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News for physicians from the

Bluhm Cardiovascular lnstitute

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NEW VALVE GUIDELINES

MEDICARE CERTIFICATION FOR

HEART TRANSPLANTATION

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 WELCOME
New Valve Guidelines Drive
Dear Colleague, Higher Standards of Care

This issue of Cardiovascular Revia,u covers exciting updates on our work in

the areas ofvalve disease, heart transplantation, cardiac catheterization and
A national con-imittee of experts including
women's cardiovascular health.
cardiologrsts, cardiac srlrgeons and cardiac
anesthesiologists recently published the
Our Center for Hearl Valve Disease stands aparl from other valve programs updated American College of Car:diology
because of our strong commitment to understanding ail aspects of vaive (ACC)/American Heart Association (AHA)
disease. We selected Naiini Rajamannan, MD, to direct the Center for Heart guiclelineslor the management of patients
Valve Disease not only because of her intemational visibility and ground- with vah'u1ar heart clisease. The committee
brealdng research in the development ofvalve disease, but also because of rvas chaired by Robert O. Bonow, MD. co-
her leadership. Our clinicians have incorporated into clinical care the new clirector ol the Bluhm Cardiovascular Institute
valve guidelines published by the American College of Cardiology and and chief ol the Division of Cardiology at
the American Hearl Association, including changes in the areas of disease Northwestern Memorial Hospital and the Max
management strategies, diagnostic criteria, thresholds for recommending and Lilly Goldberg Distinguished Professor of
surgery and referral considerations. We continue to advance surgical care Medicine at Northwestern University's Feinberg
in valvular heafi disease. Our cardiac surgeons repair 95 percent of mitral School of Medicine. The nerv gr-ridelines are
valves that a:-e referred for surgery. In addition, the majority of our patients available on the ACC and AHA Web sites (www.
experience no residual regurgitation following mitral valve repair. acc.org and www.americanhealt.olg).

Nofihwestem Memorial recently eamed Medicare approval for heart kans-
plantation after performing 15 heart transplants, including several medically
complex transplants, within a one-year timeframe with 100 percent survival.
To date, our team has performed 21 heaalt transplants while maintaining a
100 percent sun ival rate.
Our cardiac catheterization laboratory is one of the premier invasive cardi-
ology programs in the country Over the past 10 years, there have been no
cardiac deaths and no myocardial infarctions related to performing diagnos-
tic catheterization at Norlhwestern Memorial.
We are excited to announce the establishment of our new Center for
Women's Cardiovascular Health, which evolved out of the need to help
\\omen and ther physicians recognize their risks for cardiovascular disease
and to conduct gender-based research to improve teatments and outcomes.
Our cardiologists are committed to fomulating institutional evidence-based
protocols as guidelines for the care of women.
We hope you will find this issue of Cardiovascular Review informative and
heipful in practice. We look forward to collaborating with you as we con-
tinue to advance specialized cardiac care for patients who need it.
Regards,
The committee based the new gr"ridelines, which
are the first published since 1998. primarily
on peer consensus. beczruse r.vhile there was
a need for new guidelines. there was a lack of
rzrndomized controlled clinicai trials on which
to base them. There are an estimatecl 15 to 20
rnilliorr people with ralve disease. Fiiepelcenr
of the U.S. population has mitrtrl valve prolapse,
the leading cause of mitral legLLrgitation. Two
percent of the U.S. population has bicuspid aortic
valves. which can lead to either aortic stenosis
or aortic regurgitation. In addition, trs the U.S.
population ages, there is an increasing number
ol elclerlv patients presenti ng r.r,it h degenerative
aortic and mitral valve disease. Approrimately
95,000 surgical valve operations are perlormed
rn the Unrted States each year.
"Conducting clinical trials in valve disease is
not ensy because it is a mechanical problem and
a chronic process." says Dr. Bonow. "It is hard
to shor.v improvement in mortality with valve
inten entions unless patients are followed lor
a long time. The gurdelines in this case are an

W
RosERr O. BoNow, MD Plrnrcx M. McC,mrHv. MD
attempt to pull together what we kr-row based
on consenslrs opinion.''

