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Heart Center Outcomes

Heart Center Outcomes

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Published by: Nationwide Children's Hospital on Dec 08, 2009
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There’s a family behind every number, percentage and statistic. We never lose sight of that fact.

Achievements
The Heart Center, a comprehensive approach to excellence.

On the day this photo was taken, Catherine was on her way home following a successful heart procedure. As a result of recent advancements, her procedure no longer requires an overnight stay.

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Dear Colleagues, The Heart Center’s mission is to focus on providing the highest quality, family centered, most cost effective and comprehensive care to all patients, regardless of age, with congenital heart disease. In doing so, the Heart Center at Columbus Children’s Hospital is one of the leading congenital heart disease centers in the world for infants, children and adults. And we are accomplishing that mission without losing site of an important fact: At the Heart Center, we treat patients and families, not customers. We provide expertise and diagnostic and therapeutic technology that is second to none. At the same time, we believe that the patient deserves an ongoing relationship that is built not only on technical competence, but also on communication and trust. The patient, the family and the referring physician are at the center of the circle, not off to the side. Thus, our motto: “Out in front. By your side.” In the pages that follow, we will provide information about all aspects of our Center. In each of the sections of the Center we will present data about our outcomes as they compare to the rest of the state, country or world. We will also display our complication rates, volumes, information about access to services and stories about individual patients and families who have used the Center.

Timothy Feltes, MD, FACC, Co-Director of the Heart Center, Chief of Pediatric Cardiology, Cardiac Intensivist, and Associate Professor of Pediatrics, The Ohio State University College of Medicine

Mark Galantowicz, MD, FACS, Co-Director of the Heart Center, Chief of Cardiothoracic Surgery, and Associate Professor of Surgery, The Ohio State University College of Medicine

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Outpatient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Diagnostic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Cardiothoracic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Cardiac Catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Hybrid Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ISHAC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Electrophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Transplantation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Adult Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . 27 Research Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 International Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 The Heart Center Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Welcome Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Physician Liaison Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Referral Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Out in front. By your side.
The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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A great Heart Center such as ours begins with making sure that access is easy. Through the efforts of the cardiology faculty and outpatient nursing staff, significant growth has occurred in the total number of patients seen on an annual basis.

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in 2005, patients waited one day for a routine appointment despite the huge increase in volume—the lowest wait time in the state.

Growth in Outpatient Volume

Part of making access easy has to do with geography: how far does a parent have to travel to be seen by one of the Heart Center cardiologists? Not only are there a number of convenient locations in the Columbus area, but we have outreach clinics located throughout Ohio and one in Kentucky.

Clinics in the Greater Columbus area

Clinics across the region

All of these clinics have diagnostic services on site.

With this extensive network of clinics, patients can be seen and evaluated by one of our cardiologists. If further workup or diagnostic studies are indicated, virtually every modality is available at the Heart Center. Also, long-term follow up after surgery or transcatheter therapy can be conveniently scheduled without having to return to the main campus.

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The percentage of patients in which information from a Transesophogeal echocardiogram in the operating room helps guide post-therapeutic management strategy.

It was not that long ago that a full diagnostic workup consisted of a history, physical examination with a stethoscope, chest X-ray, EKG, and cardiac catheterization. It is a different world today. Even though the history and physical examination are still the foundation of the patient’s evaluation, there are many other non-invasive modalities, frequently making a formal cardiac catheterization unnecessary. Perhaps the most useful is Echocardiography providing anatomic and physiologic information about heart structure, blood flow patterns and estimated pressures inside the heart with essentially no risk from the Echo itself. Echocardiograms can be obtained in two dimensions (2D) or three dimensions (3D); they can be obtained from outside the chest (transthoracic), from the esophagus (transesophogeal echocardiography – “TEE”), from inside the heart on a catheter mounted unit (Intracardiac Echocardiogram – “ICE”), or even from inside a vessel (Intravascular Ultrasound – “IVUS”).

2D color Doppler echo demonstrating a moderate sized midmuscular VSD.

A 3D transthoracic echo in a newborn with Hypoplastic Left Heart Syndrome is shown.

A 3D transesophageal echo (TEE) nicely demonstrates a centrally located secundum ASD.

2D Echos are also obtained of patients in utero. This fetal echocardiography can allow the Heart Center professionals, as well as the parents, time to chart out the optimal course for delivery and immediate post natal care. In the future it may be possible to intervene in the fetal heart interventionally or surgically in a way that could increase survival and options. 3D Echocardiograms are particularly useful in clarifying the anatomy of defects inside the heart in preparation to close them with a device in the cath lab as opposed to an operation (see “Interventional Cardiology”). Three dimensional details can help determine the type of device to be used.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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Intracardiac Echocardiography (“ICE”) is most commonly used to assist in the placement of devices or dilating balloons inside the heart. It can document the internal anatomy and define areas for intervention. Intravascular ultrasound (“IVUS”) can provide details of the anatomy of vessel wall and/or define an area of disruption such as a pseudoaneurysm.

Transesophageal echo (TEE) is used to image a 16 mm ASD with deficient retroaortic rim. The TEE will guide transcatheter device closure of the defect.

Intravascular ultrasound (IVUS) is used during cardiac catheterization to image abnormalities of the blood vessel. In this example, an aneurysm has developed after surgical repair of coarctation of the aorta. In the adjacent angiogram the posterior aneurysm and residual coarctation are seen.

Growth in Echo Studies

n Tee/iCe n Fetal n Transthoracic

The volume of all types of Echo studies has increased dramatically since 2001, which is a testimony to the usefulness of the modality. It can be performed sequentially to assess changes over time in function, flow or pressure. In 2005, more than 8,200 studies were performed.

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Echo services are available not only on Children’s Hospital’s main campus, but at all Children’s Hospital operated Neonatal Intensive Care Units around Columbus as well as most of our outreach clinics. Anatomy of cardiac and vascular structures can also be evaluated by High Definition stop ventilation Computed Tomography (HDCT) with three dimensional reconstruction. The quality of these images is quite remarkable and can be viewed from many different angles. They can be useful for understanding individual pathology as well as planning a surgical or transcatheter approach.

A volume rendered, 3D multi-slice CT (MSCT) scan beautifully demonstrates severe transverse aortic arch hypoplasia after complex congenital heart disease repair in a 7 month old infant.

This 3D MSCT scan was performed after serial stents had been placed in the descending aorta in a 5 year old with middle aortic syndrome. A 19 mm long aneurysm is demonstrated on the scan. Subsequent transcatheter therapy was successfully performed.

