnosedwith severe congestive heart failure. He wasnoted to be in atrial fibrillation, and anechocardiogram showed severe systolicdysfunction with a left ventricular ejectionfraction of percent. His atrial fibrillationcould not be controlled with antiarrhythmicmedications. He underwent radiofrequencyablation, which terminated the atrialfibrillation. He also required cardiacresynchronization therapy (biventricularpacing) and an implantable cardioverter

defibrillator. His ca rdiac function hasreturned to normal, with a left ventricularejection fraction of to percent.

MydoctorknewIwasintrouble

andifhedidntdosomething

itwouldbebadHemadesure

IgotthecareIneededandhestill

checksinwithmeIhaveallthe

praiseintheworldformydoctor

BothelectrophysiologistsatRVMC

arecertifiedbytheAmericanBoard

ofInternalMedicineincardiovascular

diseaseandelectrophysiology

Rogue Valley Medical Centers electrophysiology (EP) program provides comprehensive diagnostic and therapeuticmanagement of simple and complex heart rhythm disorders, device management for heart fa ilure, evaluationand management of syncope, and sudden-death risk assessment and management. Our large procedure volumes,well-equipped electrophysiology laboratories, and highly experienced electrophysiologists and staff account for the

excellent patient outcomes and are comparable to the nations highest-rated programs.

DiagnosticElectrophysiologyStudies

Diagnostic EP studies are routine heart catheterizationprocedures used to identify and guide the treatment ofheart rhythm disorders. Sophisticated, state-of-the-artthree-dimensional electroanatomical mapping systemsare used (like a heart GPS) to guide t he cliniciansunderstanding and treatment of complex arrhythmiamechanisms. Often these diagnostic procedures aredone in the same setting a s therapeutic intracardiac

ablations, pacemaker insertions, or defibrillator implantsas indicated. Tese tests have a complication ratewell below percent.

NoofDiagnostic

ElectrophysiologyStudies

EPStudies LoopRecorderImplants

TiltTableTesting

Tis simple noninvasive test is used to evaluatefor neurocardiogenic (vasovagal) physiology as partof the evaluation of patients with syncope. Te testis often used to eva luate patients with recurrentsyncope of unknown cause unlikely to be relatedto pathologic arrhythmia, such as those withstructurally normal hearts.

Noof

TiltTableStudies


19/56


CartoDmapofleatriumwithlesionsatrialfibrillationablation

Fromtotherehave

beennoprocedure-relateddeaths

PulmonaryVeinAntralIsolation

Pulmonary vein antral isolation, also known as atria l fibrillation ablation, is used to treat problematic atrialfibrillation when antiarrhythmic medications fail. Te procedure isolates nests of atrial fibrillationgenerating tissuein the posterior part of the left atrium and sometimes the superior vena cava. Mapping systems are used to generateatrial geometry that is then merged with computed tomography scans of the posterior atria and pulmonary veins toguide ablation and electrical isolation of areas of the heart that trigger and sustain atrial fibrillation. Cure rates varywith the extent of cardiac pathology and range from to percent.

Pacemakersanddefibrillatorsare

implantedandmanagedonlyby

physicianswhoarecertifiedbythe

HeartRhythmSociety

IntracardiacAblation

Ablations are catheter-based procedures performed to treat a variety of arrhythmias, including many supraventriculartachycardias, atrial flutter, atrial fibrillation, and some types of ventricular tachycardia. Radiofrequency energy is usedto ablate arrhythmia foci and reentrant circuits to manage tachyarrhthmias. Cure rates for many arrhythmias exceed percent, with complication rates usually less than percent.

Fromtotherehavebeennoprocedure-relateddeaths

NoofAblationProcedures

ARRHYTHMIAS


20/56

ARRHYTHMIASARRHYTHMIAS

DeviceImplantation

RVMCs electrophysiology laboratory implants the full range of cardiac rhythm management devices, includingpacemakers, implantable cardioverter defibrillators (ICDs), implantable loop recorders, and cardiac resynchronization(biventricular, or Bi-V) devices for the management of heart failure. ICDs have dramatically reduced arrhythmic

and all-cause mortality in at-risk individuals. Biventricular pacing (with and without an ICD) has become a routinepart of managing patients with advanced heart failure. Pacing leads are used to synchronize activation of the right andleft ventricles to improve contractile dynamics, left ventricular ejection fraction, exercise capacity, and survival.

PercentageofPatients

Procedure-relatedDeaths

Infections HematomaRequiring

Re-exploration

Pneumothorax LeadDislodgement

ChamberPerforation

DeviceImplantationComplicationRates

ComplicationratesareforpacerbiventricularpacerandICDimplantsFordeviceimplantscomplicationratesaredefinedasprocedure-relatedmortalityinfectionhematomarequiringre-explorationpneumothoraxleaddislodgmentandperforation