Key changes to the guidelines were made in

Co-ornEcron the areas ol disease management strategies.
BruHu Canorovescuran INsrrruru Brullv Cenoror,lscuLan INSrrrurE

0N THE CoVER: Patrlck l\4. Mccarrhy, IrID, Nalini M Ralamannan, MD and Robert 0. Bonow l\4D

diagnostic criteria, thresholds lor recommending
surgery and referral considerations. In terms of
management strategy, the nes- _suideiines state
that in many situations there is no "correct"
management strategy and strongly recommend a
frank discussion with the patient about the risks
and benefits oltreatment options, which is crucial
in determining the best treatment p1an.
The new guidelines also include the standards
for echocardiography, which have been set by
the American Society of Echocardiography. "We
incorporated these standards into the new ACC/
AHA guidelines because we feel that quantilication
of valve disease severity is important for accurate
diagnosis and treatment strategies," says Dr.
Bonow. "The criteria adopted for use of echo help
to at least level the playing field in terms of how the
diagnosis is made. That's important because when
considering surgery for patients with valve disease,
we usually don't recommend surgery if the valve
"We chose un earlier stage of ventriculur
dysfunction, based on the systolic volume, to
recommend surgery because the chronic overloud
that results from mitral regurgitation cun lead
to heart failure."
disease is mild. However, surgery is often indicated
when a patient has severe disease, especially if it is
causing problems. So echocardiographic criteria
are crucial and must be standardized."
The thresholds for recommending surgery have
been lowered in many cases in the new guidelines.
The changes include patients with aortic stenosis,
mitral regurgitation and aortic bicuspid valve. The
1998 guidelines allowed for aortic valve replacement
in patients with aortic stenosis for three primary
indications: symptoms, evidence of left ventricular
dysfunction or patients with a stenotic valve who had
another indication for surgery such as a coronary
artery bypass operation. The new guidelines include
the above indications, but add that if the patient
has severe stenosis with no symptoms and normal
left ventricular function, and there is evidence that
the valve may progress rapidly over the course
of the next couple ol years, it is satisfactory to
recommend surgery.
866 562-3467
2A07
There were several key changes w'ith regard Providing the Best Patient
to mitral regurgitation. "We chose an earlier Care and Outcomes
stage of ventricular dysfunction, based on the At Northwestern Memorial
systolic volume, to recommend surgery because Hospital, the outcornes of
patients undergoing valve
the chronic overload that results from mitral and other cardiac surgery
regurgitation can lead to heart faiiure," explains are carefully monitored. The
Dr. Bonow. "Sometimes this happens even before charts on Page 4 show the
patients experience symptoms, which means operative rnortal ity for
that by the time they do experience symptoms, patients undergoing a variety
of valve operations since the
some may already have developed irreversible
left ventricuiar dysfunction, and it is now too
Bluhm Cardiovascular lnstitute
of Northwestern Memorial
late to expect a good outcome with mitral valve Hospitalwas formed in April
repair or replacement." The guidelines emphasize of 2004. In comparison are
the calculated predicted
monitoring left ventricular dysfunction in patients
mortality for each patient
with mitral regurgitation and recommend surgery
using the Society of Thoracic
when there is early evidence of left ventricular
Surgeons (ST5), EuroSCORE
systolic dyslunction. The left ventricular systolic and the Ambler score from
dimension is a good measure lor this. Circulation 2005.
Northwestern Memorial's
Another key change involving mitral regurgitation
observed mortality is better
is that in asymptomatic patients it now is considered than the benchmarks for
satisfactory to recommend surgery if the valve has all qroups by all measures
severe regurgitation demonstrated quantitatively by including patients
undergoing coronary artery
echocardiography and there is a 90 percent certainty
bypass grafting. Overall,
that the valve can be repaired successfuily.
patient rnortalities predicted
The new guidelines make a strongrecommendation by the risk calculations are
between 1.5 to nine times
for valve repair instead of replacement for severe
less likely to occur at
mitral regurgitation. Of the patients in the United Northwestern Memorial
States who require surgery for mitral regurgitation, as generally expected.
roughly 95 percent have valves that are potentially
repairable. About 50 percent of these patients
actually receive surgery to repair the valve. "That
matters because the mitral apparatus is a very
complicated structure that not only prevents
the valve from leaking but also contributes to
ventricular shape, volume and function," explains
Dr. Bonow. "So when the mitral apparatus is
disrupted and replaced with an artificial valve,
this can cause left ventricular dysfunction."
The new guidelines state that if the ventricle is
showing progressive signs of enlargement over
time, a lower threshold of left ventricular dilatation
is a satisfactory indication for surgery. 'Although
the left ventricle dilates in response to the volume
ioad as a compensatory mechanism to augment
systolic function, severe enlargement increases the
risk of heart failure," says Dr. Bonow.
CAR DI OVASC L]LAR R EVIEW
 Aortic Valve Replacement +,1- Other
Valve Guidelines in conjunction with their primary care
13.5.,
1Aak
ph.vsicians," says Nalini M. Rajamannan,
120h
100,,b
q.3q" MD. rvho recently was named director of
8oi; 1.8e, A new discussion in the guidelines is the Centel lor Heart Valve Disease and
6clc the management of the large number ol assistant professor of Medicine at the
4a/c

