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CardioVascular Institute at Beth Israel Deaconess Medical Center

A Decade of Advances in Cardiovascular Health

Robert E. Gerszten, MDChief, Division ofCardiovascular Medicine

Kamal R. Khabbaz, MDChief, Division ofCardiac Surgery

Our patients are our inspiration.

Recent years have seen remarkable advances in heart and vascular care. Breakthroughs in theunderstanding of cardiovascular disease—ranging widely from the identification of molecular mechanismsto the impact of lifestyle choices—have led to the development of powerful new diagnostics and therapies.

Never before have so many people with cardiovascular disease had so much opportunity to live longer,healthier lives.

Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School, has a proud legacy ofleadership in cardiovascular medicine, cardiac surgery and vascular surgery. In 2007, these three disciplinesformed the CardioVascular Institute (CVI) at Beth Israel Deaconess Medical Center (BIDMC). Thisconfluence transformed a tradition of informal collaboration into a tightly integrated, intentional family ofexpert healthcare providers and researchers.

Over the past decade, the CVI has pioneered exciting innovations in cardiovascular care, clinical research,medical education and scientific discovery. We maintain a steadfast commitment to analyzing clinicaloutcomes to ensure patients get the best care.

The CardioVascular Institute’s first decade has led to important advances in innovation, integration andoutcomes. Please turn these pages to learn more.

Cover Photo: Danielle Duffey

Marc L. Schermerhorn, MDChief, Division ofVascular and Endovascular Surgery

C O N T E N T S

2 Fast Facts 4 CVI Highlights 5 Our Legacy 7 Integration 12 Innovation 20 Outcomes 32 Meet Our Team36 Contact Us

10YEARSCelebrating

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Cardiovascular Medicine

Cardiac Surgery

Vascular and Endovascular Surgery

2007-2017

CardioVascular Institute Fast Facts

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A decade of collaboration at BIDMCCardiovascular MedicineCardiac SurgeryVascular and Endovascular Surgery

6 community hospital affiliationsAnna Jaques HospitalBeth Israel Deaconess Hospital–Milton*Beth Israel Deaconess Hospital–Needham*Beth Israel Deaconess Hospital–Plymouth*Lawrence General HospitalSignature Healthcare*BIDMC member hospitals

10 YEARS

76 physicians, surgeons andresearchers

404 nurses and advancedpractice providers

98 dedicated cardiovascularcare beds and 23 intensivecare beds

1,128 cardiac surgery cases

4,793 Cath Lab cases

2,299 Electrophysiology Lab cases

2,060 Vascular Surgery cases

35,403 CVI clinic encounters (3 divisions)

In 2016

Photo: Michael Fein

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U.S. News & World ReportTop “High Performing”recognition

Heart FailureHeart Bypass SurgeryAortic Valve Surgery

“Hospitals that earned a high performingrating were significantly better than thenational average.”

U.S. Centers for Medicare &Medicaid ServicesPatient Experiences Survey

Overall rating ofHospital ExperienceandWillingness toRecommend the Hospitalsuperior to state andU.S. averages

65 activeclinical trials following 699 PATIENTS

CardioVascular Institute Highlights

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• The CVI is a national leader in transcatheteraortic valve replacement (TAVR) andtranscatheter mitral valve replacementtherapies.

• The Division of Cardiac Surgery has attainedthe Society of Thoracic Surgeons’ top 3-Starrating for isolated coronary bypass graftingprocedures. Just 12%-15% of hospitals receivethis rating, denoting the highest category ofquality (see page 22).

• Clinical researchers in the Division of Vascularand Endovascular Surgery are developingnew technologies and evaluating minimallyinvasive repair of aortic aneurysms and lowerextremity bypass.

• The Richard A. and Susan F. Smith Center forOutcomes Research in Cardiology evaluatesthe effectiveness of clinical practice, therapiesand policies to advance cardiovascularhealthcare delivery in the United States.

• Genomics and metabolomics researchsupported by the National Institutes of Healthis identifying molecular changes underlyingexercise and physical activity, a first step inpersonalized cardiovascular medicine.

