OUTCOMES IN CARDIOLOGY AND CARDIOVASCULAR SURGERY

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					OUTCOMES IN CARDIOLOGY AND
     CARDIOVASCULAR SURGERY
PURPOSE
At The Methodist Hospital, quality means ensuring a safe patient
care environment where its physicians, nurses and staff provide
clinical excellence with integrity and compassion. For more than
90 years, Methodist has maintained a reputation for the highest
quality care and an unwavering commitment to patient safety and
patient satisfaction. We believe this continuous focus on quality
translates to superior health care outcomes.

We have developed a series of brochures to provide our colleagues
and patients with a glimpse of our volumes (workload) and out-
comes, trends, treatment approaches and new developments.
The mortality rates provided in this brochure compares outcomes
for both surgical and interventional procedures performed at the
Methodist DeBakey Heart & Vascular Center with the national
average as benchmarked by University HealthSystem Consortium.
We trust you will find this data insightful and valuable.

Improving patient outcomes and the quality of life for patients
worldwide are the driving forces behind The Methodist Hospital’s
pursuit of discovery, innovation and excellence. To review other
outcomes brochures, visit The Methodist Hospital’s quality Web
site at methodisthealth.com/outcomes.
TABLE OF CONTENTS
 Welcome Remarks .......................................................................... 2

 Center Overview ............................................................................ 3

 Quality Measures............................................................................ 5

 Department of Cardiovascular Surgery...................................... 6

 Department of Cardiovascular Anesthesiology......................... 14

 Department of Cardiology ............................................................ 15

 Innovation........................................................................................ 24

 Patient Satisfaction Scores ............................................................. 28

 Faculty Listings ............................................................................... 30

 Referrals ........................................................................................... 32




                                                                                                            1
    WELCOME REMARKS
    Welcome to the outcomes report from the
    Methodist DeBakey Heart & Vascular Center
    at The Methodist Hospital. We are excited and
    proud to relay the center’s clinical and research
    advancements and illustrate how they are trans-
    lating into better and safer care for our patients.     Miguel A. Quiñones,
                                                            M.D., F.A.C.C.
    When asked, most patients feel they have            Chairman, Department of
                                                        Cardiology
    received quality care when: 1) their treatment      Medical Director,
                                                        Methodist DeBakey Heart
    has produced the expected result, and 2) their      & Vascular Center
    care has been provided in a respectful, clean and The Methodist Hospital,
                                                        Houston, Texas
    attentive environment. This brochure will
    demonstrate how the Methodist DeBakey Heart
    & Vascular Center is doing just that. Through advances in clinical
    research and technology, the heart center continuously strives to
    enhance outcomes, increase satisfaction and restore our patients to
    optimal health.
    Although we are well equipped and experienced in treating the
    most complex illnesses, we also are committed to reducing the
    incidence of serious cardiovascular events such as myocardial
    infarction, heart failure, strokes and death through a comprehensive
    cardiovascular prevention program. In turn, our commitment and
    experience have earned us a spot as one of the country’s top 30
    hospitals for cardiac care by U.S.News & World Report.
    Our center is vital to Methodist’s Leading Medicine vision which
    does not rest with past and present accomplishments, but propels us
    to keep raising the bar in research, education and clinical care. Our
    patients deserve no less.
    Thank you for taking time to read this report. We hope you find its
    content both informative and valuable, and we appreciate any feed-
    back that can help us continue our mission of providing the highest
    quality care available.


2
CENTER OVERVIEW
The Methodist DeBakey Heart & Vascular Center strives to
improve the quality of life for patients with cardiovascular disease
through an integrated, interdisciplinary program of leading-edge
clinical research, pioneering teaching and exemplary patient care.
With a rich history of innovation and experience, the center’s
physicians conduct some of the most sophisticated diagnostic and
therapeutic procedures in the country and work daily to develop
more effective techniques for managing and preventing cardio-
vascular disease.
Academically affiliated with Weill Cornell Medical College, the
center encompasses extensive resources and a dedicated team of
more than 500 employees and 100 board-certified physicians in the
departments of cardiology, cardiovascular surgery and anesthesia.
They bring vast experience and a commitment to excellence, both
individually and collectively, to the care and treatment of each
patient.
The center works continuously to advance the field of cardio-
vascular medicine, receiving more than $15 million annually in
research support from the National Institutes of Health, American
Heart Association and other sources. Research activities by physi-
cians and researchers at Methodist DeBakey Heart & Vascular
Center led to more than 120 publications in 2007. The center focuses
on innovative care as well as complex and high-risk care, building
on the legacy of Dr. Michael E. DeBakey in these areas.
Recent innovative accomplishments include the first blood test
designed to help predict a patient’s risk for ischemic stroke;
development of minimally invasive hybrid techniques that allow
stenting of aneurysms in the ascending aorta, descending aorta
and aortic arch without sternotomy or cardiopulmonary bypass;
robotic cardiac valve surgery including mitral valve repair,
catheter-based repair of paravalvular leaks; and stem cell therapies
for peripheral artery disease and heart failure. We are also proud
                                                                       3
      North Campus
      Future site of the Methodist DeBakey Heart & Vascular Center