zoh
patients with bicuspid aortic valves ir'ho Feinber-e School. "Working as partners
0orb have associated disease of the aortic in managing these patients is the best
lsolaied AV Repla(ement AVR wifi CAB
in 09)1 (n = 68) root or ascending aorta. In many such \\.a]' to achieve optimal outcomes."
Procedure patients, the aortic enlargement becomes
r Norfiwesiem Memorlal obserued mortality
r 5T5 predicted
more of a problem than the valve itself.
EuroSC0RE
risk (Northwestern Memorial population)
"In these patients. one has to perform "Our teontwork upproach includes performing
Ambler predicted risk valve replacement plus aortic root repair echocardiogrums on every patient in the oper-
3bs:ryic€xpected: isolated AVR = 0.20i AVR wirh CAB = 0
or. hopefully. a valve-sparing aortic root ctting room, before discharge and periodically
repair," says Dr. Bonow. after disclturge. This allows ,ts to track our
Mitralvalve Repair +/- Other
results ttnd msintain our level of care,"
16!,"
'r49tr
The Center for Valve Disease
12.6,,;
I t10 10.3% Cardiac surgeons on the medical stalf at
10%
Northwestern Memorial repair 95 percent "We chose Dr. Rajamannan because of
gok

6% of the mitral valves that are referred for her research accomplishments in how
4% surgery. Northwestern Memorial surgical valve disease develops and how to slow
2a/o

00k
volumes have doubled in the past two years its progression as well as her advanced
Repai'. with CAB- AFAblaiion' predominately because of the surgical training in echocardiography. She has the
- 78)
1n
(n .45) (n = 92)
treatment of patients with valve disease. background and ability to pull together all
Procedure
These surgeons use a minimally invasive of the various people who see patients with
r Northweslern Memorial observed mortality
EurosC0RE approach with more cosmetically appealin-e valve disease and those who do research
Ambler predicted risk incisions lor appropriate candidates. "Our into a cohesive team," says Dr. Bonow. "We
*To
date - 5Ts does not calculate predicted risk for mitral valve repair
are not only focusing on excellent patient
teamwork approach includes performing
0bserued/expeared: MVR = 0.52; MVR with CAB = 0.27; MVR with
AF ablation = 0.1 0 echocardiograms on every patient in the care, but also research'and education so we
operating room, before discharge and can conlribute beyond our own patients
lsolated Coronary Artery Bypass (CAB) periodically after discharge. This allows to the greater community."
1ZYo1
us to track our resuits and maintain our
10%l
level of care." says Dr. Bonow.
New research initiatives include
8%l imagrng protocols integrating standard
60/o
2D echocardiography with advanced
4ah-
2cto 1.5"r "We work with patients in u consultative 3D echocardiography, MRI and CT to
0'lo
0.0qt I manner, in conjunction with their primary evaluate valve morphology, hemodynamic
lsolated tAB (n - 394)
Procedure care physicians. Working us partners in severity and left ventricular and left atrial
r Northwestern N4emorial observed mortality managing these patients is the best geometry and function. Surgical studies
r 5T5 predicted risk (Norlhwestern Memorial population)
way to achieve optimal outcomes." include development and evaluation
EuToSCORE
Ambler predicted risk
of new annuloplasty rings and repair
3bserued/expectedi lsolated CAB = 0 techniques. Northwestern Memorial
Northwestern Memorial provides a also has embarked on genetic studies
Gold. J. B. Society of Thoracic Surgeons National comprehensive approach to care of in collaboration with Northwestern
Database. September 26. 2006. www.sts.org/sections/
stsnationaldatabase/riskcalculator/ patients with valvular heart disease University and basic research in
Nashel S.A., Roques. F.. Michel. P, Gauducheau. E., from diagnostic clinical evaluation mechanisms of valve degeneration
Lemeshow. S., Salamon, R. European System for Cardiac
Operative Risk Evaluation (EuToSCORE). Eur J
and imaging to directing the treatment and calcification. Clinical trials in
Cardiothorac Surg. 2005 Jrnl'2'7(6):1129;. author reply options for these patients. "We work percutaneous aortic valve replacement
1129-32.
with patients in a consultative manner, treatments are planned for the future. r
Ambler, G., Omar. R.2.. Royston. P. Knisman.
R., Keogh, B.E.. Taylor, K.M. Generic. simple risk
stratificatiol nodel for heart valve surgery. Circulation
2005 l u\ 121 1 2(2):22-4 -31.

