5
YEARS Five Years of Significant Growth Five Stories of Changed Hearts
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HEARTS
THE HE ART INSTITUTE
2013 Report of Accomplishments
The First Five Years DEFINED BY GROW TH, INNOVATION AND QUALIT Y IMPROVEMENTS
In 2008, the Heart Institute at Cincinnati Children’s Hospital Medical Center set out to do something remarkable — to transform the diagnosis and treatment of pediatric heart disease through the integration of clinical care, molecular cardiovascular research and education. The goal was to revolutionize outcomes for children with heart disease. That remarkable vision is being realized each day.
The Heart Institute is led by David L.S. Morales, MD, Jeffrey A. Towbin, MD, and Jeffrey Robbins, PhD.
With a family-first approach, the last five years have seen the creation of 16 new clinical programs, novel research discoveries and new safety and quality improvement initiatives. Together, these developments have helped catapult the Heart Institute into the top five in Cardiology and Heart Surgery in U.S. News and World Report’s 2013-14 Best Children’s Hospitals rankings as well as top three in heart care in Parents magazine’s 10 Best Children’s Hospitals survey. The Heart Institute’s focus on quality and safety improvements, clinical programs and translational research is illustrated through impressive outcomes and volume data. But the real testament to the vision of being a change agent for pediatric cardiovascular medicine comes from the patients themselves.
Here we will highlight five years of significant growth, five changed hearts in the last year and a top five ranking. The Heart Institute has come a long way in the last five years, but there is a lot more to do to continue improving the health of children and young adults.
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VITAL STATISTICS
OUTPATIENT VISITS
CARDIAC INTENSIVE CARE UNIT PATIENT DAYS
9,163
FY09
FY09
10,740
FY10
FY10
11,928
FY11
FY11
13,384
FY12
14,196
FY13
CARDIAC MAGNETIC RESONANCE IMAGING
525
FY11
658
FY12
FY12
729
FY13
CARDIOVASCUL AR GENETICS PATIENT VISITS FY09 FY10 FY11
6,015 6,550
FY13
FY10
FY11
4,530
FY12
FY09
336
FY10
3,863
PEDIATRIC / ADULT ECHOCARDIOGRAMS
318
FY09
3,149
8,366 9,293 10,276 11,516
FY13
12,581
INTERNATIONAL REACH
In the past five years, Cincinnati Children’s Heart Institute treated patients from 40 countries (in blue).
0 35 434 948
FY12
1,115
FY13
CARDIAC CATHETERIZATION CASES FY09 FY10 FY11
405 428 548
FY12
678
FY13
687
Fiscal year (FY) notations throughout this report represent July - June data.
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Continuous Quality Improvement The Heart Institute’s goal is to be the safest program that achieves the best outcomes while providing cutting-edge care. Cincinnati Children’s is an international leader in improving patient safety, management, value of care and quality of outcomes. The Heart Institute has embraced these initiatives by developing safety and quality initiatives of its own. These efforts focus on critical metrics such as surgical mortality and morbidity, infection rates in the cardiac intensive care unit, readmission rates, patient wait time in clinics and overall patient satisfaction with care. These and other metrics are tracked serially so that areas that do not meet standards can be quickly identified, allowing the Heart Institute to make interventions aimed at improvement on a real-time basis.