With all of the diagnostic imaging available, most patients go to surgery without a cardiac catheterization for diagnosis, and there are rarely any surprises in the operating room. As discussed in the next section, all information is reviewed on each patient by the entire Heart Center team to make sure that, when patients are referred to surgery, all appropriate information is available and current.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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While mortality rates under 5% for open heart surgery are considered acceptable, the Heart Center at Columbus Children’s rate of 1.02% is significantly lower than the 2005 statewide rate of 3.4% for all other centers.

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Virtually every type of Cardiothoracic Surgery is performed at the Heart Center with results that are outstanding at a national level. All congenital cardiac deformities can be repaired or palliated, many with techniques that were developed here in Columbus. Working hand-in-hand with the interventional cardiologists and electrophysiologists, the optimal therapy is individualized for each patient, no matter what the complexity of their situation. If no further options are workable or practical for selected patients, transplantation of the heart, lungs or both are available, and their long-term care coordinated by experts in the management of heart and lung transplants. Our surgical team includes the perfusionists, who run the heart lung machine, which keeps the patient’s body supplied with blood while the heart is rested during repair. Our team of four perfusionists has a combined total of 57 years of service at Columbus Children’s and is also active on the national and international scene. Fifty-three abstracts and presentations as well as 11 scientific papers have been authored by our perfusion team. Along with the surgeons, they have developed techniques using very small components and tubing that allows for open heart surgery on infants and even newborns without using blood. Thus the basis for our “blood conservation program.”
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Total Cardiothoracic Surgical Procedures

The perfusion team has miniaturized the cardiopulmonary bypass circuit to allow ease of operation during an open heart procedure performed in the Hybrid Suite.

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The number of out-of-state referrals for surgery at the Heart Center in the last year. The number of referrals per year has increased steadily.

When looking for meaningful outcomes results in pediatric cardiac surgery, mortality rate for the Arterial Switch Procedure is frequently viewed as a good barometer. This complex operation is typically performed in the first few weeks of life. All parts of the system must perform very well to obtain good outcomes: from preoperative evaluation and management, to excellence in the operative suite of anesthesia, perfusion and surgeons, and meticulous attention to detail in the Cardiac ICU afterward. The creation of our Heart Center, related recruitment activities, and consolidation of all aspects of the clinical services occurred in late 2002 and early 2003 with a corresponding and marked decrease in operative mortality.

Mortality Rate of Arterial Switch Operation for Transposition of the Great Arteries
n statewide Average n Columbus Children’s

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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A great deal of attention is paid to safety and prevention of complications. One of the most common and worrisome complications is infection. The Heart Center is represented on a national panel of experts for the prevention of surgical wound infections. Recently, even more progress has been made toward minimizing this complication using innovations in and out of the operating room.
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Cardiac Surgical Infection Rate

Team members consider treatment of a patient during our bi-weekly case management conference.

Results like these require more than great surgery, they require great teamwork at every stage of the process. That starts with a collaborative approach to planning the therapy, where all members of the multidisciplinary team have input to planning the care. With the large amount of expertise available at the Heart Center there may well be several different ways to potentially solve the patient’s problem. These options are discussed at our bi-weekly case management conferences.

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One indication of how well we are doing treating our patients and families is the growth in referrals to the Center, which have more than doubled and widened regionally, nationally, and now include referrals from other countries. Our surgical and interventional cardiology programs are now internationally renowned.
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Referred patients in 2000

Referred patients in 2005

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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It also takes considerable expertise to make sure the patient is “tuned up” prior to and after surgery and managed with exquisite attention to detail in the dedicated Cardiac ICU. Staffed by Cardiac Intensivists, Critical Care Physicians and advanced level Nurse Practioners, dedicated rooms staffed by dedicated nurses provide comprehensive and professional care. All types of mechanical heart and lung support devices and technicians are also available if necessary.
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Nurse practitioners working in the CICU during rounds.

And through all of this, we remain centered on the patient and the family. Our brand new operating suites not only include spacious rooms with the finest of equipment, but also are designed for parental presence. A parent can accompany their child, in their street clothes, to the induction room and be with him or her until they fall asleep – a great comfort for both child and parent. After cardiac surgery, the patient goes directly to the CICU where the parent can be with them as soon as they are checked in and connected to monitors. The new CICU has 24-hour parental presence as part of the way we do business. And we just moved into our newly remodeled step down unit, which has all private rooms with showers. This is what our parents think of us:

Questions on Parent Satisfaction Survey (2005)
Answers to questions were understandable risks and benefits were discussed prior to surgery doctors and nurses worked well together rate policy for visiting/staying with child

% Positive
98% 98% 97% 97%

New Cardiac Step Down unit with Private Rooms

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A total of 339 diagnostic catheterizations were performed in the cath lab during the last three years with both mortality and complication rates of 0.39%.

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The cardiac catheterization suite serves three different functions that are becoming increasingly separate and distinct: diagnosis, intervention, and electrophysiology study and treatment. Diagnostic catheterization is the traditional study of the gathering of pressure and oxygen saturations in all chambers and vessels, as well as visualization of anatomy and flow by introducing contrast agent and obtaining digital angiography. Calculations based on these measurements can frequently be used to calculate flow, shunts, and resistance. This information allows the planning of medical, interventional or surgical options for patient treatment. Interventional catheterization employs the use of specially designed catheters and devices (balloons, stents, occlusion devices, etc.) to actually treat an intracardiac or vascular problem, as opposed to just diagnosing it. Most of the time, the interventional procedure is accomplishing a task that would otherwise require a heart operation. Electrophysiology studies use specialized catheters guided to the inner surface of the heart to analyze the electrical characteristics and pathways that are creating rhythm disturbances in patients. If an abnormal pathway is detected and causing arrhythmias, it can be ablated with radiofrequency energy. In addition, pacemakers and defibrillators are implanted in patients with life threatening rhythm distrubances.

Catheterizations by type
n interventional n diagnostic n electrophysiological

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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during the last three years Children’s completed 895 interventional procedures with a 0.02% complication rate and a mortality rate of 0.48%.

