CARDIOLOGY
& Heart Surgery

Home of the World-Renowned Texas Heart® Institute

2020 Volumes

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Electrophysiology Procedures
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Inpatient Heart Failure Admissions
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Cardiac Cath Lab Procedures
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Heart Surgeries
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Vascular Procedures
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Minimally Invasive Heart Surgeries
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Heart Transplants
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LVAD Implants

A Letter From the Chief of Our Cardiovascular Service Line

Dear Colleagues,

It is with great enthusiasm that we bring to you this brochure summarizing what we do very well at the Texas Heart® Institute at Baylor St. Luke’s Medical Center: take care of very sick patients.

After the implementation of a state-of-the-art, multidisciplinary, protocolized approach to the management of extremely complex end-stage heart failure patients, Dr. Alexis Shafii and Dr. Andrew Civitello, surgical and medical directors of the Heart Transplant Program at Baylor St. Luke’s, have performed successful heart transplants in over 50 patients, with a 1-year survival rate of 96%.

We continue to be at the forefront of cardiac surgery. Dr. Kenneth Liao, chief of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke’s Medical Center, is the only surgeon in Houston, TX, currently using the da Vinci Robotic Surgical System for cardiovascular procedures.

You will find in the brochure a detailed description of the multidisciplinary centers of excellence that we have created to serve our patients with complex valvular, pericardial, and amyloid heart disease.

In addition to our clinical excellence, and true to its mission, Texas Heart® Institute continues its tradition as a pioneer in cardiovascular research and education. It would be impossible for us to continue to lead in the fields of cardiology and cardiac surgery if we did not have the researchers and scientists innovating every day in the areas of stem cell therapies, devices, and management of arrhythmias. We are equally proud of our cardiology and CV surgery fellows in training. We recruit them from the finest institutions in the United States. They come here because they are attracted to the idea of being exposed to the highest possible acuity of cardiovascular care, delivered in a compassionate way by the leaders in the field.

Thank you for trusting your most challenging and difficult patients to us. We are very proud of what we have accomplished, and we are excited about our next firsts in cardiovascular discovery.
Juan Carlos Plana, MD, FACC, FASE
Chief, Cardiovascular Service Line
Texas Heart® Institute at Baylor St. Luke’s Medical Center

Robotic-Assisted Cardiac Surgery Performed

Led by Kenneth K. Liao, MD, PhD, the team at Texas Heart Institute at Baylor St. Luke’s Medical Center is focused on using state-of-the-art robotic technology to perform minimally invasive mitral valve repair and coronary artery bypass grafting surgery. The advanced robotic technology uses 3D high-definition scope and robot-controlled fine instruments inside the chest, which allows the surgeon to perform gentle and complex surgical maneuvers inside the heart. The advantages of robotic cardiac surgery include very small incisions through rib space (1-2 inches), less blood loss, lower risk of stroke and wound infection, and quicker recovery.

Currently, Dr. Liao is among a handful of highly experienced robotic cardiac surgeons in the U.S. and the only cardiac surgeon in Greater Houston using the da Vinci Robotic Surgical System to treat valve and coronary disease. His robotic cardiac surgery program at Texas Heart Institute at Baylor St. Luke’s Medical Center is among the top 10 programs in the U.S. Since his arrival at Texas Heart Institute at Baylor St. Luke’s Medical Center in 2019, he has performed over 150 robotic heart surgeries, making it the fastest growing program in the country.

Kenneth K. Liao, MD, PhD
Chief of Cardiothoracic Transplantation and Mechanical Circulatory Support at Baylor St. Luke’s Medical Center