QUALIT Y AND SAFET Y
Rates of major catheterization lab complications, ventilator associated pneumonia days and rates of catheter-associated blood stream infections, which are among the lowest reported CATHETERIZATION L AB COMPLICATION RATE
FY13
1.3%
CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS PER 1,000 CATHETER-DEVICE DAYS
FY13
1.15
Discharge Improvements Discharge of children and adults with congenital and acquired heart disease requires complex education, care coordination and disease surveillance. Deficiencies in hospital-to-home care transition quality have been linked to high medication error rates, lack of appropriate follow-up and information transfer, and higher readmission rates. To improve the care and services delivered to these patients when discharged from an inpatient setting, the Heart Institute is developing parent-focused videos on topics such as wound care. In addition, a discharge checklist was developed, and is visible to families and nurses in each patient’s room, that provides a list of the specific discharge actions that need to happen before the patient goes home. Our goal is to contact 100 percent of our patients with a follow-up phone call within 2-3 days of discharge to identify any unmet needs or family concerns, to support a smoother transition to home for patients and families, to better prepare each family to care for their child at home, and ultimately to allow patients to stay at home and prevent hospital readmission. 4
VENTIL ATOR ASSOCIATED PNEUMONIA PER 1,000 VENTIL ATOR DAYS
FY13
0.61
Dedicated Single Ventricle Interstage Clinic While outcomes with available treatment options have improved, single ventricle defects, such as hypoplastic left heart syndrome, remain one of the most challenging congenital heart lesions to manage. The interstage period between the first heart surgery and Bidirectional Glenn/comprehensive stage II palliation remains a high risk period for these infants, with mortality estimated between 10 to 15 percent. In August 2012, the Heart Institute created a dedicated Single Ventricle Interstage Clinic led by Haleh Heydarian, MD, to establish a standardized multidisciplinary approach to optimize care coordination during the interstage period and ultimately decrease associated morbidity and mortality. In the last year, the Interstage Clinic has had a 100 percent survival rate of neonates in the interstage period. The Heart Institute’s Interstage Team of four cardiologists, a nurse coordinator, two cardiac nutritionists, a speech therapist and a social worker is able to provide a broad, multidisciplinary management plan for these high risk infants. For example, the clinic has successfully addressed the nutritional challenges of these babies, achieving improved growth during the interstage period. In addition, interstage patients participate in Interstage Clinic patient Hudson daily home monitoring of weight and Demartini, age 4 months, celebrates oxygen saturation. Since establishing his graduation from the interstage the clinic 15 months ago, 25 patients period with a custom made cap and have been followed serially during gown. The Interstage Clinic celebrates their interstage. To date, 18 babies this milestone with a graduation have successfully celebrated their celebration for all patients. “graduation” from the interstage period by undergoing Bidirectional Glenn surgery, with several other children awaiting their next surgery. Utilizing quality improvement methods, the Interstage Clinic is continuously improving the care and outcomes of infants with single ventricle defects.
SURGICAL HIGHLIGHT
Delivered at an outside hospital, an infant boy was diagnosed with hypoplastic left heart syndrome and mixed total anomalous pulmonary venous return. The parents were told that their newborn was unlikely to survive his life-threatening heart condition. Three hours after birth, the infant was transported to Cincinnati Children’s, where his exact heart defects were quickly delineated by the heart team, and he was resuscitated. David Morales, MD, Chief of Cardiothoracic Surgery, took the infant to the operating room and performed a Norwood procedure and total anomalous pulmonary vein repair, a rare combined procedure, in order to palliate his disease. The infant successfully recovered and was discharged home. During the interstage period, the child received a balloon dilation of his pulmonary veins in the cardiac catheterization lab, followed three months later by a successful transatrial sutureless pulmonary vein repair and Bidirectional Glenn operation. The child, who is now healthy, just turned 1 year old.
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BROOKLYN MERTENS After diagnosing severe heart defects in utero, specialists at Cincinnati Children’s put into place a birth plan for Magdelen Mertens and her unborn baby, Brooklyn. Brooklyn’s heart disease consisted of heterotaxy syndrome, double outlet right ventricle, transposed great vessels, an atretic pulmonary valve, discontinuous pulmonary arteries and obstructed total anomalous venous return. This combination of defects put Brooklyn at risk for dying within hours of birth. With a carefully coordinated plan devised by the Cincinnati Fetal Center, the Heart Institute’s cardiovascular critical care team, the Newborn Intensive Care Unit, the high-risk obstetrics service, the congenital heart surgery team and two anesthetic teams, Brooklyn Mertens was delivered directly in the Fetal Surgery Unit on Thanksgiving eve, 2012. Immediately after birth, Brooklyn was taken to the cardiac operating room with Dr. Morales and his team. Surgery was started on Brooklyn within one hour of her birth. Surgical interventions performed included repair of mixed total anomalous venous return, and the creation of central pulmonary arteries as well as a source of blood flow to her lung arteries with a Blalock-Taussig shunt. Brooklyn was discharged home just a few weeks after surgery and gained tremendous strength, which allowed her to undergo her second stage surgery, a Bidirectional Glenn procedure, in May, 2013 with no issues. Brooklyn celebrated her first birthday in November with photos of Cincinnati Children’s surgical and nursing teams proudly displayed.