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Since the creation of the Heart Center, the use of the cardiac catheterization suite has changed considerably. The number of diagnostic catheterizations has decreased because ECHO and other imaging modalities have provided the relevant information without the risk of catheterization. This means that patients who do come to the cath lab will be more complex, frequently more compromised patients. A dedicated interventional The Amplatzer Occlusion Devices are shown and are used to non-surgically close intracardiac defects associated with congenital heart disease. cardiology team was recruited in 2002 to offer cutting edge, transcatheter therapies to all children and adults with complex congenital heart disease. As a result,the number and complexity of interventions has increased dramatically—many times avoiding an operative procedure.
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A right upper pulmonary vein angiogram nicely demonstrates a large secundum ASD in a 2 year old. After balloon sizing of the defect, an Amplatzer Septal Occluder is successfully implanted. Nearly 100 patients each year undergo successful non-surgical device closure of ASD in our catheterization suite.

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The past 15 years have seen an explosion of non-surgical, transcatheter options to close intracardiac defects, such as atrial and ventricular septal defect, as well as patent ductus arteriosus. Percutaneous valve implantation is being developed and will become available in selected centers in the future, including our own. Adult patients with neurologic events or migraine headaches associated with patent foramen ovale requiring transcatheter closure are being referred to our Center during clinical trials. As a matter of fact, adult patients with complex congenital heart disease comprise over 25% of the interventional procedures performed in our Hybrid Cardiac Catheterization Suites. All transcatheter therapeutic options are available in our Center, regardless of size, complexity, or age of the patient. Like the Cardiothoracic Surgical Service, patients from across the USA and abroad are referred here for transcatheter therapy.

Color flow Doppler TEE demonstrates a multi-fenestrated ASD. Under an FDA approved clinical trial, a Cribriform Septal Occluder was successfully implanted and is shown in the adjacent TEE image.

Since The Heart Center was established in 2002, we have been involved as a Principal Investigator in over eight FDA sponsored clinical trials, three interventional cardiac registries, and over 50 IRB approved studies. In addition, our Center is one of eight sites that are involved with establishing Congenital Cardiac Catheterization Outcomes, which will provide important data to define expected outcomes for all diagnostic and interventional procedures. Finally, our Interventional Team has been responsible for 23 manuscripts in scientific journals, nine book chapters, 47 published abstracts, 132 oral and poster presentations given nationally and internationally, and has been invited to perform live case broadcasts to teach other interventionalists attending scientific symposia worldwide.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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The interventional cardiology team works closely during advanced transcatheter therapies. In these photographs, IVUS is being performed to help guide balloon angioplasty and stent implantation after surgical repair of tetralogy of Fallot.

An aortic angiogram demonstrates near complete interruption of the aorta in a teenager with CoA. After compassionate use approval, a covered stent is implanted and there is complete relief of obstruction.

Volume rendered, 3D MSCT scan is very important after transcatheter interventions. The above images nicely demonstrate in-stent stenosis after pulmonary artery rehabilitation in an infant after tetralogy of Fallot repair. Additional interventional therapy was required.

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Mortality Rate for First Stage Palliation of Hypoplastic Left Heart Syndrome
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At the Columbus Children’s Heart Center, we have pioneered the concept of the Hybrid approach to complex congenital heart disease. A Hybrid case is one that combines the talents of a cardiac surgeon and an interventional cardiologist. An example is our new Hybrid approach for the initial palliation for Hypoplastic Left Heart Syndrome. The traditional approach (The Norwood Procedure) involves an extensive open heart procedure which creates a neoaorta, disconnects the pulmonary arteries and provides pulmonary blood flow by a Gore-Tex® shunt which provides adequate pulmonary flow while protecting against overcirculation. Cardiopulmonary bypass and circulatory arrest are typically required. In contrast, our Hybrid approach protects against pulmonary overcirculation by banding the pulmonary arteries individually through a limited incision in the chest without cardiopulmonary bypass. The cardiac surgeon then provides access to the patent ductus through the proximal pulmonary artery, allowing the interventional cardiologist to place a stent in the ductus arteriosus, thus keeping it open, serving as the conduit to the aorta. Just prior to discharge, a transcatheter balloon atrial septostomy is performed, allowing unobstructed flow for the left side to the right side of the heart. The same objectives are obtained as the Norwood Procedure, but with the Hybrid approach there is no bypass involved, and no circulatory arrest. Therefore, the procedure can be performed without blood, which in part explains our international reputation among parents of the Jehovah’s Witness faith. Avoiding open heart surgery and circulatory arrest in the newborn period has several theoretical long-term advantages, both in terms of mortality and morbidity as well as long-term neurologic outcome. The effect on overall outcomes for Stage I palliation at the Heart Center has been remarkable. In the most recent year, 13 Stage I palliations were carried out, 11 by Hybrid approach and two with a traditional Norwood Procedure without a mortality. These results are excellent by both national and regional standards.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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This type of innovative approach requires a new look at space and equipment. Traditional cardiac catheterization laboratories are not designed to be operating rooms. The cath tables provide best access to the patient from the groin area and have maximum flexibility for the table and biplane imaging equipment. Access to the chest First-of-a-kind Hybrid Suite and Table is limited and there is not space and support for cardiopulmonary bypass equipment. Operating rooms, on the other hand, are set up for bypass, maximum access to the chest, and plenty of room for anesthesia and diagnostic equipment, but have only rudimentary imaging equipment. The two Hybrid Suites in The Heart Center have been specifically designed with both needs in mind. Built to Operating Room standards, all necessary space and access exist for an open heart surgical team. At the same time, state-of-the-art imaging and physiologic equipment gives the interventional cardiologist the necessary tools to perform the intervention. Our two Hybrid Cardiac Catheterization Suites opened in 2004 and were the first in the world specifically designed for Hybrid procedures.
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ben and Veronica sneesby moved halfway around the world – from Australia to Columbus, ohio – to save their daughter’s life. phelicity was diagnosed in utero with hypoplastic left heart syndrome. The sneesby’s were told there was no hope for their unborn child. but the family searched and found dr. Mark galantowicz, Co-director of Columbus Children’s Hospital Heart Center, and his colleague, John p. Cheatham, Md, director of Catheterization and interventional Therapy, who had achieved excellent results with a new “Hybrid” technique to treat hypoplastic left heart syndrome without the use of blood. The sneesbys didn’t hesitate; they sold their home and began the 9,000-mile journey to Columbus. phelicity brooke-lyn sneesby was born in Columbus on July 18 and just 12 days later, dr. galantowicz and dr. Cheatham, along with their teams, performed the first of two procedures that allowed her to breathe without a respirator. phelicity, only the 12th child to undergo this new treatment, came through with flying colors. phelicity has now completed all three procedures leading to a Fontan circulation without the use of blood! The sneesbys have returned to Australia to rebuild their lives at home, where dr. galantowicz and his team expect phelicity to continue to enchant them with her bright inquisitive ways and energy.

