Cardiothoracic Surgery

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					     The Section of
     Cardiothoracic Surgery
                                                                       Surgery at Cincinnati Children’s Hospital Medical Center and
                                                                       the Divisions of Cardiology, Pulmonary Medicine, and
                                                                       Oncology of the Department of Internal Medicine offer both
                                                                       young and adult patients a multidisciplinary approach to
                                                                       cardiac and thoracic disease.

                                           Walter H. Merrill, MD            In 2004 the ACGME granted accreditation for a residency
                                        John B. Flege, Jr. Professor   training program in cardiothoracic surgery. The first resident in
                                                                       the program, Dr. John Mehall, began his training on July 1, 2004.
                                                  Chief, Section of    Dr. Mehall was elected President of the Thoracic Surgery
                                          Cardiothoracic Surgery       Residents Association (TSRA) and was one of three course
                                        directors for the TSRA Cardiothoracic Technology Symposium
                                                    513.584.3278       held May, 2006, and again in May, 2007, at the University of
                                                                       Cincinnati (see the website at
                                                                       Dr. Mehall completed his training in cardiothoracic surgery
    The Section of Cardiothoracic Surgery, comprising the              June 30, 2007.
Division of Cardiac Surgery and the Division of Thoracic
Surgery, continues on the forefront of advances in the treat-               Our second cardiothoracic surgery resident, Dr. Jeffrey
ment of patients with cardiothoracic diseases, including the           Garrett, continues his training, and our newest resident,
application of minimally invasive techniques for cardiac and           Dr. Julian Guitron, began his training July 1, 2007.
thoracic disorders such as atrial fibrillation and lung cancers.
                                                                           The residency training program provides three continuous
     The Section’s experience and expertise continues to grow          years of clinical training in cardiothoracic surgery, with one
in minimally invasive cardiac and thoracic surgery, including          new resident starting each year. Residents rotate on adult
robotic-assisted surgery and minimally invasive treatment for          cardiac surgery at The University Hospital and at the Good
atrial fibrillation, lung cancer and other disorders.The increased     Samaritan Hospital, on general thoracic surgery at The
referral of patients from throughout the country for the               University Hospital, and on pediatric cardiac surgery at
specialized care offered at the University of Cincinnati has           Cincinnati Children’s Hospital Medical Center.
resulted in the ongoing growth in clinical programs involved in
treating tumors of the mediastinum, minimally invasive                 The Division of Cardiac Surgery
removal of lung tumors, and specialized treatment of heart dis-            The Division of Cardiac Surgery leads the region in the
ease, including the insertion of left ventricular assist devices for   discovery and advancement of innovative treatment for
the failing heart, heart transplantation, and other procedures.        patients with cardiac disease. Programs in robotic-assisted and
                                                                       minimally invasive surgical techniques, as well as the develop-
     The UC Heart & Vascular Center and the Cincinnati                 ment and application of bio-tech advances such as the growth
Children’s Hospital Medical Center provide the only two                of new blood vessels, have made the cardiac program at the
cardiac transplant programs in the region. Collaborative               University of Cincinnati a state-of-the-art referral center for
relationships with the Division of Pediatric Cardiothoracic            both standard and complex cases.

                                          The Section of Cardiothoracic Surgery | Page 48
Patient Care
    The UC Heart & Vascular Center includes the only adult
cardiac transplant program in the region. Cardiac trans-
plant volume has been steady, and 20-30 transplants per
year are expected in the coming years. This multidisci-
plinary treatment effort has met with excellent clinical
results. Clinical services are performed at The University
Hospital, the Veterans Affairs Medical Center, and the
Cincinnati Children’s Hospital Medical Center.