NORTHWESTF,RN MEMORIAL HOSPIT\t liEAtil [ii\,1]+ oRC

 Staff Biographies
William G. Cottl MD, is medical director
of the Advanced Heart Failure program
in the Bluhm Cardiovascular lnstitute of
Northwestern Memorial Hospital and
assistant professor of Medicine at Northwestern University's
Feinberg School of Medicine. He is board certified in internal
medicine and cardiovascular disease.
Dr. Cotts has experience with ventricular assist devices,
vasodilators, inotropel right heart catheterization and heart
transplantation. He has received six grants for multi-center
trials in medications for heart failure, valvular disease and
other cardiac diseases. His research initiatives include studies
of anemia, exercise, sleep apnea and natriuretic peptides in the
management and treatment of heart failure. He is a reviewer
for five leading medical lournals.
Jeffrey J. Goldberger, MD. is medical director
of the Cardiac Electrophysiology section at
Northwestern Memorial and professor of
Medicine at the Feinberg School. He is board
certified in internal medicine, cardiovascular disease and cardiac
electrophysiology. He is a fellow of the American College of
Cardiology and the American Heart Association.
Dr. Goldberger's research focuses on pacemaker and beta
blockertherapy in post-myocardial infarction patients, cardiac
parasympathetic effects in exercise and recovery vagus nerve
stimulation, catheter ablation for atrial fibrillation and device
therapy. He is an editorial consultant and abstract reviewer
for more than 20 medical journals. He also is on the editorial
boards of three major journals.
Jon S. Matsumura, MD, is a vascularsurgeon
on the medicalstaffat Northwestem Memorial
and associate professor of Surgery at the
Feinberg School. He is board certified in
general surgery and vascular surgery.
Dr. Matsumura has extensive experience in open and
endovascular treatment of aortic aneurysms, carotid artery
disease and stroke prevention. He is the first author of numerous
publications of endovascular procedures, and he is a course
directoi for multiple endograft and carotid stent courses.
He leads several national and international clinical trials to
study new treatments for thoracic aortic aneurysm, dissection,
abdominal aortic aneurysm and carotid stents.
866 661 a CARDIO\'.\SC
RECENT EVENTS
Mada A. Mendelson. MD, is medical director
of the {enter for Women's Cardiovascular
Heahh in dre BIuhm Cardiovascular lnstitute
of Northwestern Memorial Hospital and
associate professor of Medicine and Pediatrics at the Feinberg
School of Medicine. She is board certified in internal medicine
and cardiovascular disease. The 2006ACCF Heart
Valve Summit
Dr. Mendelson conducts research on heart disease during
Northwestern Memorial Hospital
pregnancy, heart disease in women and adult congenital
partnered with the American
heart disease. She is the founder and director of the largest College of Cardiology Foundation
program for the care of women with heart disease during (ACCF) to hold the 2006 ACCF
pregnancy, She also has been a national speaker on the Valve Summit in Chicago.
topic of cardiovascular disease in women to both healthcare The keynote speaker was Alain