PacemakersICDs Bi-VDevices

DistributionofDeviceImplantation

PopulationTota

lCombined

PacemakerandImplantableCardioverterDefibrillatorVolumes

Biventricularpacing/ICDleadsinheartCourtesyofBostonScientific

RVMCparticipatesin

theAmericanCollegeof

CardiologysICDRegistry


21/56


CardiacarrestduetoventricularfibrillationVF

orventriculartachycardiaVTunrelatedtoa

reversiblecause SustainedVTassociatedwithstructural

heartdisease

Syncopeofundeterminedoriginwithinducible

VTattimeofelectrophysiologicstudiesEPS

NonsustainedVTinpatientswithischemic

cardiomyopathyejectionfractionEF

percentandinduciblesustainedVTatEPS

Cardiacsyncopeinpatientswith

cardiomyopathyandnoexplanationof

mechanismofsyncopeaerEPS

a Syncopeinseingofcardiomyopathy

warrantshospitalizationandreferraltoarrhythmiaspecialist

Patientswithpotentiallylethalgeneticdisorders

andhigh-riskcharacteristics

a ProlongedQTsyndrome

i Recurrentsyncopedespitetreatment

withbeta-blockers

ii Significantfamilyhistoryofunexplained

suddencardiacdeathSCDespecially

ifpatienthassyncope

iii VF

b Brugadasyndrome

i SyncopewithspontaneousBrugadaEKG

ii VF

c Hypertrophiccardiomyopathy

i Hypertrophymm

ii Significantfamilyhistory

iii NonsustainedVT

iv Syncope

v Abnormalbloodpressureresponsetoexercise

vi VT/VF

d Rightventriculardysplasia

i Syncope

ii SignificantfamilyhistoryofSCDiii VT/VF

PrimarypreventionofSCDinpatientswith

ischemiccardiomyopathyandEFpercent

a Receivingoptimalmedicaltherapyb Atleastdaysaermyocardialinfarction

c Lifeexpectancyofatleastoneyearwithgood

functionalstatus

d ClassIIIIcongestiveheartfailureCHF

e ClassIVCHFifcandidateforbiventricularpacing

PrimarypreventionofSCDinpatientswith

nonischemiccardiomyopathyandEFpercent

a Receiptofoptimalmedicaltherapyfor

pastthreetoninemonths

b ClassIIIIICHF

c ClassIVCHFifcandidateforbiventricularpacing

BasedontheDeviceImplantationGuidelinesandtheSeptemberPreventionofSuddenCardiacDeathGuidelines

IndicationsforBiventricularPacing

ClassIIIorIVheartfailuresymptomswithle

bundlebranchblockLBBBorintraventricular

conductiondefectIVCDwithQRSms

a Receiptofoptimalmedicaltherapyfor

pastthreetoninemonths

b EFpercent

Anypatientwithsignificantcardiomyopathythat

requiressustainedventricularpacingsupport

a Rightventricularapicalpacingisknown

tobedetrimentalinthispatientsubset

b Itisreasonabletoupgradeapatientfroma

dual-chamberpacingdeviceifEF percent

andClassIIIIVCHFsymptomsarepresent

Patientswithatrialfibrillationwhorequire

atrioventricularnodalablation

a Heartfailuresymptoms

b Leventriculardysfunction

IndicationsforICDTherapy

MortalityRate

Months

TreatmentGroups

Amiodarone-yearmortalityrate

Placebo-yearmortalityrate

ICDTherapy-yearmortalityrate

SuddenCardiacDeathinHeartFailureTrial

SourceBardyGetalKaplan-MeierestimatesofdeathfromanycauseNewEnglandJournalofMedicine -

LeadExtractions

Te effectiveness and the dramatic increase inthe use of implanted cardiac devices have resultedin the need for complex device management and,

at times, the removal of implanted pacing and ICDsystems, including leads that have been in place foran extended time. Laser lead extraction is used toremove highly fibrosed lead systems from the heartand vascular system after extended use. Althoughserious intrathoracic bleeding can occur duringlead removal, careful planning, monitoring, andtechnique by experienced physicians have led toa high success rate.

CARDIAC SURGERYCARDIAC SURGERY


22/56

CARDIACSURGERYCARDIACSURGERY

Num

berofSurgeriesPerformed

CardiacSurgeriesPerformedYearTotal

Cardiacsurgicalprogram

establishedyearsago

CardiothoracicSurgery

Te cardiothoracic program at Rogue Valley Medical Center has been in existence for more than years, during which time more than , cardiac operations have been performed by six surgeons.Excellence in cardiothoracic surgery requires an integrated team effort and represents the collective

experience gained over the many years of the program as well as a continuing commitment to innovationand expertise provided by physicians, operating room staff, Coronary Care Unit (CCU) nurses, andsupport staff. A team of four cardiothoracic surgeons, each of whom individually performs more than operations per year, along with their cardiac anesthesia colleagues perform more than cardiacoperations each year. Excellence in postoperative care is achieved by a team of highly experienced CCUnurses, who along with intensivists and cardiologists have cared for thousands of cardiac patients.

HEART AND VASCULAR OUTCOMES


23/56


IsolatedCABG

AorticValve

ReplacementAVRTotal

IsolatedAVR

MitralValve

ReplacementMVRTotal

IsolatedMVR

MitralValve

RepairTotal

TransmyocardialRevascularization

SurgicalAtrial

FibrillationAblationMaze

DistributionofCardiacProcedures

CoronaryArtery

BypassGraingCABGTotal

Days

MedianLengthofStayCardiacPatients

RichardSilvawithwifeGloria

Mr. Silva () is a retired c arpenter whonoted mild right-side chest and upper-backdiscomfort. A diastolic heart murmur wasnoted, and an echocardiogram showed severe

aortic regurgitation and an ascending aorticaneurysm (. cm in diameter). A C scanshowed an aneurysm extending from theascending aorta to the aortic arch (. cm indiameter). An aneurysm was also noted in thedescending thoracic aorta at the level of thediaphragm. Coronary angiography revealed a percent stenosis in the right coronary artery.Mr. Silva underwent open heart surgerywith aneurysm resection in the ascendingaorta and arch, replacement of the aortic valve,and placement of a bypass graft to the rightcoronary artery. Four months later, a stent graftwas placed via the femoral artery approach,effectively sealing off the descending thoracicaortic aneurysm. Mr. Silva recovered from hisstaged operations and is currently doing well.

Isurvivedthatwasafeatinitself

Thedoctorsnursesandeveryone

involvedhaveallbeengreat

CARDIACSURGERYCARDIAC SURGERY


24/56

CARDIACSURGERY

n

n

n

n

n

n

n

n

CABGMortalityRateforFirstOperation

SocietyofThoracicSurgerySTSComparableHospitalBenchmarkRVMC

n

n

n

n

n

n

MortalityRateforSecondThirdorFourthCABGSurgeryReoperation

STSBenchmarkRVMC

AnAbiomedleventricularassist

deviceisavailableforpatientswith

severeleventriculardysfunctionand

associatedcongestiveheartfailure

cardiacoperations

performedsince

LeventricularassistdeviceCourtesyofAbiomed

CoronaryArteryBypassGra

Board-certifiedAnesthesiologists

HEART AND VASCULAR OUTCOMES


25/56


ValveProcedureVolume

DistributionofPrimaryValveProcedures

AorticValveRepair/ReplacementCABG

MitralValveRepair/ReplacementCABG

Aortic/MitralValve

Repair/ReplacementCABG

TricuspidValve

Replacement/Annulplasty

IsolatedMitralValveRepair/Replacement

IsolatedAorticValveRepair/Replacement

DistributionofPrimaryValveProceduresn

ValveReoperations

PrimaryValveOperations

RVMCIntensivists

ValveProcedures

Thesixintensivistsat

RVMCareboardcertifiedin

criticalcaremedicineandfour

arepulmonologists

Anintensivistispresentinthe

hospitalaround-the-clockHospitals

withanintensivistprogramare

associatedwithbeeroutcomes

andlowermortalityrates

CARDIACSURGERYCARDIAC SURGERY


26/56

CARDIACSURGERY

JoeMaxeywithwifeDixie

Mr. Maxey () is a part-time machinistwho noted progressive shortness of breath overthe past year. When he walked uphill to themailbox, he had to walk at a very slow pace