     The Division performs a wide variety of operative
procedures in patients with cardiac and vascular diseases,
including off-pump coronary revascularization, modified
MAZE procedure for atrial fibrillation without the need for
a sternal incision, left ventricular assist device (LVAD) inser-
tion, heart transplantation for severe heart failure, as well as
all-arterial myocardial revascularization and mitral valve
repair.The Division is alone in the Tristate in offering chron-    nurses, pharmacists, nutritionists, rehabilitation providers,
ic long-term LVAD support for heart failure, and it serves as      social workers, clergy, and family in one place at the same
a hub center for referral of patients requiring specialized        time. Studies conducted by Harvard confirm improved
cardiac care. An additional focus is the treatment of adults       patient care, outcomes and satisfaction.
with congenital heart disease.                                          As part of the collaborative effort, the CICU nurses have
     Surgeons and physicians at the UC Heart & Vascular            collaborated with the diabetes specialists at The University
Center continue their innovative treatment of heart                Hospital and with the cardiac anesthesiologists to develop
patients with a growth factor protein (FGF1) in an attempt         patient care protocols that are aimed at controlling blood
to grow new myocardial blood vessels (angiogenesis).               glucose levels in patients undergoing cardiac surgical
The procedure involves injecting the growth factor directly        procedures. This multidisciplinary team approach has led
into the heart to trigger new blood vessel growth to               to improvement in blood glucose values, and there is
increase blood flow around blocked arteries and to relieve         evidence to suggest that this will lead to better overall
the chest pain associated with coronary artery disease. The        outcomes and especially a lowered risk of infection. An
UC Heart & Vascular Center is one of a small number of U.S.        outgrowth of the effort to control blood glucose levels
medical centers involved in an early-stage clinical trial to       perioperatively has been an increased focus on postopera-
test myocardial injection of FGF1 as a method to relieve           tive follow-up and care of diabetic patients once they leave
chest pain.                                                        the hospital.

    The collaborative rounds program established in 2005           Education
continues to be highly successful in raising the standard of           PGY-1 residents and mid-level residents are offered
patient care in the cardiac intensive care unit at The             one- and two-month rotations, respectively, on the service.
University Hospital. The collaborative round brings togeth-        Third year medical students rotate on the service as part of
er everyone involved in the treatment and recovery of              their surgery clerkship, and a month-long clerkship is
heart surgery patients including the patient, surgeons,            offered to 4th-year medical students.

                                                                        Members of the Division actively collaborate with
                                                                   colleagues in adult cardiology and pediatric cardiac
                                                                   surgery and offer a broad array of educational conferences
                                                                   and laboratory research opportunities. Dr. Peter Manning
                                                                   and his colleagues from Cincinnati Children’s Hospital
                                                                   Medical Center teach pediatric cardiothoracic surgery to
                                                                   residents both at that institution and at the University of
                                                                   Cincinnati College of Medicine.

                                                                       All the faculty participate in weekly cardiothoracic
                                                                   teaching conferences, cardiac catheterization conference,
                                                                   and roundtable discussions with the residents.

                                                                       The recent mandatory reduction in resident work-
                                                                   hours led to the recruitment of physician assistants and
                                                                   nurse practitioners to reduce the clinical workload of facul-
                                                                   ty and residents, allowing additional time for research and
                                                                   other academic pursuits.

                                          The Division of Cardiac Surgery | Page 49
           The Section of Cardiothoracic Surgery and the
      University of Cincinnati College of Medicine offer a course
      called “Summer Surgery Experience at UC.” This two-week
      program teaches 24 undergraduates from various colleges
      the art and science of surgery. Participants are exposed to
      cardiac anatomy and physiology, learning cardiac diagnos-
      tic techniques, receiving hands-on experience in the
      clinical skills lab, learning about the DaVinci robot, and
      shadowing in the operating room. The students also
      perform library research on several clinical cases and give a
      presentation at the close of the program. John Flege Jr., MD,
      serves as director of the program.