professionals and the public, Carpentier; MD, PhD (pictured
above), who is known as the father
of modern nritral valve repair for
his pioneer work in the development
of tissue heart valves and mitral
Mark D. Morasch, MD, is co-director of
valve repair techniques.
the Thoracic Aortic Surgery program in the
Bluhm Cardiovascular Institute's Center for
Cardiovascular Conference
Vascular Disease and associate professor of
Vascular Surgery at the Feinberg School. He is board certified The 2007 ACCF HeartValve
in general surgery and vascular surgery and is a distinguished Symposium
fellow of the Society for Vascular Surgery. June 7-9,2007
Dr. Morasch has a strong interest in complex extracranial Boston
cerebrovascular arterial reconstruction as well as 'in Course Directors: David H.Adams,
treating complex aortic pathology, including thoracic and MD; Robert.0. Bonow, MD; Patrick
T.O'Gara, MD and Patrick M.
thoracoabdominal aneurysms. His research interests include the
McCanhy, MD
use of MR technology in atherosclerotic plaque characterization.
He has published 48 peer-reviewed manuscripts,26 textbook
chapters and seven online publications.
Nalini M. Rajamannan, MD
Nalini M. Rajamannan, MD is directorof the
Bluhm Cardiovascular lnstitute's Center for
HeartValve Disease and assistant professor
of Medicine at the Feinberg School. She
received her training at the Mayo Clinic and is board certified
in internal medicine and cardiovascular disease.
Dr Rajamannan has developed animal and in vitro models of valvular
heart disease. She currently is developing translational approaches
for valvular heart disease to clinical medicine and practice. Her work
has received many prestigious awards, such as the 0utstanding
lnvestigator Award from the Histochemistry and Cytochemistry
Society and the Junior lnvestigatorAward fromAmerican Federation
for Clinical Research. 5he also has grant support from the National
lnstitutes of Health and theAmerican HeartAssociation,
U L \R REVIEW
New Cardiovascular Guidelines
Help Ensure Appropriate Diagnosis
and Treatment of Women
Heart diseirse is the leadin-s cause of death ltrr'
\\'onlen in the Unrted States. Unfortr-rnatel1..
the number ol pro-urams addressing women s
cardirrr.ascular healtl'r does not reflect the gror,r,ir.rg
necd lbr diagnosis and treatment.
"Our Center tbr Wornen's Cardiovascr"rlar Health
evoh ed oftheneedtohelpworlen and theilprirr-ran'
or-rt
calc phi'sicians reco*rnize that u'omen are at lisk fbr'
caltliovascillar disease ancl to collect inlonlation
thr or-Lgh research so that \\ e call impror e treatment
and outcomes.'' sa1's Marla Mendelson, MD, medical
director oi- the Cenler lor Women's Carcliovascular
Healtli at North',r,estern Memorial Hospital and
assistant prol-essor olMedicine and Pediatrics in the
Dir.ision of Cardiolo-uy at Nolthn,estem Unir.ersitr's
Fcin bcr-r Schooi ol' Medici rre.
"With
the construction olthe ncu'Prentrce \\,'ornen's
Hosprtal and t1.re derelopment ol its related
women's health proglams. Northu estern \{er.norial
" sal s Dr. Rigolin.
is |ulther der elopin-s its \\:omen s health lbcus. sar s
Robert O. Bor.ror.r'. MD. co-director ol the Bluhrr-r