Cardiology in the Time of COVID-19

“2020 was a difficult year for us all. Although we at the Texas Heart Institute (THI) are constantly making breakthroughs in cardiovascular research, when the COVID lockdown began, we felt the need to lead efforts against the pandemic. Despite our laser focus on cardiovascular research, THI soared in the field of COVID research. The discovery of cardiac involvement in many patients with COVID sparked the intellectual imagination of our clinical researchers and professional staff,” said Emerson Perin, MD, PhD, medical director of the Texas Heart Institute.
Our professional staff members and communications team made huge strides in education about COVID-19. We updated our website with timely and accurate information about the virus and disease for both the public and healthcare professionals. In our “Cardiology in the Time of COVID-19” series led by Dr. Zvonimir Krajcer, we focused on the impact of the disease in the population we know best — patients with cardiovascular disease.
THI also took a leadership role at Baylor St. Luke’s Medical Center to make possible early and impactful inpatient treatment for COVID patients. The NIH-sponsored trial “Therapeutics for Inpatients with COVID-19” was implemented with Dr. Emerson Perin and THI taking the lead. Coordinating this hospital-wide effort across multiple specialties “engendered great optimism about the future outcomes of our hospitalized patients with COVID,” said Dr. Perin after his first Zoom call with all of the investigators at Baylor St. Luke’s.
THI has taken a leadership role against COVID-19, making available cutting-edge treatments that otherwise would not be accessible. We are here, using our knowledge and hard work, to fulfill the mission set forth by Dr. Denton A. Cooley. Alongside our engagement in COVID research and treatment, we continue to move innovative research projects and “The Next First” in cardiovascular medicine forward.
Emerson C. Perin, MD, PhD
Cardiologist at Baylor St. Luke’s Medical Center, Medical Director of Texas Heart Institute, and Clinical Professor of Medicine at Baylor College of Medicine

Pericardial Disease Center of Excellence

Physicians at Baylor St. Luke’s recently treated a patient with a severe case of pericarditis and pleuritis. Brett Sweeny had dealt with pericardial constriction for years, taking anti-inflammatories and steroids, with no change in his symptoms. The pleura around his right lung had also been affected.

To treat Mr. Sweeny’s condition, Dr. Gabriel Loor, co-chief of adult cardiac surgery at Baylor St. Luke’s Medical Center and a specialist in the surgical treatment of constrictive pericarditis, partnered with Dr. Juan Carlos Plana, imager and chief of the cardiovascular service line, and Dr. Phil Carrott, thoracic surgeon. After a thorough assessment involving echocardiography, MRI, and cardiac catheterization, Mr. Sweeny underwent a pericardiectomy and right-lung decortication. He had no perioperative morbidity and made an excellent recovery. These results were the product of precision imaging, surgical partnership, and consideration of all potential comorbidities to make the procedure as safe as possible for the patient.

1st Hospital in Texas Medical Center To Offer the Convergent Procedure

The convergent procedure is a new hybrid procedure for treating atrial fibrillation. Dr. Jennifer Cozart, cardiac surgeon at the Texas Heart Institute, uses the subxiphoid approach to advance an ablation catheter. A set of linear ablations are performed from distal to proximal along the posterior wall of the left atrium. Then, Dr. John Seger, cardiac electrophysiologist at Texas Heart Institute, maps and completes the isolation of the pulmonary veins and posterior wall.

The procedures can be done the same day or in two stages (6-8 weeks apart). In a recent study, normal sinus rhythm was restored in 87% of patients, 43% were off their AFib medications three months after the procedure, and 76% were no longer having symptoms at the 6-month mark.

New Implantable Device Treats Heart Failure

Baylor St. Luke’s Medical Center is now treating heart failure patients by using a novel implantable device that optimizes cardiac function. A team led by Mihail G. Chelu, MD, PhD, was the first in the larger Texas Gulf Coast area to implant the Optimizer Smart System.
“Heart failure occurs when the muscles of the heart weaken,” Dr. Chelu said. “It can be caused by a number of issues, such as a myocardial infarction, coronary artery disease, or uncontrolled hypertension. The heart muscle becomes damaged and cannot pump properly to supply the body with the oxygenated blood it needs to function normally. This can be a slow, painful progression that can lead to death. While this new device cannot fix the heart, so to speak, it does improve heart function, which decreases dyspnea and improves the ability to perform physical activity. Overall, it improves the quality of life for those living with heart failure.”
This device is indicated for patients with EF between 25%-45% and New York Heart Association Class III.
“Patients can walk farther, have longer conversations, and not tire as easily, giving them more of a normal life. Studies have shown that this type of device reduced hospitalization rates for heart failure and improved exercise tolerance and quality of life,” Chelu said.