           David Melvin, MD, PhD, continues to apply his
      advanced training in Biomedical Engineering to discover
      breakthroughs in ventricular performance and its enhance-
      ment and support with various mechanical techniques.            The Division of Pediatric
      Dr. Melvin was chosen to serve on UC’s Intellectual Property    Cardiothoracic Surgery
      Committee which will provide advice to the vice president
      for research in numerous areas related to intellectual
      property and the administration of the university’s patent           The Division of Pediatric Cardiothoracic Surgery at
      and copyright policies.                                         Cincinnati Children’s Hospital Medical Center is comprised
                                                                      of two surgical faculty, one research faculty, four clinical
      Community Connections                                           perfusionists, four nurse practitioners, one physician
           Dr. Wolf and Dr. Flege recently launched the journal       assistant, two research assistants and four administrative
      INNOVATIONS in Cardiothoracic Surgery, which is the             support staff dedicated to the surgical care of children
      official journal of the International Society for Minimally     with cardiac problems. Based completely at Cincinnati
      Invasive Cardiac Surgery (ISMICS). Dr. Wolf has served as an    Children’s Hospital Medical Center (CCHMC), the Division
      Editor, and Dr. Flege remains as the Associate Editor.          has formed a strong collaborative relationship with the
                                                                      Section of Cardiothoracic Surgery. As an integrated
          Dr. Merrill continues as chair of the Society of Thoracic   component of The Heart Center, a multi-disciplinary
      Surgeons Workforce on Graduate Medical Education and            business unit within CCHMC, the Division has enjoyed a
      Resident Issues. He also serves as a member of the Joint        continually higher profile nationally as a leader in the man-
      Council on Thoracic Surgical Education, and he was recent-      agement of cardiac problems in children.
      ly appointed to the Residency Review Committee for
      Thoracic Surgery.                                                   The goal of the Division is to be a national and interna-
                                                                      tional leader in pediatric cardiothoracic surgical care, surgi-
           The UC Heart & Vascular Center hosted a number of          cal research and teaching. The clinical programs of the
      free educational lecture series for the lay public and for      Division continue to provide excellent care, with morbidity
      local physicians and nurse practitioners, with a focus on       and mortality rates rivaling any program nationwide.
      highlighting heart and vascular health and describing new
      technology and therapies to treat various heart and vascu-          Members of the Division of Cardiothoracic Surgery
      lar conditions.                                                 function as key faculty of the Pediatric Cardiology and
                                                                      Pediatric Critical Care fellowship training programs at
                                                                      CCHMC. Close interaction with these fellows occurs on a
                                                                      daily basis, primarily in the Cardiac Intensive Care Unit, in

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                                              The Division of Cardiac Surgery | Page 50
addition to a number of weekly teaching conferences in
which the faculty participates. The Division serves as one
of the primary rotations of the Cardiothoracic Surgery
training program, based at UC.

    The research efforts within the Division continue to
grow with two basic science laboratories presently within
the Division, as well as the collaboration of Cardiothoracic
Surgical faculty with Cardiology and other faculty on a
number of clinical research projects.


     The clinical programs in The Division of Pediatric
Cardiothoracic Surgery focus on surgical management of
cardiac problems from birth through adolescence. The
Division also has become more involved in the Fetal
Cardiology program, participating in prenatal counseling
of families with children with congenital heart defects. The   reperfusion. An NIH R03 exploratory grant from the
focus is on complete correction of cardiac defects in the      National Institute of Child Health and Human
newborn, management of complex single ventricle cardiac        Development supports investigation into the use of gene
anomalies, and techniques to limit transfusion exposures.      therapy to temporarily raise the level of protective proteins
The program has the capability of performing all levels        in the heart and lungs of neonates undergoing heart
of open and closed heart operations, including cardiac         surgery. The data from these studies have been published
transplantation and the ability to perform ECMO support.       in prestigious journals in the areas of surgery and critical
                                                               care such as Annals of Thoracic Surgery, Critical Care
    The annual review of state-wide data for pediatric         Medicine, Pediatric Critical Care Medicine, and Pediatric
cardiac programs recently revealed that Cincinnati             Research.
Children’s continues to perform the highest volume of
newborn open heart procedures in Ohio. The Heart Center             Dr. Eghtesady’s lab has been productive and continues
Encyclopedia, posted on the internet, has received over        his research in the field of experimental fetal open-heart
15,000 hits per month. Renovations to the Intensive Care       surgery in order to correct congenital malformations in the
pods have allowed the Cardiac Intensive Care Unit to           womb. Additional studies seek to understand the patholo-
expand its intensive care capacity from 10 beds to 15 beds.    gy of post-bypass placental dysfunction and the develop-
                                                               ment of protocols and tools for successful translation of
     Research has continued to be active in the Division of    fetal cardiac surgery into clinical practice. Dr. Eghtesady has
Cardiothoracic Surgery. Dr. Duffy’s research lab has focused   begun the patent process for a new, non-invasive method
on mechanisms underlying reperfusion and reoxygenation         of monitoring placental oximetry during maternal/fetal
injury in the immature cardiopulmonary system.                 surgery.This work is supported by grants from the Thrasher
Continuing NIH R01 funding from the National Heart, Lung,      Research Foundation, the Children’s Heart Foundation of
and Blood Institute supports studies to determine the          Chicago, an AHA National Scientist Development Grant,
cellular and molecular mechanisms involved in the cardio-      and additional funding from the Children’s Heart
protection offered by inactivating calpain activity and
augmenting the calpastatin pathway during ischemia and