Cardiovascular Institute and chief ol the Division
ol Cardiolo-ey at Northwestern Memorial and the
Max and Lill.v Goldberg DistinguisheclProlcssor of
Medicine at the Feinberg Schooi. "\\'hen considering
\\'ol'ne11's health. heart disease needs to be a big
errphasis. So $ e are takin_s the opportrmitv to inte-srate
tire tu'o erou,ing programs and estabhshmechanisrlrs
to deal rvjth this rlajor n omen's health issue."
Cardiologists on the rnedlcal stall at
Northrvestern Memorial are committed to
lbrmulatin g institutional evidence-based protocols
as guidelines lbl patier,t care and edr-rcation. "B-v
developing protocols. \\/e can help lacilitate the
management olcardiovascular disease and ensure
that all ph-vsicians are treatin-e patients the same
\'vay." says Vera Ri-eolin. MD. associate ntedicetl
director of the Center for Women's Cardiovascular
Healtl-r at Northwestern Memorial and associate
professor ol Cardiology and l-ellorvship clirector
1br Cardiovascnlar Disease at the Feinbers Scl-roo1.
NOR'I H \\ [STERN \4 L]\I O R I \ I P I TI
"\\ ;- r, iint tL) make it easl lor pirr sicirrns n iro aLe
th; ilr-st coniact lor 1-emale petient: trr address
-.rt..:. r lr:u.tlar r-irk lactor':."
.\ neu set ol guidelines regardin_e primarr. and
s!'c(rndar\ pfevention in n.omen rii11 be leleased
in Febnrirrr ol 1007 throu-sh t1.re Amerrcan Heart
As-srrciiiti.rn irnd the An-rerican Colle-ue of Cardiolog .
"\\'e knotr there are difl-elences betu,een u'omen and
men ir-r diagnrrsis and tleatment for carcliovascuiar
disease." sals \Iartha Gulati, MD. MS. arssociate
rnetlicirl direct,-rr ol the Center for Wor.ncn's
Caldior :rscular Health at Northwestern Memorial
and a:si:tlurt plottssor of Preventive N'[cdicine and
Cardrologl' at the Feinberg ScJrool anci one o1'the
authors olthe neu, gurdelines. "lncorpolating these
guidelines ir-rto our protocols lvil1 ensure that uiomer.r
irre treated appropliately,"
The patient-care protocols also u'ill pror,'ide er
nrechanism to triage women to the best care
resoLlrce. "With our state-of-the-art diagnostic
and treatment modalities. we want to provide the
nrost etficient pfocess to rral<e sure patients obtain
the appropriate testing and diagnostic resources."
"lt"s inconcervablc that Cardiology alone will
rnake a big impact on sulvival ln rvomen with
cnldior ascular disease because the majority of
patients are not presenting lirrst to their cardiologist."
sa-v-s Dr. Rigohn. "They are presentin-u to their
gl,necologist or theil primar-v cale physician. We
need the inr,olvement oleverl,' practicc."
The Lrltiilate goai of physician collaboration in
dia-ur-rosin-ucardiovascular disease in rvomen ls to
prevelrt clisetrse n'henever possible and to cliagnose
it at the earlieSt stage. "We strive to communicate
and collaborate u.ith the referring physician ancl to
send the patient back rvith ollr recommer.rdations.
including prevention strate-eies tliat can be
in-rpiemented bi' the primarl, car:e phvsician or
gvnecologist"" sa1's Dr. Gr"r1ati.
Watclr ttpcomin-u issues of Cut tliot u.:cLrLl/' Rc,r'iL'l
for more information on \'vomen s calcliorascular
health at Nolthrvestern Memorial Hospital.
including -sender-based research initiatives.
I