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Interventional and surgical teams from all over the country visit our Hybrid Suites to learn more about Hybrid therapies and room design. In addition, we have had visitors from Europe, South America, and Asia visit our team of specialists.

It is common for visitors from other countries to visit our Hybrid Cardiac Catheterization Suites. Guests from FuWai Cardiovascular Hospital in Beijing, China observe a Hybrid Stage I palliation for HLHS by our team.

During a Hybrid procedure for intraoperative delivery of an LPA stent on cardio-pulmonary bypass, endoscopic imaging confirms appropriate placement of the stent proximal to the upper and lower lobe branches.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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Hybrid Stage 1 palliation has been performed successfully by our team in babies as small as 1.1 kg... not much larger than your hand.

After pulmonary artery bands have been placed, a self-expandable PDA stent is implanted off cardio-pulmonary bypass. An angiogram confirms excellent placement of the stent and PA bands. A follow up 3D MSCT scan is performed prior to Comprehensive Stage II repair and nicely demonstrates the PA bands, PDA stent, and atretic ascending aorta.

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The international symposium on the Hybrid Approach to Congenital Heart disease attracted interventional cardiologists and cardiothoracic surgeons from 5 continents.

Interventional cardiologists and cardiothoracic surgeons from throughout the United States, North and South America, Europe, Australia and Asia gathered at Columbus Children’s Hospital from June 28-30, 2006, for the inaugural International Symposium on the Hybrid Approach to Congenital Heart Disease (ISHAC). This conference was the first of its kind dedicated to exploring advancements in “Hybrid” management strategies which combines surgical and transcatheter therapies in order to minimize the cumulative impact of treatment for complex congenital heart disease (CHD). Columbus Children’s Hospital is considered a benchmark institution in this area where two uniquely designed Hybrid Cardiac Catheterization Suites opened in June, 2004—the first in the world dedicated to this new therapy.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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The two-day Symposium featured lectures and panel discussions from international pioneers in the field, as well as live case demonstrations broadcast from Miami Children’s Hospital, University of Chicago Comer Children’s Hospital, and the Hybrid Suites at Columbus Children’s Heart Center. A special one day hands on Workshop was attended by selected participants and the faculty. Symposium directors were John P. Cheatham, MD, Director of Cardiac Catheterization and Interventional Therapy at Columbus Children’s Heart Center, and Mark Galantowicz, MD, Co-Director of The Heart Center and Chief of Cardiothoracic Surgery at Children’s. Both are faculty members of The Ohio State University College of Medicine. Drs. Cheatham and Galantowicz have organized this world-class event to encourage international discussion for potential Hybrid cardiac procedures that will result in improved outcomes while decreasing risks.

During the ISHAC hands-on Workshop, cardiothoracic surgeons, interventional cardiologists, and nurse practitioners receive training by our team for Hybrid Stage I palliation for HLHS.

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nearly 200 patients with pacemakers are being monitored by the ep service.

The Electrophysiology service is devoted to caring for patients with heart rhythm abnormalities. The abnormal rhythms can be divided into two broad groups, those with heart rates that are too slow and those that have fast heart rhythm problems. The key to caring for this group of patients is to offer state-ofthe-art facilities and equipment in order to adequately diagnose the abnormal rhythm and provide effective intervention to treat the abnormalities. To provide this level of care, often for complicated patients, the Electrophysiology team provides a wide range of services. They include diagnostic tests and interventional procedures. Diagnostic services include telemetry review of cardiac patients admitted to the hospital, transesophogeal and intracardiac electrophysiology testing, and tilt table tests. Other diagnostic tests include EKG’s, Holters and Event monitors.
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Fluoroscopy Image

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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The Heart Center at the Columbus Children’s Hospital has a full complement of diagnostic capabilities. Invasive diagnostic electrophysiology testing is performed in a state-of-the-art catheterization laboratory. The facilities offer both a conventional mapping system, as well as three-dimensional electroanatomic reconstruction of the abnormal substrate that is the cause of abnormally fast heart rhythm. Because we have these tools available, we can ablate the abnormal electrical impulse that is the cause of the palpitations. One of the two tools with their unique advantages is chosen based on individual patient needs. This approach affords maximal effectiveness in success and, just as importantly, minimizes the potential for serious complications. To date we have had no patients require pacemaker implantation as a result of ablative therapy. The Heart Center achieves an 80% to 95% success rate on routine SVT ablation interventional procedures depending on the area to be ablated: a rate that is comparable or better than the national average.
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The number of patients who have required pacemaker therapy after ablative therapy.

The high level of activity indicated below demonstrates the need, as well as the effectiveness, of Electrophysiology Services.

Electrophysiology Service

n interventional ep n eps n device implantation

Electrical Map created by computer

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For patients with slow heart rates that are potentially harmful, a pacemaker may be needed. The pacemakers of the present era are sophisticated devices that allow tailoring of the settings to the needs of each patient. Due to the changing needs of our patients, settings are directly related to their age and associated cardiac problems, and our staff are experienced in adjusting the settings of these devices accordingly. We implant cutting-edge devices and leads for our patients. There are patients who require devices that have the capabilities to detect abnormally fast rhythm and deliver the appropriate therapy. As our survivors of congenital heart surgery age into young adulthood, there is clearly a growing need for these life saving devices. Determination for the patient who needs such a device is performed systemically and through a team approach involving almost all the services of the Heart Center. Follow-up is performed by a very capable and highly trained staff to ensure the device is operating properly.

Medical illustration of a pacemaker device

Dr. Pamela Ro with a family.

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When no other options are available with conventional medical or surgical therapy, transplantation of a heart, a lung, or heart and lungs is a life saving option. Transplantation services began at the Heart Center in 2002, and the program has grown rapidly. We began the services only after assembling all necessary experts. In addition to surgeons and transplant cardiologists and pulmonologists, intensivists and anesthesiologists, the team includes transplant coordinators, a child psychologist, and the entire array of other supporting services such as pathology, pharmacy, nutrition, rehabilitation service, and occupational and physical therapy. Once in place, program approval was gained from the United Network for Organ Sharing (UNOS) at the national level and The Ohio Solid Organ Transplant Consortium at the state level.
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Volume of Transplant Procedures

The volume of transplantation has grown dramatically.