    of our continuing commitment to cardiac transplantation and
    mechanical support of the failing heart, management of acute
    aortic emergencies and expertise with the surgical treatment of
    complex cardiac malignancies.
    As we look for ways to improve our quality, we continuously
    review our results and request feedback from our patients and
    from our council, which consist of leaders in the Houston
    community. As part of our commitment to education, we have
    established the Journal of the Methodist DeBakey Heart & Vascular
    Center, a quarterly publication reaching nearly 40,000 physicians
    in America.
    When needed, our patients have access to some of the best special-
    ists in the country. This year U.S.News & World Report recognized
    Methodist as one of “America’s Best Hospitals” with 12 specialties
    that were ranked, the largest number by any hospital in the state of
    Texas. Our patients benefit from leading-edge medicine within a
    compassionate and caring environment. Respect for and communi-
    cation with each patient underscores our team approach and
    allows us to affect lives for the better, every day.

4
QUALITY MEASURES
The phrase “quality of care” has become synonymous with patient
outcomes. No doubt, one of the most effective ways to measure
quality is by evaluating the end result of a diagnosis or procedure.
Like other large tertiary care hospitals, The Methodist Hospital
typically treats older patients with more severe and complex
illnesses such as prior myocardial infarction, redo surgeries and
diabetic complications.

Each year, for our own internal benchmarking and to keep current
and future patients fully informed, the center compares its patient
outcomes to those of other similar hospitals. Despite a higher
volume of high-risk patients, the center’s mortality rates for both
surgical and PCI procedures continue to be lower than the national
average.

The outcomes data in this brochure compare our observed
mortality data to the expected mortality data of the University
HealthSystem Consortium (UHC). UHC is an alliance of 102
academic medical centers and 184 of their affiliated hospitals,
which represents approximately 90 percent of the nation’s
nonprofit academic medical centers.




                                                                       5
    DEPARTMENT OF CARDIOVASCULAR
    SURGERY
    The Methodist Hospital, working with Dr. Michael E. DeBakey,
    served as the birth place for cardiovascular surgery. Continuing in
    this tradition, the highly skilled physicians at the Methodist
    DeBakey Heart & Vascular Center continue to perform more than
    1,500 operations a year, ranging from coronary heart bypass to
    cardiac tumor removal. Through the center’s innovations and
    emerging state-of-the-art technologies, surgeons offer patients less
    invasive alternatives to traditional procedures as well as highly
    complex and high risk procedures.
    The Department of Cardiovascular Surgery, within the heart center
    is comprised of a group of surgeons who strive for excellence in
    clinical outcomes, research minimally invasive surgical techniques,
    and train medical students, residents and fellows. Increasingly our
    mission also focuses on re-training established cardiac and vascu-
    lar surgeons. Cardiovascular Surgery Associates is a member of the
    Methodist DeBakey Heart & Vascular Center, and represent the
    academic arm of our mission.
    The minimally invasive cardiac surgical capabilities at the heart
    center have been transformed within the last 18 months to include:
    robotic mitral valve repair, minimally invasive cardiac surgery
    (MICS), coronary artery bypass grafting, minimally invasive
    (thoracoscopic) mini-maze procedures for atrial fibrillation and off
    pump coronary artery bypass grafting. This represents one of the
    most complete set of minimally invasive procedures found in a
    single center within the United States. In addition to being the
    fourth largest lung transplant center in the United States,
    we are one of the larger heart transplant and ventricular assist
    device programs, and have recently begun a clinical trial on
    intramyocardial stem cell injection via a minimally invasive
    surgical approach.


6
As we open our new hybrid suite, including a robotic C-arm, we
look forward to increasing our hybrid coronary revascularization
and atrial fibrillation procedures.

Description of Cardiovascular Programs
Cardiovascular Intensive Care Unit
Our 40-bed CVICU provides 24-7 coverage with intensivists and
floor coverage with nurse practioners. We also have an exemplary
record in reduction of postoperative infections.

Chest Pain Unit
This 24-hour service is dedicated to the immediate evaluation
and treatment of patients with chest pain in order to significantly
reduce the impact of a myocardial infarction on ventricular
function and survival.

Heart Transplant Program
In conjunction with the Methodist Transplant Center, physicians at
the Methodist DeBakey Heart & Vascular Center comprehensively
evaluate patients referred to the heart transplant program. Physicians
assess the progression of the patient’s heart disease and ensure
that the disease is being managed as well as medically possible. In
many cases, our physicians can make significant improvement in
the health of a patient — using advanced medications, combina-
tion therapies, implanted defibrillators and pacing systems —
without immediately moving the patient to a waiting list for heart
transplantation. When a patient is moved to the heart transplant
waiting list, Methodist offers world-class surgical expertise includ-
ing a full spectrum mechanical support service. An integrated team
of cardiologists and transplant physicians work with transplant
coordinators, nurses and social workers to guide heart transplant
patients from inpatient post-surgical care to outpatient care and
long-term follow-up.