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Surgical Volume and Outcomes HEART TRANSPL ANTS
CARDIOTHORACIC SURGERIES
320
FY09
331
FY10
2004 - 2008
415
FY11
457
FY12
509
FY13
OPER ATIVE MORTALIT Y
STS
FY13
Overall Mortality
3.5%
3.3%
30-day Mortality
NA1
1.1%
PROCEDUR AL MORTALIT Y
STS
FY13
Neonatal Norwood 2
16%
10%
Truncus arteriosus repair
5.4%
0%
9.7% (41%)
0%
7%
0%
1.9%
0%
2.8% (3.5%)
0%
2.7%
0%
TAPVR repair (with BT shunt) 3 Ebstein’s anomaly repair TOF repair 4 CAVC 5 repair (with TOF/DORV) 6 ASO/ASO with VSD repair 7
MORBIDIT Y
FY13
Post-cardiotomy ECMO 8
0.3%
Neurological Deficit at Discharge
0.3%
Renal Failure at Discharge Arrhythmia requiring Permanent Pacemaker
2009 - 2013
24 39
0% 0.8%
Not available (NA) All nine neonatal Norwood survivors have undergone Bidirectional Glenn shunts 3 Includes three Total Anomalous Pulmonary Venus Return (TAPVR) repairs with Blalock-Taussig (BT) shunts for FY13 4 Tetralogy of Fallot (TOF) 5 Complete Atrioventricular Canal Defect (CACV) 6 Includes two TOF/Double Outlet Right Ventricle (DOR) Canals for FY13 7 Arterial Switch Operation (ASO) / ASO with Ventricular Septal Defect (VSD) 8 Extracorporeal Membrane Oxygenation (ECMO) within 21 days of surgery 1 2
Data source: Internal reporting and the Society of Thoracic Surgeons (STS); STS data represents calendar year reporting, aggregated for last four years (2009 - 2012)
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Ventricular Assist Devices The Ventricular Assist Device (VAD) Program at the Heart Institute is one of the largest programs in the country.
Devices Available Short-term/transport support devices
Long-term support devices
E xtracorporeal membrane oxygenation • ROTAFLOW Centrifugal Pump • CentriMag® Blood Pump • Impella® • Aortic balloon pump • CARDIOHELP System •
•
Berlin Heart EXCOR® • HeartMate II® • SynCardia Total Artificial Heart and the SynCardia Freedom® Portable Driver • Jarvik Heart® • HeartWare® Ventricular Assist Device System
STATISTICS
UNIQUE PATIENTS WITH CARDIOMYOPATHY FY09
56
FY10
255 451
FY11
600
FY12
830
FY13
VAD IMPL ANTS IN THE L AST FIVE YEARS ( FISCAL)
VAD IMPL ANTS
Berlin Hearts
12
HeartMate II
2
HeartWare 1
FY13
SURVIVAL TO DISCHARGE
SynCardia 2 ROTAFLOW 6
15
FY13
92%
“Our mission is to provide each child with the best mechanical circulatory support for their size and particular type of heart failure as well as care for those children who were thought not to have options or hope.” Angela Lorts, MD, Director, Ventricular Assist Device Program
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TIERNEE GONZ ALEZ When her transplanted heart developed end stage heart failure leading to multi-organ failure, the VAD team at Cincinnati Children’s concluded that Tiernee Gonzalez, age 19, was too ill to wait for an organ to become available for another transplant. The VAD team determined her only option for survival was a total artificial heart. Following an 18-hour surgery that removed her heart and implanted in its place the SynCardia Total Artificial Heart, she became the first female at a children’s hospital to receive a total artificial heart. Last spring, Cincinnati Children’s received compassionate care approval from the FDA to transition Tiernee from the large, wheeled power supply of the total artificial heart to the portable Freedom Driver. She was discharged from the hospital in May. Fewer than 50 patients in the U.S. have been discharged home with this device. The Freedom Driver allowed Tiernee’s artificial heart to function and for her to be discharged until another heart became available. This past December, Tiernee underwent another successful heart transplantation at Cincinnati Children’s after 414 days on the total artificial heart.