and stop frequently due to dyspnea and fatigue.His physical examination was remarkablefor a / blowing holosystolic murmur at theapex. A -lead electrocardiogram showedatrial fibrillation. An echocardiogram revealedsevere mitral regurgitation due to prolapseof the posterior mitral valve leaflet. Furtherevaluation showed moderate pulmonaryhypertension but no coronary artery disease.ransesophageal echocardiography revealedboth mitral valve prolapse and chordal rupture.Mr. Maxey underwent minimally invasivemitral valve repair and a Maze radiofrequencyablation for his atrial fibrillation. Four daysafter surgery, he went home. Mr. Maxey iscurrently active and has no mitral regurgitationor atrial fibrillation.

Icandomorenowthanwhen

IwasyearsoldItsbeena

life-changingexperience

ValveleaflettipsdonotcoaptJoeMaxeytransesophagealecho Leventricle

Leatrium

Flailmitralvalveleaflet

DopplersignalshowingtheseverelyleakyvalveJoeMaxeytransesophagealecho

Severeregurgitantjet

StandardsternotomyonleminimallyinvasiveapproachformitralvalverepaironrightCourtesyofEdwardsLifesciences

Smallthoracicincision

Vascularaccess

StandardsternotomyMinimallyInvasiveValveProcedures

Te minimally invasive thoracoscopic video-assistedmitral/tricuspid valve procedureallows valve repairor replacement to be performed without sternotomy.

Rogue Valley Medical Center cardiac surgeons usethis technique primarily for patients who requiremitral valve replacement, mitral valve repair fordegenerative prolapse, or tricuspid valve repair.

Minimally invasive surgery offers a better cosmeticoutcome and can reduce pain, likelihood of infection,and length of hospital stay.



27/56

Intraoperativetransesophageal

echocardiographyisperformed

routinelyonpatientsundergoing

valvesurgeryatRVMC

PericardialtissuevalvebioprostheticCourtesyofEdwardsLifesciences

PorcinetissuevalvebioprostheticCourtesyofMedtronic

ImplantedmechanicalaorticandmitralvalvesCourtesyofCarboMedics

StJudeMedicalmechanicalvalveCourtesyofStJudeMedical

ValveaerrepairleafletstouchnomitralregurgitationJoeMaxeytransesophagealecho

Repairedvalvenoregurgitation

ProstheticHeartValves

CARDIACSURGERYCARDIACSURGERY


28/56

GreatVessels

ThoracicAorticProcedures

EndovascularThoracicStent

Endovascular reatment of Toracic AorticAneurysm: Until recently, treatment of a descendingthoracic aortic aneurysm required an open and morbidsurgical procedure associated with a significant risk ofparaplegia. A new endovascular approach is safer andless invasive, and involves accessing the femoral artery,advancing a stent graft to the descending thoracic aorta,and deploying the stent graft across the aneurysm toseal it off. Patients often go home in one to two days.

n

n

n

n

n

IsolatedAorticValveReplacementMortalityRaten

STSBenchmarkRVMC

n

n

n

n

n

IsolatedMitralValveReplacementMortalityRaten

STSBenchmarkRVMC

n

n

n

n

n

IsolatedMitralValveRepairMortalityRate

STSBenchmarkRVMC

MinimallyInvasiveValveProcedures

JackFrost

Mr. Frost noted progressive dyspnea and

was diagnosed with congestive heart failure.He was subsequently diagnosed with severeaortic stenosis, severe mitral regurgitation,multivessel coronary artery disease, andsevere left ventricular systolic dysfunctionwith a left ventricular ejection fraction of to percent. He underwent open heartsurgery, requiring the replacement of bothheart valves, and four-vessel coronary arterybypass graf t surgery. Mr. Frosts heartfunction returned to normal, and he iscurrently running his business, Jack FrostMarine, where he repairs outboard motorson a full-time basis.

Ineverhadanounceof

painandIplayedholes

ofgolfinatournamentsix

monthsaermysurgery



29/56

TransmyocardialRevascularizationProcedureVolume

TransmyocardialRevascularization

AtrialFibrillation

MazeProcedureVolume

ransmyocardial revascularization (MR) is an option for patients with stable angina refractory to medical treatmentand not amenable to standard coronary revascularization. A carbon dioxide laser is used to fire single high-energypulses to create smooth, straight microchannels in the wall of the left ventricle. MR is occasionally used in conjunctionwith standard CABG to treat an area of myocardium that cannot be revascularized with bypass grafts or stents.Clinical tria ls have demonstrated MR to be a safe and effective means of obtain ing long-term relief of angina,improved heart muscle perfusion, and improved quality of li fe. Tis technology was introduced at Rogue ValleyMedical Center in .

RVMCCardiacIntensiveCareUnitstaff

havemorethanadecadeofexperienceincardiaccare

RVMCHeartCenterstaff

havemorethanadecadeof

experienceincardiaccare

RVMCopenheartsurgicalteam

havemorethanadecadeof

experienceincardiaccare

VASCULARSURGERYVASCULARSURGERY


30/56

TheperipheralvasculatureCourtesyofAbboVascular

ComprehensiveVascularCare

Te vascular surgical section of the CardiovascularInstitute of Southern Oregon, LLC, (CVISO) consistsof five board-certified vascular surgeons who provide

around-the-clock elective and emergent care for a widespectrum of peripheral vascular disorders. Outpatientangiography and peripheral vascular interventions areperformed in the outpatient angiography suite withinCVISO. Complex surgical reconstructive procedures,including a high-volume endovascular program forthe management of abdominal aortic aneurysms, areperformed within our regions only state-of-the-artdedicated endovascular angiographic operating roomlocated at Rogue Valley Medical Center.