                                                                         7
    Stem Cell Program
    By virtue of our experience in minimally invasive techniques,
    research interests in heart failure and stem cells, The Methodist
    Hospital now offers stem cell therapy in a first of its kind U.S.
    clinical trial.
    Bone marrow stem cells are isolated from the patient and cultured
    ex vivo. Approximately 12 days later these “super stem cells” or
    cardiac repair cells (CRCs) will be returned to the patient by direct
    injection into the beating heart using a minimally invasive surgical
    technique.
    Other firsts include the first U.S. trial to use CRCs (cardiac repair
    cells) or super stem cells, and the first U.S. center to start active
    enrollment.

    Valve Services
    The Methodist Hospital has a complete range of cardiac valve
    surgery procedures. Our aortic valve procedures include valve
    repair and replacement using mechanical, tissue, allograft and
    autograft (Ross). We also are leading medicine in mitral valve
    repair highlighted by “The American Correction” developed and
    perfected by one of our surgeons. Our comprehensive experience
    also includes tricuspid and pulmonary replacement and repair.
    We also use a full range of minimally invasive techniques including
    ministernotomy, minithoracotomy and robotic techniques. There is
    a strong research collaboration between cardiology and cardiovas-
    cular surgery on the evaluation and timing of patients for surgical
    repairs as well as in assessment of valve surgery outcomes.




8
Cardiovascular Surgery Data
                                 Annual Cardiovascular Surgical Procedure
                                        Mortality Rate Comparison
                5.0
                                                                  TMH OBSERVED MORTALITY %
                4.5
                                                                  UHC EXPECTED MORTALITY %
                4.0
                             4.18                          4.26                              4.17
                3.5                           4     3.78
  PERCENTAGE




                       3.6                                                 3.7
                3.0
                2.5                   2.99                          2.92
                2.0
                                                                                     2.23
                1.5
                1.0
                0.5
                  0
                       Q1-Q2 2006     Q3-Q4 2006    Q1-Q2 2007      Q3-Q4 2007       Q1-Q2 2008
                       1,529 CASES    1,571 CASES   1,612 CASES     1,471 CASES      1,432 CASES




                                 Annual Cardiovascular Surgical Procedure
                                              Volume Totals
               2,000
               1,900
               1,800
               1,700
               1,600
CASES




               1,500                                   1,612
                                         1,571
                         1,529
               1,400                                                  1,471
                                                                                        1,432
               1,300
               1,200
               1,100
               1,000
                       Q1-Q2 2006      Q3-Q4 2006   Q1-Q2 2007      Q3-Q4 2007        Q1-Q2 2008




                                                                                                    9
     Cardiac Valve and Other CT Procedures
     Methodist has a new approach to aortic valve repair — minimally
     invasive sternotomy, which decreases the incision site and helps
     the patient recover more quickly. We also use a full range of
     minimally invasive techniques including ministernotomy and
     minithoracotomy.
                                 Cardiac Valve and Other CT Procedure
                           Semiannual Mortality Rate Comparison 2006-Q2 2008
                    10
                     9                                                  TMH OBSERVED MORTALITY %

                     8                                                  UHC EXPECTED MORTALITY %

                     7
      PERCENTAGE




                     6

                     5                          6.01          6.06
                     4            5.25   5.26
                           4.88                                                              4.85
                                                       4.37                 4.46
                     3
                     2                                                                3.33

                     1                                               2.14
                     0
                           Q1-Q2 2006    Q3-Q4 2006    Q1-Q2 2007    Q3-Q4 2007       Q1-Q2 2008




                         Cardiac Valve and Other CT Procedure Volume Comparison
                                              2006-Q2 2008
                   250


                   200
                              205           209            206

                   150                                                  187
      CASES




                                                                                          180

                   100


                   50


                    0
                           Q1-Q2 2006    Q3-Q4 2006    Q1-Q2 2007    Q3-Q4 2007        Q1-Q2 2008




     Results
     Methodist achieved lower mortality rates compared to UHC.
     During the third and the fourth quarter of 2007, Methodist’s
     mortality rate was 52% lower than UHC. Since 2006, patient
     volumes have declined slightly.
10
Coronary Artery Bypass Grafting Procedures
Coronary artery bypass grafting is an integral part of the heart
center’s operations. We performed nearly 600 cases in 2007,
200 with inpatient cardiac catheterization. Many of these procedures
were performed on high-risk patients with acute coronary
syndrome and/or heart failure.
                            CABG Semiannual Mortality Rate Comparison
                                        2006-Q2 2008
               5.0
               4.5                                                      TMH OBSERVED MORTALITY %
                                                                        UHC EXPECTED MORTALITY %
               4.0
               3.5
 PERCENTAGE




               3.0
                                                              3.10
               2.5
                                                     2.55                   2.53              2.42
               2.0            2.30           2.41
               1.5
               1.0
                                     1.09                            1.19
                     1.07
               0.5
                                                                                       0.37
                0
                     Q1-Q2 2006      Q3-Q4 2006     Q1-Q2 2007       Q3-Q4 2007       Q1-Q2 2008
                     280 CASES       275 CASES      314 CASES        253 CASES        272 CASES