HeartCare Study Tests Genetic Risk of Cardiovascular Disease

You can’t escape your genetics, but with a little help, you can be proactive and prevent disease later in life. That is why researchers at Baylor College of Medicine’s Human Genome Sequencing Center are working with Baylor St. Luke’s Medical Center cardiologists to determine patients’ genetic risk factors for cardiovascular disease. As part of the HeartCare study, participants underwent genetic testing to identify genes that influence the risk of cardiovascular disease.

“Genomics has the potential to drive precision medicine. Some cardiovascular risk factors can be predicted or detected through genomic methods, making treatment options specific to each person,” said Dr. Richard Gibbs, Wofford Cain Chair and professor of molecular and human genetics and director of the Human Genome Sequencing Center. “This program provides the perfect opportunity to introduce genomics into the adult clinical care system. It can potentially shift the paradigm from reactive care to risk prediction.”
Hundreds of patients were tested, and for some, the results changed their doctors’ approach to their clinical care. The changes variously included recommending changes to the patient’s diet, exercise, and lifestyle; pharmacologic intervention; and further genetic testing for family members.
“So often in cardiovascular disease, we look at the symptoms and make a probable diagnosis. Now we have the ability to tell patients exactly what they have. It’s remarkable the impact genetics can make in cardiovascular care,” said Dr. Christie Ballantyne, professor of medicine at Baylor College of Medicine and cardiologist at Baylor St. Luke’s Medical Center.
“We’re focusing on adults, but the methods will ultimately be useful for children, as well,” Gibbs said. “If you can predict cardiovascular disease at an early age, then you can intervene.”

Cardiac Amyloidosis Program Established at Heart Failure Clinic

Dr. Ajith Nair, advanced heart failure specialist and assistant professor of medicine at Baylor College of Medicine, has established a Cardiac Amyloidosis Program focused on transthyretin amyloidosis within the Heart Failure Clinic. Cardiac amyloidosis, which commonly affects the heart, can be classified as AL or TTR (transthyretin). AL amyloidosis is caused by a plasma cell dyscrasia.

ATTR amyloidosis, which is now recognized as more prevalent, is caused by the deposition of transthyretin in the heart. In addition to genetic testing, Dr. Nair uses strain imaging, technetium pyrophosphate scintigraphy, and cardiac MRI to make the diagnosis. Specific therapies to treat TTR amyloidosis include oral (tafamidis), subcutaneous (inotersen), and intravenous (patisiran) medications.

FDA Granted Breakthrough Device Designation for Thoraflex Hybrid Stented Device for Complex Aortic Arch Repair

Thoraflex Hybrid is a single-use medical device combining a gelatin-sealed woven polyester graft with a Nitinol self-expanding stent graft and is indicated for the surgical repair or replacement of the aortic arch and descending aorta.
Thoracic aortic aneurysm (TAA) rupture remains a significantly fatal condition. Most patients survive no more than six hours without surgical intervention.
Joseph Coselli, MD, chief of adult cardiac surgery at Baylor St. Luke’s Medical Center and professor, vice-chair, and chief of the Division of Cardiothoracic Surgery at Baylor College of Medicine, was the principal investigator for Thoraflex Hybrid.

“This breakthrough designation from the FDA will allow U.S. physicians to treat patients who may be at great risk of rupture with a device that brings the primary benefit of requiring a single-stage procedure instead of the conventional treatment involving two procedures, thus lowering the risk of patient mortality and potentially reducing overall operating time and hospital costs,” said Coselli.

Dr. Coselli and his team at Baylor College of Medicine and the Texas Heart Institute have pioneered new approaches to treat aortic disease, including novel percutaneous endovascular repair procedures used at Baylor St. Luke’s Medical Center to treat high-risk patients.

He has extensive experience in complex aortic repair in emergent patients as well as patients with connective tissue disorders, such as Marfan and Loeys-Dietz syndromes. He and his team have performed more than 10,000 repairs of the aorta and over 3,600 repairs of thoracoabdominal aortic aneurysms, making Dr. Coselli the world’s most experienced aortic surgeon.