• Electrophysiologists are developing newapproaches for arrhythmia therapies,including ultraprecise ablation techniques andmodulation of the autonomic nervous system.

• Patient care services are continuouslyimproved through the use of LEAN principlesand Daily Management System.

• The Advanced Heart Failure program isBoston’s first non-transplant center toreceive advanced certification from The JointCommission as a Ventricular Assist DeviceDestination Therapy Center.

• The Cardiac Direct Access Unit is pioneeringa new care delivery model for urgentcardiovascular care.

• BIDMC’s clinical cardiovascular medicinefellowship program is the largest affiliated withHarvard Medical School.

• The Division of Vascular Surgery and theDivision of Cardiovascular Medicine arelong-standing recipients of National Institutesof Health T32 research grants to train thephysician-scientists of tomorrow.

• The CVI received U.S. News & World Report’stop “High Performing” recognition for heartfailure, heart bypass surgery and aortic valvesurgery.

1925Hermann Blumgart, MD, who served as chair of theBeth Israel Hospital Department of Medicine from1927 to 1962, is the first physician-scientist to useradioisotopes to diagnose cardiac disease.

1928New England Deaconess Hospital opens the nation’sfirst clinic to prevent and treat vascular complicationsof diabetes.

1930 Louis Wolff, MD, of Beth Israel Hospital is oneof three physician-scientists to describe a cardiacarrhythmia now known as Wolff-Parkinson-Whitesyndrome.

1942Howard Frank, MD, and Jacob Fine, MD, of BethIsrael Hospital highlight the value of venography forthe diagnosis of deep vein thrombosis.

1944New England Deaconess Hospital surgeon Leland S.McKittrick, MD, introduces new surgical techniquesfor limb preservation in diabetic patients with severevascular disease.

1952Cardiologist Paul Zoll, MD, surgeon Howard A. Frank, MD, and their Beth Israel Hospital team arethe first to use electrical stimulation to the chest torestore cardiac rhythm, leading to the development ofthe pacemaker and external defibrillator.

1972Beth Israel Hospital Chief of Vascular SurgeryEdward W. Salzman, MD, publishes a study on themechanisms of platelet aggregation that paves the wayfor the development of drugs that prevent blood clotformation after heart attack and stroke.

1984Dr. Salzman serves as editor of the first edition of theclassic textbook, Thrombosis and Hemostasis.

1984New England Deaconess Hospital vascular surgeonFrank LoGerfo, MD, advances surgical techniquesfor arterial revascularization of distal lesions due toperipheral arterial disease (PAD).

1992 Mark Josephson, MD, a pioneer in modern cardiacelectrophysiology, establishes the Harvard-ThorndikeElectrophysiology Institute and Arrhythmia Serviceat BIDMC.

1992-1993Richard E. Kuntz, MD, and a Beth Israel Hospitalteam publish studies that revolutionize theunderstanding of restenosis (narrowing) of coronaryarteries after stenting.

1995 Cardiac surgeons perform New England’s firstminimally invasive coronary bypass surgery without aheart-lung machine.

Cardiovascular medicine faculty lead pioneeringSTAND I and STAND II studies on devices forsuture-mediated closure of the femoral artery aftercardiac catheterization.

BIDMC’s Cardiovascular Legacy

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1996BIDMC opens one of the nation’s first atrialfibrillation clinics.

1997Faculty publish research on the effectiveness of active aspiration catheterization for removing bloodclots in coronary vessels.

Faculty publish research evaluating coronarybrachytherapy to prevent in-stent restenosis.

1998Beth Israel Hospital team mentored by Donald Baim,MD, publishes OARS and BOAT studies evaluatingstents and other devices for reducing coronaryatherosclerosis.

2000Faculty lead research in the safety and effectiveness ofcarotid stents.

2002Faculty publish research into devices that captureclots and other debris to improve the safety ofstenting coronary vessels and saphenous veins.

2007BIDMC launches the CardioVascular Institute.

2010Faculty provides national leadership of theCoreValve Pivotal Trial for transcatheter aortic valvereplacement.