                                            Total CABG Volumes
                                               2006-Q2 2008
              350

              300
                                                        314
              250
                        280              275                                              272
              200                                                       253
 CASES




              150

              100

               50

                0
                     Q1-Q2 2006      Q3-Q4 2006      Q1-Q2 2007      Q3-Q4 2007        Q1-Q2 2008




Results
Methodist’s mortality rate for CABG procedures has been lower
than the UHC expected mortality rate for the last two and half
years. Methodist’s CABG volumes have fluctuated but have
increased 7.51% since the third quarter of 2007.
                                                                                                     11
     Minimally Invasive Cardiovascular Surgery CAB

     The minimally invasive cardiovascular surgery coronary artery
     bypass (MICS CAB) procedure is a relatively new procedure being
     performed at Methodist by Dr. Mahesh Ramchandani. Methodist
     is one of the only places in the country performing it. Benefits to
     the patient include a shorter length of stay, usage on multiple
     bypasses, adaption to fit most patients and quicker recovery time.
     Most surgeons can adapt to this procedure because it uses an
     evolution of established technology and preserves the direct vision
     and tactile feedback.


      Minimally Invasive
      Coronary
      Revascularization
      • 7 cm antero-lateral access
         called “The Window”
      • IMA harvest nonrobotic
      • Multiple aortic proximals




12
Minimally Invasive Atrial Fibrillation
Mini Maze




Typical surgical treatment of atrial fibrillation, called the Cox-Maze
procedure, involves making a large incision down the front of
the chest and spreading the ribs to gain access to the heart. The
surgeon achieves a direct view of the area to be treated, and the
treatment success rate is excellent. However, due to the highly
invasive nature of this procedure, it is often performed only if
another procedure, such as a coronary bypass, must also be
performed.

Dr. Erik Beyer of the Methodist DeBakey Heart & Vascular Center
has perfected an alternative technique in which he can perform a
“mini-Maze” procedure through three smaller incisions in the side
of the chest. By performing this highly technical procedure in a
minimally invasive environment and without spreading the ribs,
patients experience less pain, heal faster, and are able to get back to
normal lives quickly. Key benefits to minimally invasive atrial
fibrillation surgery include direct vision for the surgeon, operator
independence, left atrial appendage excision and a large number
of candidates.
                                                                          13
     DEPARTMENT OF CARDIOVASCULAR
     ANESTHESIOLOGY
     The Department of Cardiovascular Anesthesiology provides a
     valuable service in the care of patients who are treated at the
     Methodist DeBakey Heart & Vascular Center. A group of 10 cardiovas-
     cular anesthesiologists, all of whom have had special training in
     cardiothoracic and vascular anesthesia, are assigned to the 10
     operating rooms. Additional services are rendered, when needed,
     for endovascular cases in one of the operating rooms specially
     outfitted for procedures that require intraoperative imaging. In
     addition, all requests for anesthesia support in the cath labs are
     provided by the same group of clinicians. Patients undergoing
     open heart and other types of cardiac and major vascular proce-
     dures benefit from the use of various up-to-date and cutting edge
     monitoring techniques, including intraoperative transesophageal
     echocardiography. Most of the cardiovascular anesthesiologists
     are certified in this particular technique. In addition to cardiac,
     thoracic and major vascular cases, transplantation anesthesia is
     provided for those patients undergoing lung, heart and kidney
     transplantation.

     Upon completion of the various procedures, patients are generally
     transferred to the 40-bed CVICU. This unit is highly specialized
     and attended by a group of cardiovascular intensivists, most of
     whom have also completed fellowship training in cardiovascular
     anesthesiology, allowing the same level of expert care received in
     the operating room in the critical care setting. The staffing of this
     unit is on a 24 hour a day, 7 day a week basis with the intensivists
     available at all times and actively involved in the care of all
     patients.




14
DEPARTMENT OF CARDIOLOGY
The Department of Cardiology within the Methodist DeBakey
Heart & Vascular Center is comprised of 101 physicians; 21 of them
actively participate in teaching and research activities in addition
to patient care. The department is organized into six divisions:
• General Cardiology
• Cardiac Imaging
• Interventional Cardiology
• Cardiac Electrophysiology
• Heart Failure
• Atherosclerosis and Peripheral Vascular Disease

The department has a large volume of clinical activities including
more than 6,000 procedures in the catheterization and electrophysi-
ology laboratories and more than 25,000 imaging procedures. The
department participates in the training of medical residents and
cardiology fellows.

The department is conducting more than 80 clinical trials in
different research areas including heart failure, vascular biology
and thrombosis, interventional cardiology, cardiac imaging,
electrophysiology and atherosclerosis.