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While the recipients range in age from 2 months to 19 years, the majority of heart transplant recipients are less than 6 months old. Also, heart transplant wait times range from 1 to 27 days, with a median wait of 10 days.

6

months

Of course, the nature of the patients awaiting transplantation is such that the full array of support must be available including mechanical support. It is of note, that even though wait times in general were relatively low, there were 3 patients who required Extra Corporeal Membrane Oxygenator (ECMO) support while waiting for an organ, including one who was on ECMO for 10 days. Supporting the service is a whole network of clinics and clinicians that screen and evaluate patients pre-transplant, and who keep track of the all-important follow-up that is so crucial in transplantation.
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At 3-months-old and in need of a heart and lung transplant, time was already running out on Jason. And while Jason’s family waited, another family at Children’s waited, as well. Their daughter, Kayla, needed a new heart in order to survive. both of their lives were being measured in weeks, rather than years. it was then that the unlikely occurred. A heart and lungs from an anonymous, out-of-state donor became available. so the transplant team at Children’s took advantage of this rare opportunity to save the lives of two children. surgeons transplanted Jason’s heart into Kayla, then transplanted the donated heart and lungs into Jason. prior to this procedure, a domino transplant had not been performed in the united states for more than a decade and never in patients this young and small. And as a result, Jason has now experienced life as an organ donor, and as an organ recipient.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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A d ulT

c on g e n i t al h e art dis e as e

Patients with repaired congenital heart disease are continuing to live longer, and as they do, the proportion of adults with congenital heart disease continues to rise and exceeds the number of pediatric patients with congenital heart disease. Many patients who have undergone total corrective surgery will have few, if any, hemodynamic residual lesions requiring infrequent evaluation and treatment (atrial septal defect, ventricular septal defect and patent ductus arteriosus). However, Rachel – Adult congenital heart patient patients with more complex lesions may have residual shunts, valvular disease, ventricular dysfunction and arrhythmias, and require more frequent evaluation, medical treatment and consideration for further surgical or catheter based interventions. As we follow patients for decades, some patients that were previously considered as “routine” may develop unforseen problems. Our programs focus resources on these patients.
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The mission and goals of The Adolescent and Adult Congenital Heart Disease Program at Columbus Children’s Hospital and The Ohio State University is to:
1. Comprehensively evaluate and treat, both medically and surgically, adolescent and adult patients with congenital heart disease. 2. Maintain a detailed patient database to support clinical and basic research in the field of adolescent and adult congenital heart disease. 3. Provide education to medical students, residents, nurses and physicians at Columbus Children’s and The Ohio State University in the subspecialty area of adult congenital heart disease. 4. Expand the field of experts in adult congenital heart disease by facilitating a Combined Internal Medicine and Pediatric Cardiology Fellowship Program.
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A d ulT

con g e n i t a l h e a rt dis e as e (co nti nue d)

Adult Congenital Heart Disease Clinic Patients

To accomplish the goals set forth requires a team of experts from several disciplines including nurse clinicians, cardiologists in many subspecialty areas (electrophysiology, heart failure/transplant, interventional cardiac catheterization), and cardiothoracic surgery. In July 2000, an adult congenital heart clinic was 2005 total patients = 1,116 (OSU – 521, CCH – 595) established at Columbus Children’s Hospital with a parallel clinic at OSU’s Heart Center – Mill Run. Initially, the clinics were scheduled once a month, but by the year’s end, the clinics had expanded to twice a month. Currently, the Adolescent and Adult Congenital Heart Disease Clinics evaluate patients in 10 separate clinics per month.
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Adult Congenital Heart Disease Cardiac MRI’s and CT’s

In order to accommodate this growth, Columbus Children’s has expanded our clinical staff. Starting with one Certified Nurse Practitioner, and adding a second, as well as a new RN to act as clinical coordinator.

Increasing number of studies by year.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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A d ulT

con g e n i t a l h e a rt dis e as e (co nti nue d)

Adult Congenital Heart Disease Cardiac Catheterizations

The number of diagnostic studies has increased with the number of patients. In addition to traditional cardiac catheterization, MRIs and Cardiac CTs have increasingly yielded useful information for the team. Also, as shown to the right, not only are a greater number of catheterizations being Increasing number of cardiac catheterizations on adults for congenital heart performed each year on adults disease, and increasing % of total catheterizations. for congenital heart problems, but they represent a growing percentage of the total number of catheterizations.
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

The Electrophysiology (EP) service has also become an integral part of the adult congenital heart disease program. By far the most common problem facing our population is arrhythmias. Research has shown that the risk of sudden cardiac death is 25 to 100 times greater than expected in an adult with congenital heart disease compared to a normal adult. Therefore, an aggressive approach to evaluation and treatment is necessary. We have learned that a combined cath/EP evaluation can provide valuable information and has lead to many patients receiving pacemakers, intracardiac defibrillators, and intraoperative ablation. The adult congenital service has maintained a fairly steady presence in the EP lab running between 30 to 35% of all cases coming to the EP lab at Columbus Children’s Hospital, with 2005 once again having a growth rate greater than 50%. Cardiac Surgery on the adult with congenital heart disease is a growing segment of our population at the Heart Center. Initially, 5% of cases seen by the Adult Congenital Heart Disease program were referred for surgery. In the most recent year, 11% were referred. These patients can be treated either at the Ross Heart Hospital of The Ohio State University or at Columbus Children’s Heart Center. At the Heart Center, our Cardiac Intensive Care Unit is designed to accommodate all patients from infants to adults.

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A d ulT

con g e n i t a l h e a rt dis e as e (co nti nue d)

As patients with previously repaired congenital heart defects mature, we are now finding and developing new techniques and procedures to care for this group. As an example, many patients who have undergone single ventricle surgery with a Fontan operation may require additional surgery for heart failure and arrhythmias. We are one of only a few institutions that perform Fontan revision on adult patients. Additionally, we are developing new open heart procedures that combine complete Jeff – Adult congenital heart patient repair with arrhythmia surgery. Previously there were no other options with congenital cardiopulmonary failure, and now Children’s Heart Center has transplant options for these patients. In the future, we will be looking at starting a transition program which essentially invites all CHD patients from Children’s Hospital to join the ACHD program at the age of 18 which would double or quadruple our current volume. The ACHD team remains active in clinical research and has accomplished many academic achievements for 2005. With the addition of full-time faculty members and ACHD fellows, the research program will continue to expand. Our plan is to add a research coordinator to the ACHD program to facilitate our research projects and support the staff of the ACHD program. In 2005, five grants were being run by the program. In addition, two papers, eight abstracts, and 15 presentations and lectures were produced. The nurses in the center produced six publications, two abstracts and three presentations.

