Cedars-Sinai reports excellent outcomes for its cardiac surgery division

LOS ANGELES (August 18, 1999) -- Cedars-Sinai Medical Center's heart surgery division - the only program of its kind in Southern California to be ranked among U.S. News & World Report's top 50 in the nation - recently released its 1998 statistics and sixth annual report card. According to the data, the division continues to have excellent outcomes despite the fact that it serves the highest-risk populations based on patient age and medical condition.

The largest private hospital west of the Mississippi River - and the only one ranked in the U.S. News top 50 for cardiac surgery - Cedars-Sinai began recording heart surgery patient information when the cardiothoracic program was launched in 1969. Theirs is the oldest long-term outcome database in Southern California.

"Because we are very concerned about long-term outcome, we follow patients forever after surgery," said Alfredo Trento, M.D., chairman of the division. He said Cedars-Sinai's is one of a very few centers that voluntarily measure and publish their data, even making it available on the Internet. Over the years, the systems to track, record and analyze information have become more sophisticated as hardware and software have improved. Today's database includes information gathered during every stage of a patient's care - from the preoperative history and physical to long-term follow-up. While the database is critical in assessing outcomes and trends, it also provides vital patient information on a day-to-day basis, immediately available to the decision-making medical team.

The cardiothoracic division includes programs in such specialty areas as coronary artery bypass grafting, heart valve repair and replacement, heart transplantation, lung transplantation, minimally invasive cardiac surgery, and pediatric cardiac surgery. Excellent outcomes continue to be seen throughout the division, as has consistently been the case since the program began.

In addition to presenting outcome statistics, the report card provides information on research and other activities taking place within the division. Over the past several years, for example, a program has been initiated to ensure that patients receive thorough post-operative education and medical therapy that will lead to even better results after discharge from the hospital. Also, Cedars-Sinai research efforts continue in many areas, including further refinement of heart valves and ventricular assist devices that provide potential transplant recipients with a "bridge to transplant" when a donor heart is not available.

"We have always had a mission to pursue the finest technical and medical care available, using techniques and technologies in existence or developing innovations to meet patients' needs," said Gregory Fontana, M.D., cardiothoracic surgeon and co-director of pediatric cardiac surgery. "All of the surgeons in this department have been pioneers in various areas of cardiac surgery," he said. "We feel that not only is it our interest but it's our responsibility to further pursue better outcomes while continuing to decrease morbidity with the surgeries we perform."

In determining its rankings of the nation's best cardiology and heart surgery programs, U.S. News & World Report, which published its ratings in the July 19, 1999 issue, took into account reputation, mortality rates, membership in the Council of Teaching Hospitals, availability of key technologies, surgical volume, the hospital-wide ratio of nurses to beds, and whether a medical center offers a trauma center. Cedars-Sinai's program ranked 12th in the nation and second in the entire state.

Since its beginning 30 years ago, the program has been on the leading edge of innovation:

• Surgeons in the pediatric cardiac surgery program were the first in the western United States to offer video-assisted thoracic surgery (VATS) for infants and children. The procedure allows surgeons to repair heart and vessel defects even in premature babies weighing only slightly more than a pound. Surgery is performed through 3- to 4-millimeter incisions using a 2.7-millimeter videoscope.

• Cedars-Sinai surgeons performed the first heart-liver transplant west of the Mississippi River.

• Cedars-Sinai surgeons specialize in various "levels" of minimally invasive cardiac surgery. In some procedures, such as VATS, tiny camera lenses, hand-crafted instruments and small incisions result in reduced scarring and fewer complications compared to open surgery. Another minimally invasive approach, called "beating heart" surgery, also reduces the risk of complications. Unlike traditional open-heart surgery, the heart is not stopped and the patient is not placed on a cardiopulmonary bypass machine. Surgery is performed on a beating, pumping heart.

• Because of a new technique called transmyocardial laser revascularization (TMR or TMLR) Cedars-Sinai surgeons can now treat certain patients who have coronary artery disease and severe chest pain but may not have the stamina to undergo a bypass operation or angioplasty. Without the need for a cardiopulmonary bypass machine, surgeons use a high-powered laser to create small holes in the heart and allow a better flow of blood to the heart muscle.

• Cedars-Sinai's is the oldest dedicated lung transplant program west of the Mississippi River, established in 1988. During the following 10 years, 77 single and bilateral lung transplants and one heart-lung transplant were performed.

• In 95 percent of coronary artery bypass operations, Cedars-Sinai surgeons use the internal mammary artery - the artery that provides the best chance of long-term survival. The experience and expertise of Cedars-Sinai's specialists - more than 13,000 bypass grafts have been performed since the program began - enables them to graft the artery that best suits the patient's needs. In comparison, some programs use the internal mammary artery in fewer than 50 percent of cases. In addition, Cedars-Sinai uses multi-arterial grafts, not just grafting from the legs, which increases the success and longevity rate of coronary artery bypass operations.

• Cedars-Sinai surgeons specialize in correcting defective heart valves. In fact, they often can repair a valve using a patient's own tissue, rather than replacing it with a mechanical device or a valve made from animal tissue. Whenever possible, repair procedures are considered a first option, but they are not the only option: Cedars-Sinai has long been involved in the development and use of replacement devices. For example, it was the second site in the United States to implant the St. Jude mechanical valve in 1978.

The surgeons and Cedars-Sinai scientists have continued to pioneer in the research and development of stentless valves that allow greater blood flow, the use of pig valves, cow pericardial valves, and homografts (the transplantation of human tissue). Cedars-Sinai surgeons also were among the first specialists in the western United States to use the Ross Procedure, which can be performed in adults or children, and addresses several problems that previously complicated the replacement of aortic valves. With the Ross Procedure, the diseased aortic valve is replaced by the patient's own pulmonic valve, which is replaced by a graft from human tissue. In a child, the "new" aortic valve continues to grow as the patient grows.

Copies of the 1998 report card may be requested by calling 310-855-3851. It also is available on the Internet at www.csmc.edu/cvs/.

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