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					HEART FAILURE AND HEART TRANSPLANT CENTRE
              ANNUAL REPORT
                 2001-2002




              PREPARED BY:


             Dr. Nadia Giannetti
              Medical Director

                    and

              Dr. Renzo Cecere
              Surgical Director
Mandate

The McGill University Health Centre Heart Failure and Heart Transplant Centre in its current
configuration was founded in February 2000. It is located at the Royal Victoria Hospital in the E
pavillion. The mandate of the Centre is to provide a multi-disciplinary approach to optimize care
for heart transplant, heart failure and mechanical cardiac assist patients and to provide cutting-
edge medical and surgical therapy to this population. The Centre serves as a back-drop for
innovative research and teaching for patients, residents and colleagues. It serves as drop-in Centre
for patients with acute medical problems with the intention of decreasing emergency room visits.


Patients

Patients followed at the Centre include heart failure, heart transplant and mechnical assist device
patients. Patients either present at scheduled visits or can present without appointments Monday
to Friday from 8:30 AM to 4:00 PM. Those who are acutely ill can receive intravenous perfusions
in the Centre thus bypassing the emergency room. Over the past year, there were 3262 patient
visits. This was an increase of 17% over 2000-2001.

There are over 400 heart failure patients currently followed at the Centre and 150
heart transplant patients. At any one time, there are 5-7 mechanical assist device patients
followed.


Staff

The clinic is staffed with a medical secretary and ward clerk. There are 3 full-time nurse
coordinators and 1 half-time coordinator. The coordinators share call such that someone is on call
7 days a week and 24 hours a day. This allows rapid access to care for ailing patients and ensures
that donor hearts get rapidly processed. There is also one full-time research nurse coordinator in
the Centre.

The medical staff includes Dr. Giannetti who sees patients in the clinic 5 days a week and Dr.
Cecere who evaluates both scheduled and unscheduled patients weekly. Dr. Elstein and Dr.
Brophy , both in the division of cardiology, assess patients in the clinic one half day per month.
Dr. Cantarovich, a member of the division of transplantation, sees heart transplant patients
concurrently with Dr. Giannetti 1 to 2 half days per week. Dr. Kimoff, a member of the division
of respirology, with an interest in sleep apnea and heart failure follows patients with heart failure
and pulmonary problems in the Centre twice per month. On a weekly basis, Sonia Page, a
dietician with an interest in heart failure assesses patients in the clinic.
Cases

The following is a list of patients who received heart transplantation or mechanical circulatory
support from April 1, 2001-March 31, 2002

Transplants
                                April 01, 2001 – March 31, 2002
Initials                 Age            Transplant surgeon      Outcome
TR (on VAD pre-          14             R. Cecere               Alive and well
transplant)
AR                       51              R. Cecere                 Alive and well
CD (on VAD pre-          32              R. Cecere                 Alive and well
transplant)
RD                       55              R. Cecere                 Alive and well
JF (on VAD pre-          60              R. Cecere                 Alive and well
transplant)
GZ                       37              R. Cecere                 Alive and well
SO (HEART AND            38              R. Cecere                 Alive and well
LUNG)
RS                       60              R. Cecere                 Alive and well
CM                       58              R. Cecere                 Alive and well
VL                       7               R. Cecere                 Alive and well
JP                       67              R. Cecere                 Alive and well
AD (HEART AND            19              R. Cecere                 Deceased: multi-organ failure
LUNG)


Mechanical Circulatory Support

                               April 01, 2001 – March 31, 2002
Initials   Age   Sex    Where from           Surgeon         Outcome
CD         31    M      LAKESHORE            R. Cecere       TRANSPLANTED
JF         60    M      HALIFAX              R. Cecere       TRANSPLANTED
AE         62    M      RVH                  R.Cecere        DIED OF CVA
EJ         2     M      MCH                  R. Cecere/C.    TRANSPLANTED
                                             Tchervenkov
MB         47    M      RVH                  R. Cecere       DIED OF MULIT-ORGAN
                                                             FAILURE
RC         37    M      QUEBEC CITY          R. Cecere       D/C HOME ON LVAD
SN         42    F      RVH                  B.              D/C HOME ON LVAD
                                             DeVarennes/R.
                                             Cecere *
RN         58    M      RVH                  R. Cecere       D/C HOME ON LVAD
DD         61    M      CHARLES              R.Cecere        D/C HOME ON LVAD
                        LEMOYNE
GM         61    M      INSTITUE DE          R.Cecere        D/C HOME ON LVAD
                        CARDIOLOGIE