Volume of Adult Congenital Heart Procedures

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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reseA rC H

p ro gram s

Cardiovascular Research at Columbus Children’s involves investigators from The Heart Center and the Center for Cardiovascular Medicine (within Columbus Children’s Research Institute), where basic scientists and clinical investigators work closely on multiple research projects. Since 2003 this active group of researchers have published more than 150 manuscripts or book chapters in leading journals and given more than 250 presentations of their research findings at national meetings. In addition, more than 30 research proposals have been submitted to national funding agencies, including the National Institutes of Health and the American Heart Association, and approximately 20 research projects have been funded from various sources totaling nearly $2 million. Investigators also have contributed to several multi-center trials for pharmaceutical development. These activities have helped to foster collaborative relationships with other specialties within our hospital and Research Institute (neonatology, pulmonary, general pediatrics, pharmacology, genetics) and involved the training of research fellows from diverse fields in translational research projects.
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Areas of research emphasis:
In-hospital patient outcomes • Innovations in surgical palliation for congenital heart defects • Prevention, prediction and treatment of poor outcomes post-surgery • Biomarkers and predispositions Outpatient and preventive medicine • Oxidant and inflammatory mechanisms in cardiac and vascular disease • Childhood antecedents of adult cardiovascular disease • Endothelial dysfunction and controllers of new blood vessel formation • Novel therapeutic strategies Basic research • Cell and tissue engineering, blood vessel and cardiac • Models of disease occurring in children and neonates • Inflammation and stress signaling pathways Clinical research • Establish animal model for the approach to hypoplastic left heart syndrome with pulmonary artery bands • Establishment of a new animal model for ventricular septal defects to facilitate testing of perventricular treatment options.

31

ed uC ATion

As part of one of the nation’s largest and busiest pediatric hospitals, The Heart Center at Columbus Children’s is engaged in a wide variety of graduate medical and continuing education activities. In collaboration with The Ohio State University College of Medicine, faculty teaches residents and fellows in the following programs: • Cardiothoracic Surgery • Congenital Cardiac Surgery • General Pediatrics • Internal Medicine-Pediatrics • Neonatal-Perinatal Medicine • Pediatric Cardiology • Pediatric Critical Care Medicine

The Heart Center staff also serves as mentors and role models for physicians, advanced practice nurses, perfusionists, and other clinicians and scientists. They give lectures, proctor clinical procedures, present live case demonstrations at national and international programs, and teleconference case conferences. Indeed, in 2005 faculty and staff gave over 100 presentations in 19 different countries outside the United States. Presentations include such diverse topics as hybrid approaches to complex congenital heart disease, new comprehensive Stage II procedure for hypoplastic left heart syndrome, and RSV prophylaxis in infants and children with hemodynamically significant CHD.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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in Ter nAT io nAl

p ro gram s

International involvement to enhance pediatric cardiac care in developing countries is a long standing tradition in The Heart Center. For more than a decade, cardiac surgeons have led teams of clinicians to offer humanitarian care in the Dominican Republic, El Salvador, Guatemala, and Peru. Typically a multidisciplinary team from Children’s Hospital assists the clinicians from these countries while they diagnose, plan treatments, operate, and coordinate postoperative care and long term follow-up. These supervised clinical teaching experiences, coupled with donations of equipment and supplies, has accelerated the adoption of new techniques and improved care to the neediest children. For example, the team from Lima, Peru has performed over 1,200 operations on indigent patients with a 98% success rate and a 1.5% infection rate, significant accomplishments for such an at-risk population. Notably these outcomes were achieved with a cash outlay of less than $70 per patient.
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The Columbus Children’s Hospital China Program officially began in 2005 with written affiliations in three hospitals: Cardiovascular Institute and Fuwai Hospital, Beijing, Shanghai Children’s Medical Center – Pudong District, Shanghai and Wuhan Children’s Hospital. To date more than 20 physicians teach and learn in the following areas of The Heart Center: • Interventional cardiology • Cardiothoracic surgery • Cardiac intensive care • Anesthesiology • Echocardiology • Cardiopulmonary perfusion

The Heart Center faculty and staff actively teach in China as well, serving as Course Directors of international scientific programs and proctoring physicians from many institutions in new techniques. In addition to China, faculty and staff from The Heart Center have also trained physicians from Bulgaria, Chile, Ecuador, El Salvador, Ghana, Guatemala, Hungary, India, Mexico, and Peru through the Stecker International Scholars Program at Columbus Children’s Hospital.

33

T He HeA rT CenTer

Te am

The specialists, nurses, technologists and other members of our staff work together to deliver the finest care to critically ill infants and children, as well as adults with congenital heart disease. Leading this effort are the members of a remarkable medical team, who are comprehensive in their scope and compassionate in their approach to care. Timothy F. Feltes, MD, FACC, Chief of Pediatric Cardiology, Cardiac Intensivist and Co-Director of the Columbus Children’s Heart Center. Chief of Pediatric Cardiology at The Ohio State University College of Medicine. Associate Professor of Pediatrics. Recipient of the Andy Paxton Endowed Chair in Cardiology. Dr. Feltes received his medical degree from Medical College of Ohio, Toledo. He completed a pediatric residency at Emory University of Atlanta and fellowship at Texas Children’s Hospital, Houston. He is board certified in Pediatric Cardiology and Pediatrics. Mark E. Galantowicz, MD, FACS, Chief, Department of Cardiothoracic Surgery and Co-Director of the Columbus Children’s Heart Center. Associate Professor of Surgery at The Ohio State University College of Medicine. Dr. Galantowicz received his medical degree from Cornell University. He completed his residency at Columbia-Presbyterian Medical Center, New York. He is certified in both Thoracic Surgery and Surgery.
• • • • • • • • • • • • • • • • • • • • • • • •