Includescarotidangiographyrenalangiographymesentericangiographyupper-andlower-extremityangiographyandabdominalangiography

PeripheralAngiographyVolumeatRVMCandCVISO

AbdominalaorticaneurysmCourtesyofMedtronic

Abdominalaorticaneurysm

Vascular surgeons, cardiothoracic surgeons, andcardiologists provide an integrated approach to themanagement of complex thoracic and abdominal aortic

disease combining thoracotomy and endovascularapproaches to the management of thoraco-abdominalaortic aneurysms and acute aortic dissections.

Vascular surgeons, interventional cardiologists,and neurologists work together to provide acomprehensive management of carotid arterydisease utilizing either surgical endarterectomyor percutaneous stent procedures.



31/56

n

n

n

ElectiveEndovascularStentGraRepairIn-hospitalMortalityRate

n

n

ElectiveAbdominalAorticAneurysmSurgicalVolume

EndovascularStentGraRepairTotalRepairs OpenSurgicalRepair

StentgraplacedacrossaneurysmeffectivelysealingitoffCourtesyofMedtronic

Iliacar teries Aneur ysm

Aorta

Stentgra

OpensurgicalrepairofabdominalaorticaneurysmCourtesyofMedtronic

EndovascularapproachviathefemoralarterieslessinvasiveCourtesyofMedtronic

Femoralarteryaccess

Leapfrogrecommends

AnnualHospitalVolumesfor

abdominalaorticaneurysmrepair

bemorethanperyear



32/56

IsolatedCarotidEndarterectomyIn-hospitalDeath/StrokeRate

StrokeDeath

n

n

n

n

n

TotalCarotidArteryRevascularizationProcedures

IsolatedCarotidEndarterectomy

CarotidStent

SimultaneousCarotidEndarterectomyandCardiacSurgery

Carotidstentprogrambeganin

CarotidEndarterectomy

While the patient is under general anesthesia, anincision is made in the skin over the carotid artery.Te carotid artery is clamped and incised, and the

atherosclerotic plaque is removed (endarterectomy).Tis is similar to removing the inner layers ofan onion. Te artery and the skin are thensurgically closed.

NaturalHistoryofCarotidDiseaseRiskofIpsilateralStroke

Symptomatic Patients (IA/Stroke) to percent stenosis: . percent per year to percent stenosis: . percent per yea r

Asymptomatic Patients> percent stenosis: to percent per year

SourceNASCETNASCETIIACASandACSTtrials

RVMCistheonly

JointCommissionapproved

strokecenterinsouthern

Oregonandhasreceivedthe

AmericanHeartAssociation

GetWithTheGuidelinesSM

Strokeawardtwice



33/56

CarotidstentdeployedfilternotyetretrievedCourtesyofAbboVascular

Bloodflowtobrain

Filtertrapsparticlesfrom

plaquebutpermits

bloodflow

Internalcarotidartery

Stentacrosscarotidarteryplaque

Equipmentplacedviafemoralarteryinleg

NewTechnologyProfileCarotidStenting

Accunetfilterwith-micronporestopermitbloodflowCourtesyofAbboVascular

AcculinkstentCourtesyofAbboVascular

Angiogramofcarotidarterypriortostent

Angiogramof

carotidarteryaerstent

FDAapproval

inAugust

Medicareapproval

inspring



34/56

P

HighSurgicalRiskPatients

Stenting Endarterectomy

Free

domfromMajor

A

dverseEvent

DaysAerInitialProcedure

SourceTheSAPPHIREStudyNewEnglandJournalofMedicine

WhoShouldBeConsideredforCarotidStenting?

High surgical risk patient:Symptomatic patient with percent stenosis

Asymptomatic patient with percent stenosis

Normal surgical risk patient:Standard of ca re is carotid endarterectomyNational Institutes of Health (NIH)sponsoredCRES study randomly assigns patients to eithercarotid stenting or surgical endarterectomy

CriteriaforIncreasedSurgicalRisk

Congestive heart failure Class III/IV and/orleft ventricular ejection fraction


35/56

PatientsseenbyneurologistatRVMCbeforeandaerprocedure

Death MyocardialInfarction

StrokeMinor

StrokeMajor

DeathStroke

Myocardial

Infarction

CarotidStentinginHigh-RiskSurgicalPatientsComparisonwithMAVERICIICarotidStentRegistry

RVMCMAVERICII

-DayOutcomes

CarotidStentVolume

Fiveboard-certified

vascularsurgeonsprovide

around-the-clockcoverage

PatientsatNormalSurgicalRiskNIHsponsoredCRESTTrial

Rogue Valley Medical Center is one of centers inNorth America chosen to participate in the National

Institutes of Healthsponsored CRES trial. Tisstudy randomizes normal surgical risk patients withcarotid artery disease to carotid endarterectomyversus carotid stenting with distal emboli protection.Te screening process for treating physicians is rigorous;only experienced physicians with an excellenttrack record are chosen.

NeurologicalAssessment

Neurologist Walter Carlini, MD, sees all pat ientsbefore and after carotid stent procedures to provide

an objective assessment of neurological function.Te information is forwarded to a central databaseas part of the CAPUR E carotid stent registryand NIH-sponsored CRES tria l.

IMAGINGIMAGING


36/56

Echocardiogram

Treadmillstresstesting

Echocardiographyis a noninvasive ultrasonographicassessment of cardiac structure and function, includingevaluation of ischemic and nonischemic ventriculardysfunction, cardiomyopathy, valvular heart disease,and congenital malformations. Invasive transesophagealassessment is also performed in the inpatient andoutpatient settings, as well as intraoperative assessmentof cardiothoracic surgical procedures.

Transesophagealechois

availablearound-the-clock

atRVMC

readmill stress testing provides electrocardiogram(ECG) assessment for exercise-induced ischemia orarrhythmias, including chronotropic competence.readmill testing is used predominantly in patients whoare able to exercise and have a normal baseline ECG.