* Post-cardiotomy failure to ween from heart-lung bypass
Teaching/supervision


Cardiology fellows see patient in the Centre during non-invasive rotation (2 half days per week).
A number of residents in internal medicine have rotated through the clinic as part of an elective.
These have included Drs. Maggie Nguyen and Angeline Law from the MGH and Dr. Jean-
Francois Dorval from the RVH.

There has been supervision of fellows for research projects. This has included Dr. Dominique
Joyal who presented a poster at the Canadian Society of Transplantation conference in February
2002. “Low dose daclizumab post-cardiac transplantation. Also, cardiology fellow Dr. Regina
Husa presented an oral abstract at the International Society of Heart and Lung Transplantation
conference, April 2002: “Acute heart transplant rejection associated with late steroid
withdrawal.”

Dr. Cecere has established Novacor and Thoratec training programs at the MUHC. Through these
three days programs, teams of clinicians receive theoretical and practical instruction on the use of
ventricular assist devices. Practice implants are performed on a unique swine model at the animal
facilities of the Montreal General Hospital site. This year, groups from Halifax and Quebec City
were trained.


Conferences and Presentations

Dr. N. Giannetti

March 22, 2001: McGill University Continuing medical education conference (Thursday evening
lecture series) “Heart failure in the elderly”

April 22, 2001: Association des Medecins Haitien du Quebec. Continuing education. “Heart
Failure Therapy”

May 3, 2001: McGill University continuing education drug therapy course. “Heart Failure drugs”

May 10, 2001: Medical Grand-Rounds at St. Mary’s Hospital. “Chronic heart failure: advances in
therapy.”

September 2001: Primary panelist for Canadian consensus guidelines on Cardiac Transplantation.
Presented at the Canadian Cardiovascular Society meeting 2001, Halifax.

September 2001: Invited expert panelist at the Canadian Cardiovascular Society meeting 2001,
Halifax. For session on “New Therapies in Heart Failure” chaired by Dr. Peter Liu and Dr.
Malcolm Arnold.

September 29, 2001: Association des cardiologues du Quebec. “Heart failure in the Elderly.”
Mont Tremblant

October 5, 2001: Symposium on Heart Failure and Transplantation. “Heart failure: Diagnosis,
management and treatment” Royal Victoria Hospital
October 19, 2001: Cardiology nursing symposium. “Heart Failure Treatment”. Montreal General
Hospital

February 12th, 2002: Canadian Cardiovascular Society winter symposium. “When pills aren’t
enough: Surgical Therapy for Heart Failure”. Mexico.

February 27th, 2002: Cardiac Society of Transplantation , Sangstat fellows work-shop. “Updates
in cardiac transplantation”. Mont-Tremblant, Quebec.

March 24, 2002: New Horizons in Heart Failure Symposium. “Refractory Heart Failure”.
Chanteclerc , Quebec


Dr. R. Cecere

March 24, 2002: New Horizons in Heart Failure Symposium. “Surgical Therapy for Heart
Failure”. Chanteclerc , Quebec

March 2002: International Society for Heart and Lung Transplantation: Symposium on
INTREPID “The role of destination LVAD therapy”. Washington DC.



Communications

Dr. N. Giannetti

March 12th , 2002. Global television. Interview with Stuart Greer, the use of mechanical assist
devices for long-term therapy.

March 21st , 2002. TVA. Live television interview with Jocelyne Cazin in television show “Dans
Lamire” on organ donor awareness.

April 16, 2002. Live radio interview on CJAD radio with Tommy Schnurmacher. “Organ
Donation. “


Dr. R. Cecere

March 12th , 2002. Global television. Interview with Stuart Greer, the use of mechanical assist
devices for long-term therapy.