Description of Cardiology Programs
Cardiac Imaging
The Cardiovascular Imaging Center within the Methodist DeBakey
Heart & Vascular Center operates under the Imaging Division of
the Department of Cardiology. It includes the following imaging
modalities:
• Echocardiography
• Nuclear Cardiology
• Coronary and Cardiac CT Angiography
• Cardiac MRI (started in April 2008)
The imaging center operates with a faculty of nine highly experi-
enced cardiologists with level 3 expertise in one or more imaging
modalities; several of them are nationally recognized for their        15
     research contributions in imaging. The center has one of the few
     fellowships available in the country on multi-modality cardiac
     imaging.

     The Cardiovascular Imaging Center also operates the Electro-
     cardiography Laboratory that performs over 70,000 EKG’s
     annually.

     Heart Failure Unit
     The Methodist Heart Failure Unit works to improve outcomes
     of hospitalized heart failure patients by admitting them to a
     specialized unit designed to focus on tailored treatment. The
     Heart Failure Unit is a step-down intensive care unit with staff
     trained in caring for heart failure patients. Depending on the
     progression of the patient’s heart failure, these treatments may
     include inotropic therapy, percutaneous mechanical treatment,
     left ventricular assist devices and heart transplantation. The
     Heart Failure Unit is also important in studying and developing
     therapies to improve future treatment of heart failure.

     HeaRTS Heart Rhythm Treatment Services
     Heart Rhythm Treatment Services bring together the most highly-
     trained surgeons and electrophysiologists and the latest technologies
     to provide a comprehensive approach to addressing the diagnostic
     and therapeutic needs of patients with arrhythmia.
16
Cardiac Health and Rehabilitation Program
The cardiac rehabilitation program provides patients and their
families with the necessary tools to recover through a combination
of exercise and education. The program usually begins within
hours after surgery and continues after the patient has been
discharged.

Interventional Cardiology
State-of-the-art equipment, including magnetic navigation systems
and robotics, is used to visualize coronary anatomy and to restore
blood flow through blocked or narrowed arteries. Other innova-
tions include alcohol septal ablation; closure of defects (or holes)
in the heart, closure of paravalvular leads; placement of stents in
the carotid and peripheral arteries; and brachytherapy.


Cardiology Data
                              Annual Cardiology Volumes
                                   2006-Q2 2008
         3,000


         2,500

         2,000                  2,411                                  2,446
                   2,317                     2,318        2,288
 CASES




         1,500


         1,000


          500


            0
                 Q1-Q2 2006   Q3-Q4 2006   Q1-Q2 2007   Q3-Q4 2007   Q1-Q2 2008




Results
The volumes for cardiology have remained relatively steady from
2006 to the second quarter of 2008.




                                                                                  17
     Imaging

                                      Volume Percentage of Cardiac Imaging
                                                 2006-Q2 2008
                                                                          17.33%
                                                                              VASCULAR IMAGING

                                                                                            0.52%
                                                                                            CARDIAC CT

                                                                                             15.51%
                                                                                             NUCLEAR CARDIOLOGY




                                 60.29%
                                                                                       6.35%
                      ECHOCARDIOGRAPHY
                                                                                       CARDIOLOGY
                                                                                       DIAGNOSTIC




                                      Average Monthly Volumes by Procedure
                                                2006-Q2 2008
              4,500

              4,000                                                                 2006 MONTHLY AVERAGE
                                      4,108
                              3,998
              3,500                                                                 2007 MONTHLY AVERAGE

                      3,578                                                         2008 MONTHLY AVERAGE
              3,000                                                                 (Q1 AND Q2)
      CASES




              2,500

              2,000
              1,500

              1,000
                                                                                                         1,162 1,158
                                                                      1,051 1,031     962       1,028
               500
                                               415     405    387
                 0
                       ECHOCARDIOGRAPHY       CARDIOLOGY DIAGNOSTIC   NUCLEAR CARDIOLOGY        VASCULAR CARDIOLOGY




     Results
     Echocardiography makes has made up 60.29% of the total cardiac
     imaging volumes since 2006. This is followed by vascular imaging,
     nuclear cardiology, cardiac CT and cardiology diagnostic.

     Methodist’s cardiac imaging volumes have been steadily increas-
     ing over the last two and a half years. The largest increase has
     come in echocardiography with a monthly average increase of
     15.05%. Although the volumes are small relative to the other
     imaging modalities, the cardiac MRI unit, which opened in April
     2008, has performed more than 350 studies in its first nine months.
18
 Grated STRESS




CTA and SPECT Fusion Image




                             19
     PCI Stenting Procedures
     Methodist continues to use leading technology with coronary
     artery stenting. In 2007, we performed more than 1,500 procedures,
     more than 80% of which included drug eluting stents.
                         PCI Stenting Procedures Semiannual Volumes Comparison
                                              2006-Q2 2008
                   600


                   500                                                                        548
                                                 547
                              489
                   400                                        464           463
      CASES




                   300


                   200


                   100


                     0
                          Q1-Q2 2006         Q3-Q4 2006    Q1-Q2 2007    Q3-Q4 2007       Q1-Q2 2008



                                        PCI Stenting Mortality Rate Comparison
                                                    2006-Q2 2008
                   4.0

                   3.5                                                     TMH OBSERVED MORTALITY %
                                                                           UHC EXPECTED MORTALITY %
                   3.0
      PERCENTAGE




                   2.5

                   2.0
                          2.17                                    2.15                           2.23
                   1.5                       1.93          2.03
                                 1.69
                   1.0                              1.43                 1.39   1.37

                   0.5
                                                                                          0.78
                     0
                           Q1-Q2 2006         Q3-Q4 2006   Q1-Q2 2007    Q3-Q4 2007       Q1-Q2 2008



     Results
     The Methodist Hospital volumes have fluctuated some but
     increased substantially in the Q1 and Q2 of 2008 from the previ-
     ous two years.