EchocardiographyVolumesRVMCandTRCH

PediatricEchoTransesophagealEchoEcho

TotalStressTestsRVMCandTRCH

NoninvasiveDiagnosticTesting

Rogue Valley Medical Center offers a full spectrum of noninvasive diagnostic testing for cardiovascular diseases:

Echocardiography (transthoracic,transesophageal, pediatric)

readmill stress testingNuclear stress testing

MUGA scansHolter/event monitors

ilt table testingVascular imaging

Cardiac MRI (provided throughOregon Advanced Imaging)

Cardiac C angiography, coronarycalcium scoring



37/56

Nuclearstresstesting

ElectrophysiologyVolumesRVMCandTRCH

TiltTableHolter/LoopEventMonitor

Nuclear stress testing allows a noninvasive assessmentof coronary blood flow and cardiac function; it isperformed with exercise or pharmacologic stressprotocols. It is useful in assessment of ischemia witha baseline abnormal ECG, a nonspecific or possiblyfalse-positive treadmill result, moderate probabilityfor coronary artery disease (CAD), localization ofischemia in known coronary artery disease, or riskstratification after a cardiac event.

Multiple gated acquisition scans are used for evaluationof right and left ventricular systolic performance.

AHolter monitor continuously records a patientsheart rhythm for hours. Te patient notes anysymptoms, which a llows correlation of the heartrhythm to any concerning symptoms.

An event monitor is worn for approximatelyone month. When a patient ha s symptoms (suchas palpitations, lightheadedness, or dizziness), thepatient pushes a button to record the heart rhythm.Tis information is then transmitted over the

telephone to the physician for review.

ilt table testing is a noninvasive assessment forvasovagal (neurocardiogenic) syncope.

Vascular imaging consists of ultrasonographicassessment of carotid and peripheral vascular disease,including atherosclerotic blockage, aneurysm formation,and deep venous thrombosis.

Cardiac magnetic resonance imaging (MRI) is used

to evaluate for arrhythmogenic right ventriculardysplasia, constrictive pericarditis, and myocardial

viability following infarction.

PeripheralVascularImagingVolumesRVMCandTRCH

CarotidArteryUltrasound

VenousUltrasoundofLegs

ArterialUltrasoundofArmsandLegs

StressTestTypes

TreadmillOnly

StressEcho

NuclearStress

Cardiologiststrainedin

Transesophageal

echocardiography

Nuclearstresstests

CardiacCT

IMAGINGIMAGING


38/56

DcardiacCTimageCourtesyofGEHealthcare

LightspeedVCTCourtesyofGEHealthcare

NewTechnologyProfileCardiacCT

Coronary calcium score is a screening heartscan used to detect calcium deposits found inatherosclerotic plaque in the coronary arteries.

Te calcium score is then used to evaluate riskfor future coronary heart disease and events.

Coronary C angiographyconsists ofhigh-resolution, three-dimensional picturesof the moving heart and great vessels thatare used to determine whether a patienthas significant coronary atherosclerosisor any structural abnormality of the heart

and surrounding structures.

MedicareCoverageforCoronaryCTAngiography

Patients with acute chest pain presenting in anemergency room (or equivalent) when necessary

to rapidly differentiate among reasonably probableaortic, pulmonary, and/or coronary etiologiesFirst-line testing for CAD in nondiabeticpatients with intermediate risk factors presentingin an emergency room (or equivalent) with chestpain syndrome or other symptoms stronglysuggestive of coronary disease, and who havenormal or borderline enzymes and EKGs, whennegative findings will result in avoiding invasivecoronary angiographyEquivocal or suspected inaccurate stress (or stressimaging) test in patients with low to intermediate

risk factors when a negative CCA will result inavoiding invasive coronary angiographyClinical findings strongly suggestive of acongenital anomaly of the coronary vesselsor great vessels



39/56

RVMCnuclearimagingstaff

RVMCechocardiographyimagingstaff

SourceDetranoRetalCoronaryArteryCalciumScoreNewEnglandJournalofMedicine -

CumulativeIn

cidenceofCoronaryEvents

YearstoEvent

CoronaryArteryCalciumScore

>

CoronaryCalciumScore

Coronary arterial calcification is part of the developmentof atherosclerosis (hardening of the arteries), occursalmost exclusively in atherosclerotic arteries, and is

absent in the normal vessel wall. A score of impliesa low likelihood of coronary obstruction but cannottotally exclude the presence of atherosclerosis. A highscore indicates a significant plaque burden and anincreased relative risk of future heart and vascularevents. It should be understood that calcification doesnot imply significant obstruction nor is it site specificfor a stenotic lesion, but rather indicates the extentof atherosclerosis throughout the coronary arteries.

-sliceCTscanners

areavailableatRogueValley

MedicalCenterandThreeRivers

CommunityHospital

PREVENTIVECARDIOLOGYPREVENTIVECARDIOLOGY


40/56

CardiacRehabilitationProgram

Cardiac rehabilitation consists of a monitored exerciseand educational program that provides an essentialservice to patients with chronic angina and those

who have had a cardiac event such as a myocardialinfarction. Individuals who have undergone aninterventional procedure, such as coronary arterystenting, bypass surgery, or valve replacement, alsobenefit from cardiac rehabilitation. Research datahave shown that participation in a certified c ardiacrehabilitation program results in a to percentreduction in mortality and up to a percentimprovement in physical strength and endurance.

Te RVMC Cardiac Rehabilitation program has beenin place since . RVMCs program and the one at

Tree Rivers Community Hospital (RCH) are twoof the certified programs in the state of Oregon.ogether with the program at Curry General Hospital,they are the sole providers of cardiac rehabilitationprograms in Jackson, Josephine, Klamath, Del Norte,Curry, Lake, and Siskiyou counties. Tese programsare directed by cardiologists, and all the nurses aretrained in Advanced Cardiac Life Support.