“We have software and technology that allow us to virtually recreate surgeries such as the SynCardia Total Artificial Heart from magnetic resonance imaging and computed tomography scans. Because the pediatric population comes in many different body types, body sizes and body shapes, this software allows us to virtually place the total artificial heart in their chest cavity and determine if it’s going to fit.” Peace C. Madueme, MD, Assistant Professor of Pediatric Cardiology, Heart Institute and Cardiac MRI Program
The 3D virtual reconstruction of the SynCardia Total Artificial Heart was used to determine if the total artificial heart would fit into Gonzalez’ chest.
Extracorporeal Membrane Oxygenation Transport Expansion to extracorporeal membrane oxygenation (ECMO) transport highlights the Heart Institute’s commitment to the broadest range of circulatory devices anywhere in the country. The Heart Institute further expanded its already extensive mechanical circulatory support offerings this year by adding ECMO transport for children and young adults. The addition of ECMO allows for the transfer of critically ill patients, by ground or air, to Cincinnati Children’s from anywhere in the United States or international centers. The ECMO program provides transport services and access to care for the most fragile children — care that they cannot receive elsewhere. The Heart Institute has one of the only programs in the country that will provide third-party ECMO transport from outlying centers to an institution other than Cincinnati Children’s. This addition gives hope to a multitude of centers that are caring for patients in severe cardiopulmonary failure who have exhausted local resources. The addition of mobile ECMO highlights the Heart Institute’s commitment to offering a broad range of circulatory support devices for pediatric and young adults, regardless of their size or type of cardiac and/or pulmonary failure.
PATIENT HIGHLIGHT
One of the first patients with Duchenne Muscular Dystrophy (DMD) in the U.S. to receive a Left Ventricular Assist Device Last spring, Cincinnati Children’s Comprehensive Neuromuscular Program referred Susie Arroyo, a female patient with DMD, to the VAD clinic for evaluation because of her progressive heart disease. Susie had severe heart failure and was extremely ill. She had been unable to eat, had trouble breathing and was unable to concentrate despite optimal medical management. Susie was implanted with a HeartWare Left Ventricular Assist Device in March and was able to return home to Oregon
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in May. Her care is now shared between her home cardiologist and the destination/VAD clinic. Medical therapies used in the Heart Institute’s Heart Failure/VAD Clinic offer the most complete cardiovascular care for patients with DMD of anywhere in the country. These options include optimization of pharmacologic therapy, biventricular pacing, internal cardioverter defibrillator placement and implantation of a ventricular assist device, if the patient has failed medical management.
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ALE X WELLS Born at 28 weeks gestation and weighing 1.1 kilograms, Alex Wells was diagnosed with a narrowed aortic valve at another hospital. Because of his cardiac defect, prematurity and small size, his mom, Jessica, was told he had little chance of survival. Alex was then transported to the Cincinnati Children’s Newborn Intensive Care Unit, where his diagnosis was broadened to include a malaligned ventricular septal defect (VSD) along with narrowing of the left ventricular outflow tract and severe narrowing of the aortic arch. In the setting of his extreme prematurity, small size, and complex congenital heart disease, the standard surgical approach to his disease would have proven deadly. Instead, Heart Institute physicians David Morales, MD, Chief of Cardiovascular Surgery, and Bryan Goldstein, MD, Assistant Professor of Pediatrics, Cardiac Catheterization and Intervention Program, opted for a less invasive surgical strategy. The pair chose to perform a Hybrid Stage I procedure, combining surgical and transcatheter approaches to complete the initial palliation without use of cardiopulmonary bypass, thereby reducing the risk of neurologic injury. Alex thrived post-operatively and was able to undergo a complete biventricular operative repair at 8 months of age. Nearing 1 year of age now, Alex continues to thrive, without evidence of significant sequelae either from his extreme prematurity or his need for early cardiac surgery. Drs. Morales and Goldstein are currently authoring a paper on Alex’s case, as he is the smallest patient found in literature to have undergone a Hybrid Stage I procedure.