     The Methodist Hospital PCI stenting mortality rate has gradually
     declined over the last two and a half years. For the Q1 and Q2
     of 2008, Methodist’s mortality rate was 65% lower than the
     UHC rate.
20
Carotid Artery Stent Procedures
Currently, physicians at The Methodist Hospital are studying
several new stent models, as well as variety of new antithrombotic
drugs for patients with stents, in order to improve our outcomes.

Our carotid stent series has low complication rates. We are study-
ing several new carotid stent and distal protection devices and are
uniquely positioned to monitor intracranial circulation through
transcranial Doppler monitoring. We also have a large carotid
endarterectomy program for open vessel repair in order to offer
the patient the best approach.



                     Carotid Artery Stenting Mortality Rate Comparison
                                       2006-Q2 2008
              2.0

              1.8   TMH OBSERVED MORTALITY %
                    UHC EXPECTED MORTALITY %
              1.6
              1.4                                                1.49
 PERCENTAGE




              1.2
                                                                             1.09
              1.0
              0.8
              0.6
              0.4
                                 0.48
              0.2                                         0.76
                      0                        0
                0
                            2006                      2007                2008
                          42 CASES                 106 CASES            67 CASES


Results
Methodist’s mortality rate from 2006-2007 was 0%, which was
lower than the UHC expected mortality rate. The first and second
quarter of 2008 show a 36.7% higher mortality.




                                                                                    21
     Ablations

                                 Ablation Average Monthly Volumes
                                           2006-Q2 2008
              50
              45
              40
              35                                                            41

              30
      CASES




              25            30                       31

              20
              15
              10
               5
               0
                   2006 MONTHLY AVERAGE     2007 MONTHLY AVERAGE   2008 MONTHLY AVERAGE




     Results
     Over the past two and a half years, Methodist’s ablation volume
     has increased each year with the total average monthly volume
     increasing 36.7% from 2006 to 2008.




22
AICDs
The data below looks at all cardiac defibrillator implants without
cardiac catheterizations for the year of 2007.

                                   AICD Mortality Rate Comparison
                                          2006-Q2 2008
              3.0

                                                                            TMH OBSERVED MORTALITY %
              2.5
                                                                            UHC EXPECTED MORTALITY %

              2.0
 PERCENTAGE




              1.5

                                     1.49
              1.0
                    1.16
              0.5                                       0.86    0.85            0.79         0.76
                           0.60             0.53                                                    0.55
               0
                                                                           0
                    Q1-Q2 2006       Q3-Q4 2006         Q1-Q2 2007        Q3-Q4 2007         Q1-Q2 2008




                                   AICD Monthly Volume Comparison
                                           2006-Q2 2008
              50
              45
              40
                              44
              35
              30                                           36
 CASES




              25
                                                                                        28
              20
              15
              10
               5
               0
                    2006 MONTHLY AVERAGE           2007 MONTHLY AVERAGE         2008 MONTHLY AVERAGE




Results
Methodist’s mortality rate has declined 34.5% since 2006. Its rate
for the first and second quarter of 2008 was 38.18% higher than the
UHC expected mortality rate.




                                                                                                           23
     INNOVATION
     The Methodist Hospital is integrally involved in improving clinical
     outcomes through evidence-based medicine. Physician-scientists at
     the Methodist DeBakey Heart & Vascular Center conduct leading-
     edge research to advance scientific investigation into practical and
     effective treatments for patients.

     Methodist’s rich tradition of developing innovative new strategies
     and therapies for treating patients with heart disease began with
     the pioneering work of Dr. Michael E. DeBakey. Since then, the
     center has developed a fully integrated translational research pro-
     gram that brings bench research findings to the patient bedside.

     Magnetic Navigation
     As opposed to traditional devices, where physicians manually
     twist, turn and push catheters through the blood vessels and
     coronary arteries to reach the intended blockages or lesions within
     the heart, the Stereotaxis Magnetic Guidance System uses a mag-
     netic field to direct the catheter through the arteries as directed
     remotely by a physician. The magnet located at the catheter guide
     wire’s tip gives physicians increased control and more precise
     access to affected arteries.




24
The magnetic guidance system was designed to improve interven-
tional procedures, such as stenting blocked arteries, alcohol septal
ablation for obstructive hypertrophic cardiomyopathy and ablation of
atrial fibrillation. The system is useful in procedures in which physi-
cians must guide catheters to areas of the heart that are difficult to
reach; the stereotaxis system increases access to complex anatomy
of a patient’s arteries and can greatly reduce the duration of such
procedures.