Fewerthanpercentof

patientshadunacceptable

bloodpressureatthecompletion

oftheircardiacrehabilitation

percentofpatients

experiencedanobjective

improvementinstrength

andendurance

Cardiacrehabilitationis

recommendedbytheAmericanHeartAssociationandtheAmerican

CollegeofCardiology

RVMCandTRCHareboth

certifiedbytheAmerican

AssociationofCardiovascularandPulmonaryRehabilitation

percentofpatients

wereverysatisfied

withtheirexperience

percentofpatients

haveagreaterthanpercent

improvementinexercisecapacity

RVMCcardiacrehabstaff

RVMC TRCH

NumberofPatientsOverFiveYears



41/56

RVMCcardiaceducators

RogueValleyMedicalCenterCardiacRehabilitation

Tird Floor Northwest East Barnett Road

Medford, OR () -

ThreeRiversCommunityHospitalCardiacRehabilitation

Washington Outpatient Center NW Washington Blvd.Grants Pass, OR () -

CurryGeneralHospital

CardiacRehabilitation East Fourth StreetGold Beach, OR () -

CardiacEducators

RVMC cardiac educators, who are all registerednurses, visit with patients who have had heart failure,angina, or a heart attack. Tey teach patients aboutthe nature of their illnesses and the steps they can

take to avoid future problems. Tese nurses also workwith patients who have cardiac procedures, such asopen heart surgery, placement of a coronary or carotidstent, insertion of a pacemaker, or implantation of adefibrillator. Nurse educators provide an additionallevel of care and answer patients questions. Teyreview important instructions, discuss the procedure,and show patients actual bal loons, stents, pacemakers,and defibrillators. Te purpose of their visits is toensure that patients understand their medical conditionand upcoming outpatient care plan.

Goals

Optimize a sense of well-being and functionIncrease enduranceEducate patients and families

regarding cardiac diseaseLearn healthy habits, particularly dietand exerciseDetermine the level at which a patient cansafely exercise

Cardiac rehabilitation is recommended for the followingconditions if they occurred within the past year:

Myocardial infarctionAcute coronary syndromeCoronary artery bypass graft surgeryPercutaneous coronary intervention

(such as a coronary stent)Stable angina pectorisHeart valve surgical repair or replacementHeart or lung transplantation

Heart Transplant CareMark Huth, MD, PhD, FACC, specializes inthe care of patients who have had heart transplants.He earned both his doctor of philosophy and his

medical degree and served as an assistant professor ofmedicine at the University of Washington in Seattle.Myocardial biopsies are per formed to monitor forrejection. Coronary angiography and intravascularultrasonography are available to monitor coronaryallograft vasculopathy.

QUALITYOURAPPROACHQUALITYOURAPPROACH


42/56

RVMCperformanceimprovementstaff

Te divisions of cardiology and ca rdiothoracic surgerybelieve in the importance and value of a robust qualityimprovement approach to the delivery of healthcare.With the assistance of the chief quality officer forAsante Health System, Patricia Martinez, MD, andthe performance improvement staff, clinica l outcomes

are compared with external benchmarks to continuouslyidentify areas of potential improvement and providepatients with information useful in their ownhealthcare decisions.

RVMC has participated in the development of Centersfor Medicare & Medicaid Service (CMS) projectsand strives to achieve high levels of compliance withthe current CMS Core Measures for Best Practice.Guidelines and best practices from a wide rangeof resources, including the Leapfrog Group, the

Institute for Healthcare Improvement K LivesBest Practices campaign, the American College ofCardiology, and the American College of ToracicSurgery, are used to define standards of care andgoals for future improvement.

Trough participation in national initiatives, we supporttransparent public reporting of healthcare quality dataand participate in the following initiatives:

Joint Commission Performance MeasurementInitiative (www.qualitycheck.org)Centers for Medicare and Medicaid

Hospital Compare ( www.hospitalcompare.hhs.gov)

Itisourbeliefthat

Experiencedboard-certifiedphysicians

patientvolume

well-designedhospitalsystemregularoutcomesreviewwithappropriatefeedbackQualitygoodoutcomes

AmericanHeartAssociation

GetwiththeGuidelines

AwardRecipient

ThomsonSolucientTop

HospitalsCardiovascular

BenchmarksforSuccessAward

CoronaryArteryBypassGraing

PercutaneousCoronary

Intervention

AbdominalAorticAneurysmRepair

AorticValveReplacement

LeapfrogEBHREvidence-BasedHospitalReferralSafetyStandard

Volume

RVMCVolume

RecommendedAnnualVolume



43/56

CMSCoreMeasuresBestPracticesLeapfrogGuidelines

CoronaryArteryBypassGraingCABG

Favorable hospital volume

( or more procedures per year)Participation in Society of Toracic Surgeons(SS) data collectionSS score better than national averagefor risk-adjusted mortalityMinimum surgeon volume per year for CABG( cases per year)

PercutaneousCoronaryInterventionPCI

Favorable hospital volume( or more procedures per year)Participation in the American College of CardiologyNational Cardiovascular Data Registry (ACC-NCDR)or > percent adherence to the Leapfrog Expert PanelEndorsed Process Measures for QualityScore better than the national average forrisk-adjusted mortalityMinimum surgeon volume per year for PCI( cases per year)

Aspirin

atArrival

AspirinatDischarge

ACEInhibitor/Angiotesin

ReceptorBlockerforLVSystolicDysfunction

SmokingCessation

Beta-blocker

atArrival

Beta-blockeratDischarge

PercutaneousCoronary

InterventionWithinMinutes

AcuteMyocardialInfarctionCMSQualityMeasure

Compliance

December

AspirinatDischarge

AntibioticsWithinHour

AntibioticsDiscontinuedWithinHours

CoronaryArteryBypassGraSurgeryCMSQualityMeasure

Compliance

December

DischargeInstructions

LeVentricularLVAssessment

ACEInhibitor/AngiotesinReceptorBlockerforLV

SystolicDysfunction

SmokingCessation

CongestiveHeartFailureCMSQualityMeasure

Compliance

December

PHYSICIANBIOGRAPHIESPHYSICIANBIOGRAPHIESAsante Cardiovascular and Thoracic Surgeons


44/56

Asante Cardiovascular and Thoracic Surgeons

CharlesCarmeciMDFACS

CardiovascularandThoracicSurgery

Specialties Coronary artery bypass graft surgery,valve surgery, thoracic aortic aneurysm repair,minimally invasive valve surgery, thoracic oncology,minimally invasive thoracic surgery