New Thoracic Surgery Integrated Residency Program Led by Joseph Coselli, Chief of Adult Cardiac Surgery

Baylor College of Medicine, in partnership with Baylor St. Luke’s Medical Center, has officially launched a six-year Thoracic Surgery Integrated Residency Program. Whereas the traditional thoracic surgery residency program begins after general surgery training and runs for three years, this new program includes six years of training, with two additional years in research focused on cardiothoracic surgery or general thoracic surgery. This Integrated Residency Program will attract the best medical students and maintain a highly competitive program nationally.
The program includes three initial years that provide rotations in cardiac, vascular, general thoracic, surgical oncology, trauma surgery, and cardiology. After this foundational experience, residents may participate in research for a maximum of two years. The final three years provide senior experience in cardiothoracic surgery in adult and congenital cardiac surgery and general thoracic surgery.
Similar to our traditional residency program, residents will have extensive hands-on experience in complex aortic surgery, robotic cardiac and general thoracic surgery, heart and lung transplantation, mechanical circulatory support, and structural heart transcatheter interventions.

How a Change of Heart Improved Jerry DeHaven’s Life

On October 9, 2006, business owner and farmer Jerry DeHaven was driving to the Houston airport when he blacked out. Thankfully, this happened before he was going to merge onto the interstate.
He was taken to Baylor St. Luke’s Medical Center, where doctors discovered he had cardiomyopathy. This began a 13-year journey that included four different pacemakers and defibrillators and 50 cardioversions.
After the first cardiomyopathy episode, Mr. DeHaven’s doctors implanted a pacemaker and defibrillator to better regulate his heart. Over the ensuing years, all of the shocks to his heart caused it to weaken and enlarge.
Dr. Mehdi Razavi, an electrophysiologist at Baylor St. Luke’s, referred Mr. DeHaven to a cardiologist, who told him repeatedly that he needed a new heart. But despite the fatigue he felt and the trouble he had completing work on his farm or playing golf with his wife, he was resistant to having a heart transplant.
“He kept telling me every time I saw him, ‘Jerry, you need a new heart,’ and I kept telling him, ‘Doc, I don’t want a new heart. I have a heart. I like it. I’ve had it a long time, and I want to keep it.'”
In October 2019, almost 13 years to the day since his first cardiomyopathy episode, Jerry blacked out yet again during a meeting, just weeks after he sold his business. He was taken to Baylor St. Luke’s and put on the transplant list for a new heart. Within a few weeks, he had one. The surgery was performed by Dr. Alexis Shafii, surgical director of heart transplantation at Baylor St. Luke’s Medical Center.
A year later, Jerry says he is doing well. In March 2020, when COVID-19 halted his cardiac rehabilitation program, he adapted it to do it on his own at home. The program includes walking, running, lifting weights, stationary exercises, and other calisthenics.

“This transplant has really been the easiest transplant ever in the history of mankind…except for the scars on my chest, I can’t tell I have a problem,” said Jerry, now 73 and living with his wife in the Memorial area. “Get over the fear of a transplant. If they are telling you that you have a problem and you need a new heart, don’t argue with them. Just play along, and it ends up being almost a non-event. Yeah, you have to go back to the med center once a month for a blood test, and every now and then, you have to have a heart biopsy. Big deal. It’s not that complicated, and once you get out of the hospital and start to walk and then run, you have it made.”

Clinical Research Update: Stem Cell Treatment for Heart Failure in Cancer Survivors

Heart failure induced by cancer treatments is often irreversible and disproportionately affects women and young adults. Texas Heart Institute’s Medical Director, Dr. Emerson Perin, and colleagues across the U.S. evaluated a new treatment approach using allogeneic, bone-marrow-derived stem cell treatment, which is safe and might improve heart function. The research lays the groundwork for further testing in clinical trials. The SENECA Trial was a Phase 1, first in-human study of allogeneic mesenchymal stromal cells (allo-MSCs) in patients with anthracycline-induced cardiomyopathy (AIC). Results were presented at the annual Heart Failure Society of America meeting held virtually this year and appeared in JACC CardioOncology.