                                                  Hansen Robotic
                                                  System
                                                  On the left, the opera-
                                                  tor uses a fluoroscopic
                                                  view to guide catheter
                                                  manipulation. On the
                                                  right, the bedside
                                                  robotic arm transmits
                                                  catheter motions.


Robotic Navigation
Dr. Miguel Valderrábano, cardiologist at the Methodist DeBakey
Heart & Vascular Center, became the first physician in Houston to
use a robotic catheter to ablate atrial fibrillation. By manipulating
the robotic handle at a separate control panel, physicians have
greater catheter control and reach, as well as superior precision
and stability.

The movement of the robot’s joystick is very intuitive for the
cardiologist. Like the most advanced gaming systems, the technology
incorporates tactile feedback for the cardiologist as he or she views
visual feedback on high-definition monitors in a catheterization
lab. This advancement may provide physicians with a more precise
and safe treatment for many of the more than 2.5 million
Americans with arrhythmias.




                                                                            25
     Robotic Mitral Valve Repair
     Dr. Gerald Lawrie, a cardiothoracic surgeon at the Methodist
     DeBakey Heart & Vascular Center, became the first to use a surgical
     robot to successfully repair a mitral valve using an advanced tech-
     nique of repair called the “American Correction.” The procedure
     developed by Dr. Lawrie, was performed using the da Vinci robot
     to repair a mitral valve. Instead of opening the chest, Dr. Lawrie
     made four small incisions along the right side of the chest to insert
     small surgical instruments attached to adjustable robotic arms.
     Attached to one arm is a camera that transmits images back to a
     console from which he operated the other surgical instruments
     attached to the arms. The da Vinci System’s design allows the
     surgeon to operate from a comfortable, seated position at the con-
     sole with eyes and hands positioned in line with the instruments.
     To move the instruments or reposition the camera, the surgeon
     simply moves his/her hands. While the surgery currently takes
     longer than a traditional procedure, there is less scarring, fewer
     wound complications and a quicker recovery time for patients.



                                                 Da Vinci Surgical
                                                 System
                                                 Pictured, left, the original da
                                                 Vinci Surgical System in the
                                                 OR. The surgeon sits at the
                                                 console. The three-arm robot
                                                 is docked on the right side of
                                                 the patient, preventing
                                                 access for an assistant.




26
Percutaneous Paravalvular Leak Repair
Physicians at Methodist now close paravalvular leaks in a mitral
prosthesis through a tiny puncture in the groin, using live 3D
imaging for precise guidance. During the procedure, the cardiolo-
gist snakes a catheter from the groin into the heart, where a duct
occluder device is deployed to close the leak around the mitral
valve. Methodist offers this combination treatment as an alterna-
tive to open heart surgery for patients considered to be at high
risk for a redo operation. Methodist is the only hospital in Texas
to offer this advanced therapeutic procedure.




                                                                     27
     PATIENT SATISFACTION SCORES
     Just as patient outcomes are used to determine quality of care,
     so too are patient perceptions. By measuring patient satisfaction
     concerning several key indicators, we can determine not only how
     we are doing but also how our care can be improved. Patient satis-
     faction levels are measured throughout the year in key diagnostic
     groups and are based on three criteria: the patient’s personal
     experience with their physician, their likelihood of recommending
     Methodist for their procedure and their overall rating of the care
     received.

                          CARDIOLOGY SERVICE OVERALL PATIENT SATISFACTION
                  92

                  91
                                   TMH
                                                91.1
                  90               TOTAL MEAN                        90.9
                         89.9      600+ BED
     PERCENTAGE




                  89
                                   GROUP MEAN
                  88
                                   UHC PEER
                  87               GROUP MEAN                                      87.8
                                                                            87.4
                  86                                   86.7   86.6
                  85            85.8   85.8
                  84

                  83
                        OVERALL IMPRESSION       LIKELIHOOD OF       OVERALL RATING OF
                       OF TREATING PHYSICIAN    RECOMMENDING            CARE GIVEN
                                                    HOSPITAL            DURING STAY



     The hospital then compares its patient satisfaction rates against
     national averages as determined by the University Healthsystem
     Consortium (UHC) Peer Group Mean. Based on 2007 scores,
     patients receiving care at Methodist had a higher level of
     satisfaction than patients undergoing similar treatment at other
     comparable institutions.

     The patient satisfaction data indicate the satisfaction that patients
     experienced during treatment at The Methodist Hospital, as
     compared to two benchmark groups: hospitals with more than
     600 beds and the hospitals of the UHC. The data present the
     mean score of all respondents on a 100 point scale.




28
Results

The Methodist Hospital patient satisfaction scores for cardiology
services were higher across all three criteria compared to hospitals
with 600+ beds and to the UHC peer group. Compared to the 600+
bed hospitals, Methodist achieved higher patient satisfaction rates:
4.1 points for Overall Impression of Treating Physician; 4.4 points
for Likelihood of Recommending Hospital; and 3.5 points for
Overall Rating of Care Given During Stay. Similarly, Methodist
achieved higher rates compared to the UHC peer group, 4.1
points for Overall Impression of Treating Physician; 4.5 points for
Likelihood of Recommending Hospital; and 3.1 points for Overall
Rating of Care Given During Stay.