MedicalDegree Medical College of Virginia

Internship/Residency General Surgery at StanfordUniversity Medical Center

CardiothoracicSurgeryFellowship University ofWisconsin

BoardCertification American Board of Surgery,

American Board of Toracic SurgeryHonors/Awards Graduated with honors fromGeorge Washington University (undergraduatedegree) and Medical College of Virginia

DavidLFolsomMDFACS


Specialties Coronary artery bypass graft surgery,valve surgery, thoracic aortic aneurysm repair,minimally invasive valve surgery, thoracic oncology,minimally invasive thoracic surgery

MedicalDegree University of Utah

Internship/Residency General Surgery atCase Western Reserve University

CardiothoracicSurgeryFellowshipCase WesternReserve University

BoardCertification American Board of Surgery,

American Board of Toracic SurgeryHonors/Awards Chairman, Department of Surgeryat Rogue Valley Medical Center ; AllenResearch Fellow at Wade Park VA Medical Center

RogerVHallMD


Specialties Cardiovascular and thoracic surgeryMedicalDegree University of Utah

Internship/Residency General Surgery atMadigan Army Medical Center

CardiothoracicSurgeryFellowshipLettermanArmy Medical Center

BoardCertification American Board ofToracic Surgery



45/56

CardiologyConsultants PCstaff OregonSurgicalSpecialistsPCstaff

HeartClinicofSouthernOregonandNorthernCaliforniaPCstaff

AsanteCardiovascularandThoracicSurgeonsstaff

GeorgeRWilkinsonMDFACS


Specialties Cardiovascular and thoracic surgeryMedicalDegree University of Iowa

Internship/ResidencyGeneral Surgery atripler Army Medica l Center

CardiothoracicSurgeryFellowshipLettermanArmy Medical Center

BoardCertification American Board ofToracic Surgery

PHYSICIANBIOGRAPHIESPHYSICIANBIOGRAPHIESCardiology Consultants PC Grants Pass


46/56

Cardiology Consultants, PCGrants Pass

BradleyEPersoniusMDFACC

Cardiology

Specialties Consultative cardiology, transesophagealechocardiography, pacemakers, complex lipiddisorders, preventive cardiology, cardiac C,nuclear cardiology, cardiac catheterization

MedicalDegree Loma Linda UniversitySchool of Medicine

Internship/Residency Internal Medicine at WilfordHall Medical Center, Lackland Air Force Base, exas

CardiologyFellowshipWilford Hall Medical Center

BoardCertification Internal Medicine, Cardiology,

Cardiac Device Specialist

DouglasTBurwellMDFACC

Cardiology

Specialties Consultative cardiology, preventivecardiology, echocardiography, nuclear cardiology,coronary angiography

MedicalDegree University of California,Los Angeles

Internship/Residency Internal Medicine atUniversity of California, Irvine

CardiologyFellowship University ofCalifornia, Irvine

BoardCertification Internal Medicine, Cardiology

Dr. Burwell received his undergraduate degree fromStanford University.

RichardLSniderMDFACC

Cardiology

Specialties Consultative cardiology, valvularheart disease, complex lipid disorders, congestiveheart failure, echocardiography, nuclear cardiology,cardiac catheterization

MedicalDegree Georgetown University

Internship/Residency Internal Medicine atUniversity of New Mexico

CardiologyFellowshipUniversity of New Mexico


Dr. Snider graduated with a bachelors degree

in biomedical engineering and worked in theHematology Department at Walter Reed ArmyInstitute of Research.

HEARTANDVASCULAROUTCOMESCardiology Consultants PCMedford


47/56

Cardiology Consultants, PCMedford

NicholasHDienelMDFACC

Cardiology

Specialties Consultative and preventive cardiology,complex lipid disorders, congestive heart failure,echocardiography, nuclear cardiology

MedicalDegree University of Pennsylvania

Internship/Residency Internal Medicine atUniversity of Michigan

CardiologyFellowshipUniversity of Pennsylvania


Honors/Awards Graduated with highest honors fromPennsylvania State University (undergraduate); Alpha

Omega Alpha Medical Honor Society

ToddSKotlerMDFACC

Cardiology

Specialties Consultative cardiology, interventionalcardiology, general cardiology, nuclear cardiology

MedicalDegree Stanford University Schoolof Medicine

Internship/Residency Internal Medicine atUniversity of California, Los Angeles

CardiologyFellowshipCedars-Sinai MedicalCenter, UCLA

BoardCertification Internal Medicine, Cardiology,Interventional Cardiology

Honors/Awards Highest honors from Universityof California, Santa Cruz (undergraduate)

PHYSICIANBIOGRAPHIESPHYSICIANBIOGRAPHIESCardiology Consultants, PCMedford


48/56

Cardiology Consultants, PC Medford

KristinMLinzmeyerMDFACC

Cardiology

Specialties General and invasive cardiology, heartdisease in women

MedicalDegree Oregon Health Sciences University

Internship Internal Medicine at University of Utah

ResidencyInternal Medicine at Oregon HealthSciences University

CardiologyFellowshipUniversity of New Mexico

BoardCertification Internal Medicine,Cardiovascular Disease

DavidJMartinMDFACC

Cardiology

Specialties Electrophysiology, intracardiacablation, pacemakers, defibrillators, invasive andnoninvasive cardiology

MedicalDegree Dartmouth Medical School

Internship/Residency Internal Medicine atCedars-Sinai Medical Center, UCLA

CardiologyFellowshipCedars-Sinai Medical Center

BoardCertification Clinical CardiacElectrophysiology, Cardiovascular Disease

Honors/Awards Alpha Omega Alpha Honor Society

in medical school, Phi Beta Kappa

KennethMLightheartMDFACC

Cardiology

Specialties Consultative cardiology, transesophagealechocardiography, nuclear cardiology, coronaryangiography, cardiac C

MedicalDegree Oregon Health Sciences University

InternshipInternal Medicine at LegacyPortland Hospitals

Residency Internal Medicine at David GrantMedical Center, ravis Air Force Base, California