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Adult and Adolescent Congenital Heart Disease Program The Adult and Adolescent Congenital Heart Disease (AACHD) Program added two adolescent transition physicians this year to help patients with congenital heart disease (CHD) make a more seamless transition from pediatric to adult care. The Heart Institute’s AACHD team is now comprised of five physicians dedicated to these patients. Complemented by fetal echocardiographers, the AACHD team is partnering with area maternal fetal medicine specialists to provide holistic care for pregnant patients with CHD as well. The AACHD team has over 50 years of experience treating adults with CHD.
The AACHD team has over 50 years of experience treating adults with congenital heart disease.
Beginning next year, Gruschen Veldtman, FRCP, MBChB, Director of Inpatient AACHD Services, will implement a Fontan program with the mission to improve comprehensive care for patients needing a Fontan procedure, including those with involvement of multiple organ systems outside of the heart. The new program will integrate expertise from non-cardiac subspecialty areas including pulmonary medicine, hepatology, radiology, hematology, vascular surgery, gastroenterology and nutrition, cardiac rehabilitation and clinical psychology. The new program will also integrate advanced heart failure services, including mechanical assist and transplant options when necessary for the patient.
A ACHD STATISTICS
PATIENT VISITS
FY09 FY10 FY11 FY12 FY13
12
TOTAL PATIENTS WHO HAVE UNDERGONE PROCEDURES
225
FY09
211
FY10
357
FY11
430
FY12
530
FY13
98 121 142 154 192
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DANIELLE FRITSCH Danielle Fritsch’s previous surgical tricuspid valve replacement, the result of Ebstein’s anomaly, was failing. The 27-year-old had been suffering for years with prosthetic tricuspid valve stenosis, resulting in severe exercise intolerance and a diminished quality of life, including difficulty working and keeping up with friends. She was told she would need another open-heart surgery to repair the valve, or possibly a heart transplant. She sought the advice of her AACHD physician, Gary Webb, MD, Director of the AACHD Program, who referred her to cardiac catheterization physician Bryan Goldstein, MD, Assistant Professor of Pediatrics, Cardiac Catheterization and Intervention Program. Dr. Goldstein proposed an innovative alternative: a Melody valve, commercially available for transcatheter pulmonary valve replacement, placed in the tricuspid valve position. He had performed the procedure in training for a patient in dire circumstances, but it would be the first such procedure at Cincinnati Children’s. Because the procedure was non-standard, Dr. Goldstein would have to use non-standard equipment for delivery of the valve, creating additional technical challenges and procedural risk. Danielle was also informed there was a risk the procedure might not work because of the large size of her existing prosthetic tricuspid valve, in which the Melody valve would be implanted. Danielle opted to take the risk. The valve implantation procedure was uncomplicated and function of the new tricuspid valve is excellent. She was able to avoid another open-heart surgery; her recovery time was just a few days (she was out of the hospital the day after the implantation procedure) and her quality of life is much improved. She is back to work and thriving.
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Center for Better Health and Nutrition Community outreach allows more at risk and obese children to get help The Heart Institute’s Center for Better Health and Nutrition (CBHN) last year took an innovative and comprehensive approach to childhood obesity by providing an in-school health and nutrition clinic. In collaboration with Cincinnati Public Schools, CBHN opened what is believed to be the first Level 3 in-school obesity clinic in the United States at Frederick Douglass Elementary School. The CBHN obesity clinic sees Frederick Douglass students who are referred with a Body Mass Index score at or above the 85th percentile, have rapid weight gain, and/or have health concerns related to obesity. The program expanded in November 2013 to the Norwood Public School system and encompasses the entire district and students of all ages.