Hugh D. Allen, MD, FAHA, FACC, Physician-In-Chief of Columbus Children’s Hospital. Clinical Cardiologist and Professor of Pediatrics of the Heart at The Ohio State University College of Medicine. Dr. Allen received his medical degree from the University of Cincinnati. After completing his residency, he received fellowship training at the University of Minnesota. He is certified in both Pediatric Cardiology and Pediatrics. Todd L. Astor, MD, Director of the Lund and Lung/Heart Transplant programs at Columbus Children’s Hospital. Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Astor received his medical degree from George Washington University. After completing his residency at Loyola University Medical Center, he received fellowship training at University of Colorado Health Sciences Center. He is certified in Internal Medicine, Pulmonary Medicine and Critical Care Medicine.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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T He HeA rT C enT er

Te am (co nti nue d)

John Anthony Bauer, PhD, Director of the Center for Cardiovascular Medicine, Columbus Children’s Research Institute Dr. Bauer received his PhD in Pharmacy from State University of New York at Buffalo. His central research interest is to conduct basic science with an opportunity to impact therapy. Dr. Bauer is also an Associate Professor in the Division of Pharmacy at The Ohio State University. Steven C. Cassidy, MD, FACC, Director of Research in the Section of Pediatric Cardiology and Medical Director of Inpatient Cardiology at Columbus Children’s Hospital. Associate Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Cassidy received his medical degree from State University of New York, Brooklyn. After completing his pediatric residency at Brown University in Providence, Rhode Island, he received fellowship training in Pediatric Cardiology at the University of California San Francisco. He is certified in both Pediatric Cardiology and Pediatrics. David Chan, MD, Director of Electrophysiology. Director of Fellowship Training. Clinical Associate Professor of Pediatrics of the Columbus Children’s Heart Center and at The Ohio State University College of Medicine. Dr. Chan received his medical degree from Wayne State University. After completing his residency at Wayne State University, he received fellowship training from both The Ohio State University Medical Center and the Mayo Clinic. He is certified in both Pediatric Cardiology and Pediatrics. John P. Cheatham, MD, FAAP, FACC, FSCAI, Director of Cardiac Catheterization and Interventional Therapy at the Columbus Children’s Heart Center. Clinical Professor of Pediatrics and Internal Medicine at The Ohio State University College of Medicine. Dr. Cheatham received his medical degree from the University of Oklahoma. After completing his residency at Children’s Hospital Medical Center, Boston, he received fellowship training at Texas Children’s Hospital, Houston. He is certified in both Pediatric Cardiology and Pediatrics. Dr. Cheatham has pioneered and developed new transcatheter devices and techniques, as well as helped design new imaging equipment. Stephen C. Cook, MD, Combined Fellow in Cardiovascular Medicine and Pediatric Cardiology at The Ohio State University College of Medicine. Dr. Cook received his medical degree from Boston University. He completed his residency at Albert Einstein Medical Center (Temple University) and received fellowship training from both Columbus Children’s Hospital and The Ohio State University Medical Center. He is certified in both Internal Medicine and Pediatrics.
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THe HeA rT C enT er

Te am (co nti nue d)

Clifford L. Cua, MD, Clinical Cardiologist and Cardiac Intensivist at the Columbus Children’s Heart Center. Assistant Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Cua received his medical degree from Indiana University School of Medicine. After completing his residency, he received fellowship training at Columbus Children’s Hospital and Children’s Hospital Medical Center in Boston. Dr. Cua is certified in Pediatrics. Curt Daniels, MD, Director of the Adolescent and Adult Congenital Heart Disease Program at the Columbus Children’s Heart Center. Assistant Professor of Clinical Cardiology at The Ohio State University College of Medicine. Dr. Daniels received his medical degree from The Ohio State University. He completed his residency and received fellowship training from Children’s Hospital in Columbus. He is certified in Pediatrics, Internal Medicine and Cardiology, and is therefore uniquely qualified to diagnose, treat and provide long-term care for the growing number of adolescents and adults who are diagnosed with congenital heart disease. J. Terrance Davis, MD, FACS, Member of the Division of Cardithoracic Surgery at Columbus Children’s Hospital. Professor of Clinical Surgery at The Ohio State University College of Medicine. Dr. Davis received his medical degree from University of Pennsylvania. He completed his residency at Hospital of the University of Pennsylvania. He is certified in Thoracic Surgery. Dr. Davis originated and developed the world’s most successful surgical treatment for Jeune’s Syndrome. David Fisher, MD, Medical Director of Columbus Children’s Hospital. Professor of Pediatrics and Academic Vice Chairman of the Department of Pediatrics at The Ohio State University College of Medicine. Dr. Fisher received his medical degree from Tufts University School of Medicine. He completed his residency and received fellowship training at University of California. He is certified in both Pediatrics and Pediatric Cardiology. Timothy Hoffman, MD, FACC, Medical Director of the Heart Transplant and Heart Failure Program at Columbus Children’s Hospital. Assistant Professor of Clinical Pediatrics, Division of Cardiology, at The Ohio State University College of Medicine. Dr. Hoffman received his medical degree from West Virginia University. He completed his residency at West Virginia University Medical Center and received fellowship training at Children’s Hospital of Philadelphia. He is certified in Pediatric Cardiology and Pediatrics.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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THe HeA rT C enT er

Te am (co nti nue d)

Ralf J. Holzer, MD, Assistant Director of Cardiac Catheterization and Interventional Therapy at Columbus Children’s Hospital. Clinical Assistant Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Holzer received his medical degree from Johannes Gutenberg Universitat Mainz in Germany. After completing his residency, he received fellowship training at Royal Liverpool Children’s NHS Trust in England and University of Chicago Children’s Hospital. Katherine Mizelle, MD, FAAP, Director of Outpatient Services Columbus Children’s Heart Center. Clinical Assistant Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Mizelle received her medical degree from University of Virginia. She completed her residency at Madigan Army Medical Center, Washington. After her residency she received fellowship training at Oregon Health Sciences University. She is certified in both Pediatric Cardiology and Pediatrics. Aymen N. Naguib, MD, Director of Heart Center Anesthesiology at Columbus Children’s Hospital and Clinical Assistant Professor at The Ohio State University College of Medicine. Dr. Naguib received a medical degree from Cairo University School of Medicine, Cairo, Egypt, followed by residency in surgery at the College of Physicians and Surgeons of Columbia University at Harlem Hospital, and a residency in anesthesiology at Illinois Masonic Medical Center. He did his fellowship training at Children’s Memorial Hospital, Northwestern University, Chicago, Illinois, in pediatric anesthesiology. He is certified by the American Board of Anesthesiology. Alistair Phillips, MD, Attending Surgeon, Department of Pediatric Cardiothoracic Surgery at Columbus Children’s Hospital. Assistant Professor of Surgery at The Ohio State University College of Medicine. Dr. Phillips received his medical degree from Columbia College of Physicians and Surgeons in New York. After completing his residency, he received fellowship training at New York Presbyterian/Weill Cornell, Memorial Sloan Kettering Cancer Center, and Children’s Hospital of New York. He is certified in both Surgery and Thoracic Surgery. Pamela Ro, MD, Clinical Assistant Professor of Pediatrics of the Columbus Children’s Heart Center and The Ohio State University College of Medicine. Dr. Ro received her medical degree from Northwestern University. After completing her residency at Children’s Hospital of Pittsburgh, she received fellowship training from Children’s Hospital of Philadelphia. She is certified in both Pediatric Cardiology and Pediatrics.