CardiologyFellowshipWilford Hall Medical Center,Lackland Air Force Base, exas

BoardCertification Internal Medicine, Cardiology,Nuclear Cardiology

Honors/Awards Summa cum laude from BrighamYoung University, cum laude from Oregon HealthSciences University, Alpha Omega Alpha HonorSociety in medical school, Housestaff ScientificResearch Second Place Award



49/56

MarkGMoranMDFACCFSCAI

Cardiology

Specialties Interventional cardiology, pacemakerand defibrillator implantation and follow-up, invasiveand noninvasive cardiology, nuclear cardiology

MedicalDegree University of California,Los Angeles

Internship/Residency UCLA Medical Center

CardiologyFellowship UCLA Medical Center

BoardCertification Internal Medicine, Cardiology,Interventional Cardiology; estamur NASPExAM;Certified Cardiac Device Specialist IBHRE

Honors/Awards California Heart AssociationResearch Fellow; bachelors degree in biology withhighest honors from University of California, SantaCruz; Department of Medicine Intern of the Year,UCLA Medical Center; Fellow Society for CardiacAngiography and Interventions

BrianJMorrisonMDFACC

Cardiology

Specialties Consultative cardiology, adult andpediatric heart disease, cardiac C, transesophagealechocardiography, nuclear cardiology,cardiac catheterization

MedicalDegree University of Illinois, Chicago

Internship/ResidencyInternal Medicine at Universityof Colorado Health Sciences Center, Denver

CardiologyFellowshipMassachusetts GeneralHospital, Harvard Medical School, Boston

BoardCertificationCardiology

Honors/Awards Grove Outstanding Senior AwardFinalist, University of Illinois College of Medicine;Outstanding Resident eaching Award, Universityof Colorado Health Sciences Center

Dr. Morrisons training included a senior clinicalresearch fellowship at Boston Childrens Hospital. Healso spent one year as an instructor and staff physicianat the Adult Congenital Heart Disease Center at theUniversity of California, Los Angeles.

PHYSICIANBIOGRAPHIESPHYSICIANBIOGRAPHIESHeart Clinic of Southern Oregon and Northern California, PC


50/56

g

BrianWGrossMDFACC

Cardiology

Specialties Interventional cardiology, consultativecardiology, heart catheterization, echocardiography,nuclear imaging

MedicalDegree University of Rochester Schoolof Medicine and Dentistry, New York

Internship/Residency Dartmouth, New Hampshire

CardiologyFellowship University of Washington

BoardCertification Internal Medicine,Cardiovascular Medicine, Interventional Cardiology

Honors/Awards Washington Research Award

(American Heart Association), Intern and Residentof the Year; Oregon Fire Chiefs AwardMeritoriousService Award; All American Selection to the AllNew England Soccer eam

Dr. Gross served as an assistant professor at theUniversity of Washington, Division of Cardiology.

JonRBrowerMDFACC

Cardiology

Specialties Consultative cardiology, echocardiography,transesophageal echocardiography, nuclear cardiology,coronary angiography

MedicalDegree University of Arizona

Internship/Residency Neurology and InternalMedicine at University of Arizona

CardiologyFellowship University of Arizona

BoardCertification Internal Medicine,Cardiovascular Disease

Honors/Awards Residency Excellence in

eaching ( years)

Dr. Brower completed residencies in both neurologyand internal medicine.

KentWDautermanMDFACCFSCAI

Cardiology

Specialties Interventional cardiology (coronary stent),carotid artery disease and intervention (stent), coronaryartery and valvular heart disease, transesophagealechocardiography, cardiac C

MedicalDegree Johns Hopkins School of Medicine

Internship/Residency University of California,San Francisco

ChiefResidency University of California,San Francisco

CardiologyFellowship University of California,

San FranciscoInterventionalCardiovascularFellowshipCleveland Clinic

BoardCertification Cardiovascular Medicine,Interventional Cardiology

Honors/Awards Valedictorian, College of Artsand Sciences, University of oledo; op TreeGraduate, Johns Hopkins School of Medicine

Dr. Dauterman served as a Peace Corps publichealth volunteer in Zare.



51/56

RVMCHospitalists

Seventeenhospitalists

providecareformanycardiac

patientsAllhospitalists

areboardcertified

MarkMHuthMDPhDFACC

Cardiology

Specialties General cardiology, heart failure, hearttransplant, echocardiography, nuclear cardiology,coronary angiography

MedicalandDoctorateDegrees LouisianaState University

Internship/Residency Louisiana State University

CardiologyFellowshipUniversity of Washington

PostdoctoralFellowshipPhysiology at Universityof Washington


Honors/Awards Honors in physiology fromRutgers University (undergraduate); OutstandingIntern and Resident of the Year; Chairman of theAmerican College of Cardiologys Oregon GAPProject in Congestive Heart Failure

Dr. Huth served as an assistant professor at theUniversity of Washington, Division of Cardiology.

BrucePaersonMDFACC

Cardiology

Specialties Consultative cardiology, echocardiography,transesophageal echocardiography, preventativecardiology, nuclear cardiology, coronary angiography

MedicalDegree University of Pennsylvania

Internship/Residency Internal Medicine at Brighamand Womens Hospital, Harvard Medical School

CardiologyFellowship Boston UniversityMedical Center


Honors/Awards Cook Memorial Prize in Economics

at Pomona College, California; President, Alpha OmegaAlpha Honor Society, University of PennsylvaniaSchool of Medicine

Dr. Patterson earned his masters degree from thePrinceton Teological Seminary in New Jersey.

PHYSICIANBIOGRAPHIESPHYSICIANBIOGRAPHIESHeart Clinic of Southern Oregon and Northern California, PC


52/56

EricAPenaMDFACC

Cardiology

Specialties Cardiology, electrophysiologyMedicalDegree University of South Florida

Internship/Residency Emory University,Atlanta, Georgia

CardiologyFellowship Emory University

BoardCertification Cardiology, Electrophysiology

Honors/Awards Chief Medical Resident

Dr. Pena has served on the faculty of the Heart RhythmSocietys International Meeting for the past three years.

StephenJSchnuggMDFACC

Cardiology

Specialties Consultative cardiology, interventionalcardiology, cardiac catheterization, echocardio

rvmc - 2008 heart and vascular services outcomes report

Documents