March 2002: The Gazette interview and feature on the use of LVADs as destination therapy

March 2002: Feature on “Your Health” show with host Dini Petty, LVADs
Research


Funding and studies:


Non-industry funding and studies:

1999-2001: Deane Nesbitt Award (Internal scholarship from the Montreal General Hospital
Research Institute)
Awarded to Dr. Nadia Giannetti for research in heart failure
$ 10 000.00 per year x 3 year

2000-2001: The Gustav Levinski Foundation Awards
Sonia Page and Dr. N. Giannetti. For research in nutritional therapy for heart failure
$ 8597.00

2001: CIHR operating grant
Dr. M. Goldberg and Dr. N. Giannetti
The short-term effects of ambient air pollution on clinical signs and symptoms
for congestive heart failure: A pilot study
$66,490


2001: CIHR multi-centre study
Atrial Fibrillation in Congestive Heart Failure
Dr. N. Giannetti, Local principal investigator


2000: Mayo Clinic Foundation
Giant cell myocarditis treatment trial and registry
Dr. N. Giannetti, Local principal investigator


Industry funded studies

2000-2002: Candasartan in heart failure assessment of reduction in mortality and morbidity.
(CHARM). Sponsored by Astra Pharmaceuticals
Dr. N. Giannetti, Local principal investigator


2000-2002: Omepatrilat versus enalapril randomized trial of utility in reducing events in heart
failure (OVERTURE). Sponsored by Bristol -Myers-Squibb
Dr. N. Giannetti, Local principal investigator

2000-2001: A Randomized Comparative Trial of Prograf versus Neoral in the treatment of
hyperlipidemia one year after heart transplantation.
Dr. N. Giannetti, Local principal investigator and member of steering committee.
2000-2001: Randomized double-blind multi-center study of the efficacy and safety of
valganciclvir vs. oral ganciclovir formthe prevention of cytomegalovirus disease in high-risk
heart allograft recipients. Sponsored by Roche
Dr. N. Giannetti, Local co-investigator

2000-2001: Biventricular pacing in heart failure (MIRACLE sub-study)
Dr. R. Cecere, Local principal investigator
Dr. N. Giannetti, Local co-investigator

2001: Cardiac support device trial (ACORN)
sponsored by Acorn cardiovascular inc.
Dr. R. Cecere, Local principal investigator
Dr. N. Giannetti, Local co-investigator

2002: INTrEPID trial. Investigation of Non-Transplant-Eligible Patients who are Inotrope
Dependant. (Novacor Left Ventricular Assist Device as destination therapy). Sponsored by
Worldheart inc.
Dr. R. Cecere, Local principal investigator
Dr. N. Giannetti, Local co-investigator


Publications:


Chan MC, Giannetti N, Kato T, Kornbluth M, Oyer P, Valantine HA, Robbins RC, Hunt SA.
Severe tricuspid regurgitation after heart transplantation.
J Heart Lung Transplant. 2001 Jul;20(7):709-17.

Montoya JG, Giraldo LF, Efron B, Stinson EB, Gamberg P, Hunt S, Giannetti N, Miller J,
Remington JS. Infectious Complications among 620 Consecutive Heart Transplant Patients at
Stanford University Medical Center.
Clin Infect Dis. 2001 Sep 1;33(5):629-640.

Giannetti N, Management of congestive heart failure: how well are we doing?
CMAJ. 2001 Aug 7;165(3):305-6.

Giannetti N, Heridity N, Alimollah A.,Gao S.Z., Shroeder J.S., Hunt SA, Valantine HA. Mild
hyperhomocysteinemia is not associated with cardiac allograft coronary disease. Clinical
Transplantation 2001;15(4):247-252

Cantarovich M, Metrakos P, Giannetti N, Cecere R, Barkun J, Tchervenkov J. Anti-CD25
monoclonal antibody coverage allows for calcineurin inhibitor "holiday" in solid organ transplant
patients with acute renal dysfunction1.
Transplantation 2002 Apr 15;73(7):1169-1172

Cantin B, Giannetti N, Parekh H, Panchal SN, Kwok BW, Najem R, Woodman K, Hunt SA,
Valantine HA. Mycophenolic acid concentrations in long-term heart transplant patients:
relationship with calcineurin antagonists and acute rejection.
Clin Transplant. 2002 Jun;16(3):196-201.
Ross H, Hendry P, Dipchand A, Giannetti N, hirsh G, Isaac D, Singh N, West L, White M.
Canadia Cardiovascular Society Consensus Conference on Cardiac Transplantation. www.ccs.ca
(oct. 2001)


Abstracts:


M. Cantarovich, N. Giannetti, J. Barkun. Royal Victoria Hospital, McGill University Health
Center,Montreal, Quebec, Canada. Neoral dose monitoring with Cyclosporine 2-hour post-dose
levels results in a clinical benefit compared to trough levels in stable heart transplant patients.
Oral presentation at the International Congress of the Transplantation Society; Rome, August
2000.