Emerson C. Perin, MD, PhD
Cardiologist at Baylor St. Luke’s Medical Center, Medical Director of Texas Heart Institute, and Clinical Professor of Medicine at Baylor College of Medicine

New Clinical Trial at the Texas Heart Institute Explores Heart Failure Treatment After Myocardial Infarction

The Texas Heart Institute is part of the multicenter ALIVE (American Less Invasive Ventricular Enhancement) trial to evaluate the safety of the Revivent TC Transcatheter Ventricular Enhancement System for heart failure patients with left ventricular scarring. The system requires a cardiac surgeon and an interventional cardiologist working together simultaneously to restore the heart to a more normal size, with the goal of improving its pumping efficiency. The goal is to improve heart failure symptoms, quality of life, and walking ability, and to prevent heart-failure-related hospital stays.
“We are enthusiastic about the prospect of treating patients in a less invasive way that may help them avoid the pain, long recovery time, and complication risks that can come with open-heart surgery,” says Dr. Sam Sheth, principal investigator of the study.
“Participating in the ALIVE Trial enables us to be on the front lines of research into the most innovative therapies with the potential to help patients suffering from the limitations of heart failure,” says Emerson Perin MD, PhD, medical director of the Texas Heart Institute.

Complex Valvular Heart Disease Clinic

Led by Srikanth Koneru, MD, the Complex Valvular Heart Disease Clinic is focused on evaluating patients with high risk of operative mortality (who are often deemed inoperable). We offer state-of-the-art multi-modality imaging to guide various percutaneous catheter-based interventions and minimally invasive surgical procedures. Imaging is used to model the valves for optimal sizing before implantation. 3D printing is used to plan cases for patients with complex anatomy or where complications are anticipated.
TAVR Valve in Mitral Area
Tricuspid and Mitral Clasp Trial
Apollo TMVR Trial Valve Planning
MitraClip Device

From Possible Liver Transplant to Valve Surgery and an Active Life

Mr. Daniel Burges was referred to Baylor St. Luke’s Medical Center for evaluation of liver transplant candidacy. He had suffered from ascites, worsening pedal edema, and jaundice for several weeks before presenting to us. He had undergone transcatheter aortic valve replacement (TAVR) to treat severe aortic stenosis at an outside facility more than one year earlier.
At our valve clinic, he underwent 3D transthoracic echo, which showed a very eccentric jet of mitral regurgitation. Further imaging with transesophageal echocardiography confirmed that his TAVR valve was eroding into his mitral valve, causing a perforation of his anterior mitral valve leaflet. Mr. Burges went back to his general cardiologist and was told to continue medical management and hospice care and not to pursue surgery. However, Mr. Burges believed in our team and returned to Baylor St. Luke’s for treatment options.
Given his liver disease and significant associated complications, he was deemed to be at very high surgical risk (risk of mortality close to 30%). 3D printing was performed to assess the extent of involvement of his mitral valve and to plan his aortic valve replacement and mitral valve repair with utmost precision. The surgery went very well, and he was discharged home within four days. He has been following up for 12 months at our valve clinic. He no longer requires liver transplantation as his liver function has normalized. He is now leading an active lifestyle with no physical limitations, walking his dog every day.
CTA 3D printing showing perforation
CTA 3D printing showing perforation

Our Heart Transplant Program Offers Renewed Hope to Patients With End-Stage Heart Disease

Under the leadership of Surgical Director Alexis Shafii, MD, FACS, and Medical Director Andrew Civitello, MD, FACC, the Baylor St. Luke’s Medical Center Heart Transplant Program was restructured in October 2018.
Since the implementation of a state-of-the-art, multidisciplinary, protocolized approach to the treatment of extremely complex patients with end-stage heart failure, the program has subsequently performed over 50 heart transplantations, resulting in a one-year survival rate of 96%.
The Heart Transplant Program is part of the Baylor St. Luke’s Medical Center Transplant Institute and offers renewed hope to patients with end-stage heart disease. The program also offers combined heart-kidney, heart-liver, and heart-lung transplants to eligible patients with end-stage heart failure and multisystem organ involvement.