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THe HeA rT C enT er

Te am (co nti nue d)

Daniel Rowland, MD, FAAP, FACC, Director of Echocardiography at the Columbus Children’s Heart Center. Associate Professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Rowland received his medical degree from University of Rochester. After completing his residency at Medical University of South Carolina, he received fellowship training from University of Virginia, Charlottesville. He is certified in both Pediatric Cardiology and Pediatrics. Lawrence I. Schwartz, MD, Director of the Cardiac Intensive Care Unit and Assistant Professor of Pediatric Anesthesiology and Critical Care Medicine at Columbus Children’s Hospital and The Ohio State University College of Medicine. Dr. Schwartz received his medical degree from University of Pittsburgh School of Medicine. He completed his residency and received fellowship training at John’s Hopkins Hospital in Baltimore, Maryland. He is certified in Anesthesiology, Pediatrics and Pediatric Critical Care. Randy Schwartz, MD, Cardiac Intensivist at Columbus Children’s Heart Center Dr. Schwartz received his medical degree from Jefferson Medical College at Thomas Jefferson University in Philadelphia. After completing his residency at Cincinnati Children’s Hospital Medical Center, he received fellowship training at Children’s Medical Center in Dallas. Dr. Schwartz is certified in Critical Care Pediatrics Christopher J. Sutton, MD, Pediatric Anesthesiologist at Columbus Children’s Hospital and Cardiovascular Anesthesiologist at Columbus Children’s Hospital Heart Center. Clinical Assistant Professor at The Ohio State University College of Medicine. He completed his medical degree, residency and a fellowship in critical care medicine at The Ohio State University College of Medicine. He then completed a fellowship in pediatric anesthesiology at Columbus Children’s Hospital. He is certified by the American Board of Anesthesiology. Douglas W. Teske, MD, FACC, Director of Preventive Cardiology, Quality Control and Outcome for the Columbus Children’s Heart Center. Assistant Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Teske received his medical degree from University of Iowa. He completed residency training at Columbus Children’s Hospital. He received fellowship training from Children’s Hospital of Buffalo. He is certified in both Pediatric Cardiology and Pediatrics.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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THe HeA rT C enT er

Te am (co nti nue d)

D. Alan Tingley, MD, MBA, Medical Director and Administrator, Children’s Surgery Center, and Chief of the Department of Anesthesiology at Columbus Children’s Hospital. Clinical Assistant Professor at The Ohio State University College of Medicine. Dr. Tingley received his MD from Southwestern Medical School and his MBA from Capital University. He is certified by the American Board of Anesthesiology. John J. Wheller, MD, Faculty Member at the Columbus Children’s Heart Center. Assistant Professor of Pediatrics and Obstetrics at The Ohio State University College of Medicine. Dr. Wheller received his medical degree from The Ohio State University. After completing his residency at David Grant USAF Medical Center, he received fellowship training from University of California. He is certified in both Pediatric Cardiology and Pediatrics. Peter Winch, MD, MBA, Pediatric Anesthesiologist Dr. Winch received his medical degree from the University of Cincinnati College of Medicine. He completed a Residency in Pediatrics at Pittsburgh Mercy Children’s Hospital, Pittsburgh, Pennsylvania, and became certified in Pediatrics. Dr. Winch received his MBA from the University of Pittsburgh, Katz Graduate School of Business. He then went on to complete an Anesthesiology Residency with specialization in Pediatrics at Strong Memorial Hospital before coming to Columbus Children’s Hospital.

39

CA ring

f or t h e wh o le f am ily.

Here, care is delivered with compassion and understanding. We know the diagnosis of a heart condition affects not only the patient, but also the entire family. Our family-centered approach to care involves and includes every member of the patient’s family. We also offer the support of social workers as part of each child’s interdisciplinary health care team. Our Welcome Center is one of the only patient programs of its kind to offer the Sleep Well, Get Well program, which is specially designed for international and out-of-town guests. Through the program, families from outside the central Ohio area receive a free hotel stay the night before any inpatient or outpatient procedure. In addition, the Welcome Center staff can assist families with everything from making clinical arrangements to helping find answers to insurance questions. We believe the well being of the entire family is critical to the success of our patients and yours.
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Physician Liaison Program
The Children’s Hospital Physician Liaison Program is a two-way communication channel, and one additional way Children’s is working better to serve physicians, their office staff and the community. Through personal office visits, written correspondence, telephone calls, faxes and e-mail, they provide a critical connection to Children’s Hospital. To speak with a physician liaison, call (614) 722-4585. We welcome the opportunity to discuss the needs of your patients in greater detail, including the many ways the Columbus Children’s Heart Center may be of assistance.

To arrange a consult or to refer a patient, please email us at heartcenter@chi.osu.edu or 1-800-792-8401.

The Heart Center at Columbus Children’s Hospital • www.columbuschildrens.com/heartcenter

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Columbus Children’s was recently named one of America’s best Hospitals by US News and World Report. More than anything, this most recent ranking validates the efforts we make each day on behalf of the families we serve. in addition, Children’s is the first freestanding pediatric hospital in ohio to achieve Magnet status for nursing excellence from the American nursing Association. Also, Children’s emergency services are ranked #2 in the united states, our cancer program is the largest in ohio, and the Children’s research institute is among the top 10 in the country for niH funding. To learn more about Columbus Children’s, we invite you to visit www.columbuschildrens.com

Out in front. By your side.

700 Children’s Drive • Columbus, Ohio 43205 • (614) 722-2530 • 1-800-792-8401 • www.columbuschildrens.com/heartcenter

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