Northwestern Memorialt
Catheterization Lab Outcomes
Are Better than Benchmarks
The cardiac catheterization laboratory
at Northwestern Memorial Hospital has
become one of the premier inrasile cardiology
programs in the country. Since 1993, it has been
under the directorship of Charles Davidson,
MD, medical director of the Center for
Coronary Disease at Northwestern Memorial
and professor of the dir.ision of Cardiology at
Northwestern University s Feinberg School
The incidence of mortality within the
B luhm Cardiovascular Institute fo llowing
PCI remuins exceedingly low (0.9 percent)
and compares favorably with putient
outcome datafrom the 233 clinicul research
trials (7.0 percent).
of Medicine. Both established and leading
technologies are utilized in the cardiac
catheterization laboratory. In addition,
numerous clinical research trials are ongoing
to evaluate new therapies lor the non-
surgical treatment of coronary and valr,ular
hearl disease.
Diagnostic cardiac catheterization and
percutaneous coronary artery intervention
procedures have doubled in volume within
the past 10 years while maintaining positive
outcomes in comparison to nationally
available benchmarks'. Specifically, in the
past 10 years, there have been no cardiac
deaths and no myocardial infarctions
(MI) related to the performance of
diagnostic catheterization; there has been
approximately a one in 1,000 incidence of
vascular complications, which is in contrast
to the American College of Cardiology
(ACC)-National Data Registry, which
noted four in 1,000 patients. With regard
to neulological events (i.e. stroke, transient
ischemic attack), the Bluhm Cardiovascular
Institute's results (0.04 percent) remain
favorable compared to the ACC National
866-662 8457
JANUARY 2OO7
Data Registry (0.07 percent). Cardia< Catherization Volume
With percutaneous coronary artery
Diaqnostic Cardiac Catherization
intervention @CI). the Bluhm Cardiovascular (Dx Calh) and Percutaneous Coronary
Artery lntervention (PCl)
Institute remained farorable w-hen compared
3,500
to nationaliy available benchmarks. Outcome I
3,000
]
highlights include a mortality rate of 0.2 2,5001
percent, compared to the ACC Nationai o
2,000
1,500
1
Data Registry at i.4 percent, and the National ! 1,000
E
Heart, Lung and Blood Institute flrrHLBI) at z 500
0
1.9 percent. The need for emergent coronary 996 2000 2005
1
Year
artery bypass surgery due to unsuccessful r Dx Cath
PCI was 0.2 percent, which remains below PCr
the ACC (1.9 percent) and NHLBI (1.5
percent); MI following PCI is 0.2 percent at Diagnostic Cardiac Catherization
Complications
the Bluhm Cardiovascular Institute, while the 0.s%
ACC National Data Registry (3.1 percent) 0.43y"
E 0.4"/"
and NHLBI (2.8 percent) observed a higher
o!
o:x
incidence of orcurence. E 0.2o/o
F
Lastly, the outcomes of patients presenting 0.1%
to the Bluhm Cardiovascular Institute 0.0%
undergoing PCI for acute MI have
Potential Compli€ations
been compared to a study of combined ' Northwestern Memorial Hospital
outcomes fuom 233 clinical research ,, American College of Cardiology
trials'?. The incidence of mortality within
the Bluhm Cardiovascular Institute Percutaneous Coronarv Arteru
lntervention Complicitions'
following PCI remains exceedingly low 3,50/o
(0.9 percent) and compares favorably with . 3.0%
F 2.5qo
patient outcome data from the 233 clinical
J 2.0"/,
research trials (7.0 percent). ? t.s'/"
g 0,1%
The incidence of stroke and subsequent & 0.5% 0.2y"
MI including aortic closure for this 0.00/o
lvlortality
patient population also remains favorable Potential Complications
compared to the 233 clinical trials. Bluhm r Northwestern lviemorial
American College of Cardiology
Cardiovascular Institute outcomes also i National Heart, Lung and Elood Institute
demonstrated that the combined major
cardiac adverse events (i.e. mortality, Percutaneous Coronaru Arteru
lntervention Presentaiion of
MI, stroke) following PCI for acute MI is Myocardial lnfarction Complications
approximately half of that reported in the 9o/o
80/,
series of 233 combined research cliirical g 10k
trials (8.0 percent). r
E rq"
1 ? 4"/"
Compared Northwestern Memorial Hospital s Bluhm
Cardiovascular lnstitute clinical outcomes data to fi tv"
outcomes data from the American College of Cardiology
1o/o
(ACC)-National Cardiovascular Data Registry (1999); 0%
Nationa Heart, Lung and Blood Institute Registry (NHLBI)
on Percutaneous Coronary Artery lntervention (2000);
and to a study of combined outcomes from 233 clinical
research trials (Keeley, et al. Lancet 2003;361: ll-20).
z(Keeley, et al, Lancet 2003;361: 13-20)
DIOVASCULAR REVIEW
7