The Baylor St. Luke’s Medical Center Heart Transplant Program is fully accredited by the United Network for Organ Sharing (UNOS) and Centers for Medicare and Medicaid Services (CMS).

Surgical Director Alexis Shafii, MD, FACS
Medical Director Andrew Civitello, MD, FACC

Multicenter Clinical Trial of the Evaheart LVAD

Alexis Shafii, MD, and colleagues are involved in the multicenter clinical trial of the Evaheart LVAD as a bridge to heart transplant as well as destination therapy. The Evaheart LVAD is equipped with the state-of-the-art LVAD technology; it has the potential to be the best performing LVAD developed thus far. In collaboration with Baylor College of Medicine and Texas Heart Institute, Baylor St. Luke’s Medical Center is one of ten centers chosen to participate in this trial.

Increasing Acceptance of Hearts Donated After Cardiac Death

The increasing acceptance of organs donated after cardiac death (DCD) and the recent development of an ex vivo organ perfusion system have made it possible to transplant donor hearts and lungs that would otherwise be discarded.

The Organ Care System (OCS) is a novel technology that keeps donor hearts beating and lungs breathing prior to transplantation. It is only being studied and used in a few leading heart and lung transplant centers in the world. We are very proud to be the leaders in advancing this technology in both heart and lung transplantation.

Division Chief Kenneth Liao, MD, PhD, participated in the breakthrough EXPAND Heart Trial, which demonstrated that using OCS for donor heart resuscitation could increase successful transplantation using “marginal” donor hearts. Using the knowledge he learned from the EXPAND Heart Trial, Dr. Liao and his team are investigating how the OCS can be used to resuscitate and identify DCD hearts for safe transplantation and best outcomes. He is the recipient of a 3.6 million dollar grant from the Brockman Foundation for his study titled, “Increasing Heart Transplantation by Using Hearts from Donors after Circulatory Death.”

Leading Investigation of Portable Ex Vivo Lung Perfusion

Gabriel Loor, MD, and his colleagues completed the EXPAND I and II trials investigating the use of the normothermic portable EVLP for extended criteria donor lungs, publishing their results in the Lancet Respiratory Medicine. Follow-up of this study is currently ongoing. The Thoracic Organ Perfusion (TOP) registry is the largest post-market approval registry for portable EVLP, for which Dr. Loor has been able to provide lead enrollment through his large pool of patients. Dr. Loor has also been asked to direct another related clinical trial investigating the ideal blood-based perfusate for the portable EVLP.

Sharing Science Globally To Advance Medicine

Texas Heart Institute has been at the forefront of cardiovascular discovery and innovation since its formation. It continues to relentlessly pursue solutions for preventing, diagnosing, and treating heart and vascular disease. Sharing scientific discoveries advances the Institute’s mission and contributes to knowledge globally that can ultimately improve outcomes. In 2019, over 75 Texas Heart Institute members published 187 articles in reputable scientific and medical journals around the world with the help of the Texas Heart Institute Scientific Publications support teams who provide the researchers with professional, scientific editorial services.

Click here to read more on this topic and the Texas Heart Institute.

New Esophageal Suction and Deformation Device To Protect Patients From Atrioesophageal Fistula

Early studies show that a new esophageal suction and deformation device improves the safety of AF ablation by providing esophageal protection. This device is licensed by the Texas Heart Institute at Baylor St. Luke’s Medical Center.
The E-SAFE probe monitors esophageal temperature and deforms the esophagus by suction to create a narrow profile. The device is inserted into the esophagus, and the balloons inflate and apply suction. This reduces the esophageal profile, thus improving contact between the esophagus and temperature sensors. This, in turn, decreases the amount of radiofrequency energy entering the esophagus during ablation.
To date, LA ablation with this device has been tested in three pigs. At necropsy one week after E-SAFE deployment, histopathologic examination found no device-related esophageal injury. The device was granted approval of the CE Mark, and initial human studies are underway in the European Union. FDA clearance is pending.