CENTER FOR BETTER HEALTH AND NUTRITION PATIENT VISITS FY10 FY11 FY12 FY13
14
940 1,216 1,383 1,490
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JERRION TOLBERT WITH FREDERICK DOUGL ASS STUDENTS
Frederick Douglass Elementary School student Jerrion Tolbert, who was referred to the in-school obesity clinic run by the Center for Better Health and Nutrition (CBHN), gets his blood pressure taken and is evaluated by Robert Seigel, MD, Director, Center for Better Health and Nutrition. Each student referred to the program sees a physician, dietitian, exercise physiologist and nurse as part of the multidisciplinary treatment. The in-school model provides students convenient access to care and treatment, and the after-school focus is significant because that is when students often fall into unhealthy patterns: sugary drinks, empty calories and after-school screen time including TV and devices. In addition, the CBHN has promoted exercise and nutrition at the school by sponsoring breakfasts at tutoring sessions, a cooking demonstration and exercise equipment and training for the after school program.
Exercise Program Coordinator Christopher Kist, MS, discusses group exercise options with Mariah Jamison, age 10. Mr. Kist helps students like Mariah create goals for gym class, understand exercises they can do at home and finds out what students are interested in to keep exercise fun.
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Heart Institute-Kindervelt Neurodevelopmental, Education and Learning Clinic Research shows that children with complex heart problems are at a greater risk for neurodevelopmental, psychosocial and educational issues. Academic difficulties due to learning disabilities, behavioral issues and attention deficit hyperactivity disorder may result in negative long-term outcomes and impact quality of life. The Kindervelt Neurodevelopmental, Education and Learning Clinic within the Heart Institute offers a multidisciplinary approach to address the needs of these pre-school and school age patients.
The educational care team supports early identification and intervention to improve all aspects of psychosocial and neurological development.
The educational care team supports early identification and intervention to improve all aspects of psychosocial and neurological development. Education specialists work early and collaboratively with families and schools to develop individualized, comprehensive education plans and help obtain appropriate resources to address the academic needs of these children.
PATIENT HIGHLIGHT
Bobby Menner, a 7-year-old patient with DiGeorge syndrome and cardiac disease, was struggling in first grade, performing at a pre-kindergarten level in many areas. His guardians did not know how to address his school and behavioral difficulties and grappled to get school officials to recognize his developmental delays. After meeting with Gretchen Carroll, a school liaison educator in the Heart InstituteKindervelt Neurodevelopmental and Educational Clinic, Bobby, his family and school system developed
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an Individualized Education Program (IEP) with Ms. Carroll’s assistance. With her outreach to the school system, Bobby is now meeting regularly with specialists in the clinic to improve his developmental delays. His schoolwork and behavioral issues are improving. By early incorporation of educational specialists in the clinic, the Heart Institute is paving the way for academic success for children with heart disease.
Heart Institute Awarded Research Grants American Heart Association’s (AHA) Basic Research Prize awarded to three Heart Institute scientists The Heart Institute’s bench to bedside approach has been recognized in awards, funding and novel discoveries Jeffrey A. Towbin, MD, Heart Institute Executive Co-Director, was awarded the American Heart Association’s Basic Research Prize in November for his significant additions to the basic knowledge of cardiovascular disease in children. AHA President Mariell Jessup, MD, cited Dr. Towbin as an accomplished molecular pioneer in the fight to banish cardiovascular disease in children, noting that Dr. Towbin also helped to design and initiate the National Institutes of Health-funded Pediatric Cardiomyopathy Registry, the nation’s principal registry for young patients awaiting transplant. This award makes three for Heart Institute researchers. The AHA awarded its Basic Research Prize to Heart Institute Executive Co-Director, Jeffrey Robbins, PhD, in 2008, and Jeffery Molkentin, PhD, in 2012.