N. Giannetti, G. Bal, R. Cecere, M. Cantarovich. Late steroid withdrawal in post-heart transplant
patients is associated with a risk of significant rejection. Presented at the Canadian Society of
Transplantation meeting in Lake Louise in 2001.

Cantarovich M, Giannetti N, Cyr E, Chartier R, Cecere R. Improvement of acute renal
dysfunction in heart transplant patients during calcineurin inhibitor 'holiday' without rejection
under anti-CD25 monoclonal antibody coverage.J Heart Lung Transplant. 2001;20(2):233.

Cantarovich M, Cyr E, Chartier R, Giannetti N, Cecere R.Correlation between the glomerular
filtratiion rate, serum creatinine, creatinine clearance and the calculated creatinine clearance in
heart transplant patients. J Heart Lung Transplant. 2001 ;20(2):205-206.

Cecere R, Ergina P, De Varennes B, Lachapelle K, Giannetti N. Single centre experience with
pulsatile mechanical bridging to heart transplantation. The Canadian Journal of Cardiology 2001;
17 (Suppl C): 168C.

Cecere R, Giannetti N. Reducton annuloplasty and alfieri repair in the treatment of severe dilated
cardiomyopathy: Sustained improvement in clinical variable.The Canadian Journal of Cardiology
2001 ; 17 (Suppl C): 200C.

Cantarovich M, Giannetti N, Cecere R. Relationship between endomyocardial biopsy score and
cyclosporin 2-hour peak levels during the first year after heart transplantation. Abstract
presentation at the Canadian Society of Transplantation meeting, spring 2002.

Cecere R, Giannetti N. Reduction Annuloplasty and alfieri repair in the treatment of severe
dilated cardiomyopathy: Early improvement in clinical variables. Abstract presentation at the
Canadian Society of Transplantation meeting, spring 2002.

Cecere R, Ergina P, Lachapelle K, de Varennes B, Giannetti N. Successful outpatient
management of Novacor and Thoratec VAD patients. Abstract presentation at the Canadian
Society of Transplantation meeting, spring 2002.

Cecere R, de Varennes B, Ergina P, Lachapelle K, Giannetti N. Biventricular mechanical support
and heart transplantation for anthracycline cardiomyopathy in a child. Abstract presentation at the
Canadian Society of Transplantation meeting, spring 2002.
Cecere R, Ergina P, Lachapelle K, de Varennes B, Giannetti N. A bridge-to-a-bridge: using short-
term mechanical circulatory support as a selection criterionfor long-term bridging to heart
transplantation. Abstract presentation at the Canadian Society of Transplantation meeting, spring
2002.

Joyal D, Cecere R, Cantarovich M, Giannetti N. Early experience with low dose daclizumab for
the prevention of acute rejection in cardiac transplantation. Abstract presentation at the Canadian
Society of Transplantation meeting, spring 2002.

Husa R, Cecere R, Cantarovich M, Giannetti N. Acute heart transplant rejection associated with
late steroid withdrawal. Journal Heart Lung Transplant 2002 Jan; 21(1):167



Future Directions


Having demonstrated the viability of the bridge-to-transplant concept with favorable results, we
believe it is appropriate at this time to offer mechanical assist services to a much broader patient
base. Our intent is to develop a network whereby non-transplant cardiac centers can request
mechanical support for their most critical or unstable patients with the option of subsequent
transfer and management at out Centre. This hub-and-spoke paradigm has proven to be effective
at several hub-centres throughout the United States.

In addition, we have been approached to participate in several upcoming clinical trials to evaluate
novel surgical procedures and devices aimed at heart failure patients.

Due to the large volume of patients seen in our Heart Failure and Transplant Centre staffed by
highly skilled and motivated individuals, we remain very attractive as a site for carrying out
basic and clinical research.

				
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