                                       The Division of Cardiac Surgery | Page 51
Association. The lab also continues its collaborative efforts
with Professor Kenneth Clark from the UC Department of
Obstetrics and Gynecology.

     The lab was also productive in publishing in the
Journal of Thoracic and Cardiovascular Surgery, American
Journal of Obstetrics and Gynecology, Perfusion, Medical
Hypothesis, and has publications in press for the Annals of
Thoracic Surgery and the ASAIO Journal. Research on fetal
cardiopulmonary bypass, which the lab continues to
pursue aggressively, was accepted for oral presentation at
four prestigious international meetings this year. Students
in the lab were also recognized, including first author
publications and the Herman Schneider Medal awarded to
Christopher Lam as the top UC Engineering co-op student
for his experiences gained in the lab.

    Dr. Eghtesady continues to pursue clinical research into
the pathogenesis of congenital heart diseases and                   American Board of Surgery and the American Board of
hypoplastic left heart syndrome in particular. Dr. Eghtesady        Thoracic Surgery.
has begun enrolling patients in a clinical study to deter-
mine if maternal exposure to or carriers of strep B are
associated with increased incidence of fetal congenital
                                                                    Faculty - Division of Pediatric
heart defects.                                                      Cardiothoracic Surgery
     The Division continues to collaborate on a number of
                                                                    Peter B. Manning, MD, FACS
clinical research projects with other members of The Heart
                                                                    Professor of Clinical Surgery
Center, including cardiologists, intensivists, and anesthesi-
                                                                    Director, Pediatric Cardiothoracic Surgery
ologists. The projects vary from heterogeneity cate-
cholamine receptors in patients undergoing cardiac repairs
                                                                    Dr. Manning specializes in complete correction of newborn
to a project analyzing different schedules for all pain
                                                                    cardiac diseases and blood conservation in cardiac surgery.
medicines to maximize patient comfort after cardiac
                                                                    He is certified by the American Board of Surgery and the
surgery, and studies to evaluate novel approaches to assess
                                                                    American Board of Thoracic Surgery.
renal function following cardiac surgery.
                                                                    Pirooz Eghtesady, MD, PhD
Faculty                                                             Assistant Professor of Surgery
(To view the full CV, visit our website at
                                                                    Dr. Eghtesady specializes in congenital heart surgery and
Walter H. Merrill, MD, FACS                                         fetal heart surgery. He is certified by the American Board of
John B. Flege, Jr. Professor                                        Surgery and the American Board of Thoracic Surgery.
Chief, Section of Cardiothoracic Surgery
                                                                    Jodie Y. Duffy, PhD
Dr. Merrill specializes in adult heart surgery, heart trans-        Assistant Professor of Surgery and Pediatrics
plantation, and congenital heart disease in adults. He is
certified by the American Board of Surgery and the                  Dr. Duffy’s research is focused on the areas of fetal develop-
American Board of Thoracic Surgery.                                 ment and the cellular pathways that regulate reoxygena-
                                                                    tion and reperfusion injury in the immature cardiopul-
John B. Flege, Jr., MD, FACS                                        monary system.
Professor of Surgery
                                                                        Further information on the Division of Cardiac Surgery,
Dr. Flege specializes in adult heart surgery. He is certified by    including presentations and publications, can be viewed
the American Board of Surgery and the American Board of             on our website
Thoracic Surgery.

David B. Melvin, MD, PhD
Associate Professor of Surgery
Professor of Biomedical Engineering

Dr. Melvin specializes in heart transplantation and mechan-
ical support of the failing heart. He is certified by the

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The Division of Cardiac Surgery | Page 53

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