Significant Grants for 2013 Jeffrey Robbins, PhD, Program Project grant Title: Signaling Processes Underlying Cardiovascular Function Direct costs: $1,706,890 each year for five years
Josh Waxman, PhD, R01 Title: Coup-tf Dependent Mechanisms of Ventricular and Hemangioblast Specification Direct costs: $225,000 each year for five years
Jeffrey A. Towbin, MD, R01 Title: Genetics, Mechanisms and Clinical Phenotypes of Arrhythmogenic Cardiomyopathy Direct costs: $1,858,137 each year for four years
Burns Blaxall, PhD, American Heart Association Title: Small Molecule Targeting of MLK3 for Heart Failure Direct Costs: $68,183 each year for two years
Stephanie Ware, MD, PhD, was awarded the AHA Established Investigator Award. The Established Investigator Award is to support mid-career investigators with unusual promise and an established record of accomplishments. Dr. Ware received $72,000 each year for four years for Genetic and Epigenetic Mechanisms in Cardiomyopathy. GRANTS FY09
$6.3 M $7.0 M
FY10 FY11 FY12 FY13
$5.8 M $6.5 M $7.7 M
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Heart Institute Significant Accomplishments in 2013 Innovative discoveries, clinics and training driven by bench to bedside approach Novel gene discovery could lead to treatment to prevent thickening of the heart muscle Jeffery Molkentin, PhD, and Jennifer Davis, PhD, were co-investigators on a study published in the premier scientific journal, Developmental Cell, that shows that a novel gene, TRPC6, promotes cardiac fibrosis and disease by assisting in the conversion of fibroblasts into myofibroblasts. Drs. Molkentin and Davis showed that mice lacking TRPC6 had defective generation of myofibroblasts, which lessened the fibrotic response in vivo. The lab also showed how TRPC6 was activated in fibroblasts to begin this process, and identified how TRPC6 works to convert these cells into myofibroblasts. Their work suggests at least two novel nodal regulatory genes that could be inhibited with existing experimental drugs to have an anti-fibrotic effect, possibly reducing the progression of heart failure in select disease states. Heart Institute sets sights on becoming worldwide training center for pediatric mechanical circulatory support Mechanical circulatory support for children is an emerging and quickly changing field. Currently, no institute in the world has established itself as a training and resource center for the worldwide companies that create pediatric ventricular assist devices and total artificial hearts. The Heart Institute is poised to become this international reference center. The program has formed relationships with global companies interested in developing ventricular assist devices for pediatric patients. Many of these companies are leading the way in the development of new devices that can serve as bridges to heart transplant while patients wait for a heart to become available. These companies include SynCardia Systems, Inc., HeartWare, Thoratec, Berlin Heart, and Levitronix, among others. In the past year, the Heart Institute has trained physicians from Japan and South America. The Heart Institute’s surgical team will be the Primary Investigator and coordinating center for the first pediatric total artificial heart trial. The goal is to firmly establish the Heart Institute and Cincinnati Children’s as the premier worldwide training and pediatric center for mechanical circulatory support by the end of 2014.
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TRAINING AND RESEARCH
PEER-REVIEWED PUBLICATIONS
FACULT Y CONDUCTING RESEARCH
113
FY09
FY09
127
FY10
FY10
155
FY11
39
FY11
FY12
189
FY12
FY13
190
FY13
50 54 58 61
HEART INSTITUTE CLINICAL AND RESEARCH FELLOWS
FY13
14
Setting the Standard of Care 2014 conferences presented by the Heart Institute at Cincinnati Children’s Congenital Heart Disease in the Adult: An International Symposium
Pediatric Heart Failure Summit
June 10-13, 2014 in Cincinnati, Ohio Audience: Physicians and nurses interested in adult congenital heart disease
Audience: Pediatric cardiologists, nurses, critical care physicians and pediatric heart failure and transplant specialists
2nd Annual Aspen Conference on Pediatric Cardiovascular Disease
Cincinnati Clinical Exercise Testing and Therapeutics Symposium 2014
July 14-18, 2014 in Aspen, Colorado
March 8, 2014 in Cincinnati, Ohio
Audience: Pediatric and adult cardiologists, nurse practitioners and cardiology fellows
Audience: Clinical exercise and rehabilitation professionals, faculty, nurses and students
September 11-13, 2014 in Cincinnati, Ohio
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