                                                                       29
     FACULTY LISTING
     Cardiologists                  Vijay Nambi, M.D.
     Mohammed Attar, M.D.           Nadim Nasir Jr., M.D.
     Christie Ballantyne, M.D.      Carlos Orrego, M.D.
     Nabil, S. Baradhi, M.D.        Craig M. Pratt, M.D.
     Douglas R. Bree, M.D.          Miguel A. Quiñones, M.D.
     John Martin Buergler, M.D.     Albert E. Raizner, M.D.
     Sarma S. Challa, M.D.          Michael E. Raizner, M.D.
     Su Min Chang, M.D.             Tapan G. Rami, M.D.
     Clement A. DeFelice, M.D.      Frank D. Rickman, M.D.
     Timothy K. Doyle, M.D.         Howard S. Rubin, M.D.
     Stanley M. Duchman, M.D.       Alpesh R. Shah, M.D.
     Jerry D. Estep, M.D.           Dipan Shah, M.D.
     Robert E. Fromm, M.D.          Gopi A. Shah, M.D.
     Irakli X .Giorgberidze, M.D.   Hue-The Shih, M.D.
     Michael J. Gordon, M.D.        Stuart L. Solomon, M.D.
     Sasidhar Guthikonda, M.D.      Cyril B. Tawa, M.D.
     Mark John Hausknecht, M.D.     Guillermo Torre, M.D.
     Thomas E. Hong, M.D.           Valentina Ugolini, M.D.
     Robert G. Hust, M.D.           Miguel Valderrábano, M.D.
     John C. Isaac, M.D.            Brian Walton, M.D.
     Matteethra C. Jacob, M.D.      William L. Winters Jr., M.D.
     Amin H. Karim, M.D.            Nadim M. Zacca, M.D.
     John W. Kirk, M.D.             William A. Zoghbi, M.D.
     Neal Stephen Kleiman, M.D.
                                    Intensivists
     Milton Samuel Klein, M.D.
                                    Faisal Masud, M.D.
     Karla M. Kurrelmeyer, M.D.
                                    Igbal Ratnani, M.D.
     George C. Li, M.D.
                                    Hany Samir, M.D.
     Kevin A. Lisman, M.D.
                                    Pejman Soheili, M.D.
     Stephen H. Little, M.D.
                                    Kamlesh B. Thaker, M.D.
     John J. Mahmarian, M.D.
                                    Saleem A. Zaidi, M.D.
     Faisal Nabi, M.D.
                                    Asma Zainab, M.D.
     Sherif F. Nagueh, M.D.

30
Cardiovascular Surgeons           Investigators in Basic or
Brian Bruckner, M.D.              Clinical Research
Richard C. Geis, M.D.             Dale Hamilton, M.D.
Jimmy Frank Howell, M.D.          Mark Entman, M.D.
Javier A. LaFuente, M.D.          Nikolaos Frangogiannis, M.D.
Gerald M. Lawrie, M.D.            Craig Hartley, Ph.D.
Matthias Loebe, M.D.              Sandra Haudek, Ph.D.
Alan B. Lumsden, M.D.             Ron Hoogeveen, Ph.D.
Charles H. McCollum, M.D.         Peter Jones, M.D.
Imran Mohiuddin, M.D.             Dirar Khoury, Ph.D.
Joseph Naoum, M.D.                Lloyd H. Michael, Ph.D.
George P. Noon, M.D.              Ryan Neal, M.D.
Eric Peden, M.D.                  Anilkumar K. Reddy, Ph.D.
Mahesh K. Ramchandani, M.D.       George Taffet, M.D.
Michael J. Reardon, M.D.          JoAnn Trial, Ph.D.
Wade R. Rosenberg, M.D.           Zsolt Garami, Ph.D.
Scott Scheinin, M.D.
David D. Shin, M.D.               Emeritus Category
Michael Sweeney, M.D.             Rafael Espada, M.D.
Uttam Tripathy, M.D.
Hartwell H. Whisennand, M.D.

CV Anesthesiologists
Nidal M. AbdelRahman, M.D.
Nicolas Athanassiou, M.D.
Jessica Brown, M.D.
Ghazala Butt, M.D.
James Carter, M.D.
Diane Gibson, M.D.
Elizabeth Herrera , M.D.
Joseph Naples, M.D.
Karanbir Singh, M.D.
Luis Velez-Pestana, M.D.
Zbigniew J. Wojciechowski, M.D.


                                                                 31
     REFERRAL INFO

     For more information or to schedule a consultation, please call
     713-DEBAKEY or go to debakeyheartcenter.com.
     Methodist DeBakey Heart & Vascular Center
     6565 Fannin, Suite D1-040
     Houston, TX 77030




32
The Methodist Hospital
     6565 Fannin
  Houston, TX 77030
 methodisthealth.com
     713-790-3333