''\\ ir-e n e hoped fbr 00 percent sr-u'r ir ai. :rch ier ir-ig
1

th.: t-.iiestone is;rn attributiort trr the cr.rtt.LnLitntetti

Northwestern Memorial
Hospital
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or referrals, please call
Northwestern l\4emorial
Hospital's toll-free heart line at
866-NM-CVTNST (856-662-8457).
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AWARD.WINNING
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Additional information about
the Bluhm Cardiovascular lnstitute,
including a Iisting of physicians
and other caregivers, can be
found at heart.nmh.org,
Northwestern Memorial
Receives Medicare Approval
for Heart Transplantation
The Blr-rhm Calcliovasculirl Institute ol
Northu,ester n Memorial Hospital's Center lor
Heart Failure recentl)' ealned Nledicare applor.al
fbr heart tlansplantatior-r. making it one ol onlr
live hospitals in Illirrois to have been au.ardecl
the status. This means that Medicare patients
now ri,ill be able to receive services fl'om rnitial
evaluation through heart transplantation r'vithor-rt
leaving Northwestern Merrorial.
To c1ate. l7 successtirl heart trar.rsplants have
been achielecl uith a 100 percent survir,al rate.
Nolthr.r,ester n Memoriai's heart transplant
progfarn exceeded the Medicare requilements ol 12
transplants irr a 1,ear and a 73 perce[t slLrvival rate.
;l.l ski.i trithe team."" sa1's John B. O'Cr.rtnel1. \{D.
.lilectoi oi the Bluhm Cardior.ascnlirl Lrstitute's
Ce nter ioi Heart Failure at Nolthn e ste rn \lerrorlal
lrnrl p1.ris55or o1- Medicine at Nolthuestern
Unirer'.;tr s Feinberg School of N{eclicine.
"Tlierc- ilre Irlnes \\'he1r transplantation is the
onlv n.iedical pptron." sa1,s William Cotts. NID.
nredicirl direct,-rr ol the Bluhm Cardiovascr-i1at'
Institnre's .\dranced Heart Failure progran at
\orthuestern Memorial and assistant proiessor
ol Medicine at the Feinberg School. "It is an
underi.rtilizecl option for-candidates and a valuable
and u'orthr.r,hile therap.v that clrasticall,v'. can
ilnprove ther c1r-rality of lil'e."
T1-re rerlarkable archievements ol the
Nolthsestern Memotial pro-elam recentiy were
celebrated b1'the medical team at tl-re Center for
Heart Firilule and its heart transplant recipients.
"The snccess olthe healt transplant program is a
resnlt crlmnch more than one person." says Edwin
\IcGee. Jr.. N'ID. surgical director of the Bluhm
Cardiovascular Inst itute's Advanced Heart Failure
pl'ogran'l at Northwestern Memorial ar-rd assistar-rt
lrrolessor olSurgcrl'at the Feinber-e Scl-rool. "We
l.iave an ertraordinary team of prol-essronals liom
nllrses to social rvorkers and everl'one in betu.een
lvho are integral to positive patient r)utcolrcs."
Out ol the r.rearl,v 130 U.S. heart transplar.rtation
programs. only 53 percent met the Centers fbr'
Medicaid and Medicare Services critelia in 1005.

Cardiovascular Review is published by the Department of Communications, Division Northwestern Memorial Hospital
N01 iia:i ct5.
of Public Relat ons, IVarketing and Physician Services, Northwestern Memorial Hospital 25,I East Huron Street !.5. PaSlCE
PAID
ED T0Rs Dawn Martin, Jennifer Ecklund-Johnson Chicago, lL 6061 1 -2908 TH CAGO, L

DESIGNERS: Martin Austin, Charles Greiser

PHoToGRAPHY: Maria Corley (Cover and Pages 5 and 8), MoVCO (Page 5-events)
DIRECTOR OF CON,4IMUNICATIONS: BONitA BTOdt

DIRECToR 0F THE BLUHI\1 CARDIoVASCULAR INSTITUTE; Susan Campbell, RN, MBA

Northwestern lVemorial Hospital is a community of caregivers who welcome,

respect and serve with dignity all people without regard to race, color, gender,
national origin, religion, disability, age, veteran status or sexual orientation.
To arange forTDD/TTY auxiliary aids and foreign language interpretation
services, callthe Patient Representatives Department at 312-926-3112,
TDD number 3'1 2-944-2358.

O.lanuary 2007. Nanhwe$ern Memorial Hospital.

For more iniormat on about Nodhweltern Memor al Hosplta , please vieit www nmh.oro
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