BIDMC’s Cardiovascular Legacy

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2012CVI vascular surgery team publishes a pivotalstudy demonstrating the safety of treatingmost aortic aneurysms with ultrasound-guided endovascular techniques.

2013Vascular surgeons perform emergencysurgeries on critically injured BostonMarathon bombing victims.

Vascular surgeons are among thefirst worldwide to perform a complexendovascular intervention using the novelVesselNavigator intraoperative 3-D CT-fluoroscopy fusion imaging systemdeveloped in collaboration with Philips.

2014Structural Heart Center cardiologists andsurgeons are the first in the nation to implantan FDA-approved CoreValve aortic valve in a patient.

2016Faculty leads PIONEER trial, evaluatingmajor bleeding risk reduction in atrialfibrillation patients undergoing stenting forcoronary artery disease.

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Ten years of structuredcollaboration and a longtradition of close relationshipsamong colleagues in theCVI’s three divisions yieldsthe benefits of broadexpertise.

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Meet Our PatientMarie McIntyre, 81

Retired fashion model

Advanced aortic valve disease patient receiveda transcatheter aortic valve replacement (TAVR)

“I breezed through this procedure.My energy is off the charts!”

Photo: James Derek Dwyer

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STRUCTURAL HEART CONDITIONS WE TREAT

Aortic valve diseaseAtrial fibrillationAtrial septal defectCardiogenic shockCardiomyopathyMitral valve diseasePatent foramen ovalePulmonary valve diseaseTricuspid valve diseaseVentricular septal defect

VOLUMEThe CVI has performed more than500 TAVRs since 2011.70% of patients evaluated for severeaortic stenosis undergo TAVR.

BETTER PATHWAYSWe offer TAVR patients same-dayadmission, recovery in the post-anesthesia care unit and discharge in one to three days.

MITRACLIP

Our program offers the MitraClip device (pictured), which relieves thesymptoms of mitral valve regurgitation.

Structural Heart Center/Valve ProgramOur interventional cardiologists, cardiac surgeons and cardiacanesthesiologists collaborate to provide the state-of-the-art non-surgicalprocedures, multidisciplinary approaches and new medical devices thatare rapidly transforming care for structural abnormalities of the heartand great arteries.

Leadership. Faculty from the Structural Heart Center have provided—and continue toprovide—national leadership in clinical research leading to transformative, non-surgicaltherapies for severe aortic valve disease and mitral valve disease.

Therapies. The CVI offers patients a wide range of treatment options—both surgical andnon-surgical therapies for cardiac valve conditions.

Clinical trials. Trials currently underway at the CVI are evaluating transcatheter mitral valvereplacement (TMVR) systems and transcatheter aortic valve replacement (TAVR) systemsfor select populations.

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TAVR Volume

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Advanced Heart Failure ProgramOur Advanced Heart Failure Program is a strong collaboration betweencardiologists and cardiac surgeons who deliver the full range of care forpatients with all stages of heart failure. Our inpatient volume is among thehighest in New England.

Advanced certification. In 2013, the CVI became the first non-transplant center inMassachusetts to offer Ventricular Assist Device (VAD) therapy. Advanced certification forDestination Therapy VAD implantation was granted by The Joint Commission in 2017.

Transplant care. Our program maintains a partnership with a high-volume transplant centerand is distinguished by highly personalized follow-up care in our Advanced Heart Failure Clinic.

Outcomes measures. Our 30-day post-discharge mortality exceeds both national averages andthose of other Boston tertiary referral centers. We have consistently maintained a 30% reductionin our 30-day readmission rate since 2012.

Shock team. Our multidisciplinary team provides rapid, 24/7 group decision-making forpatients with cardiogenic shock and refractory respiratory failure.

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COMPREHENSIVE PRE- ANDPOST-TRANSPLANT CARE

Expert medical management by board-certified advanced heart failure cardiologistsAdvanced mechanical circulatorysupport including durablesupport, extracorporeal membraneoxygenation (ECMO), Impella,percutaneous VAD and surgical VAD

HEART FAILURE CLINICAL TRIALSParticipant in key national studies on:

Impact of novel therapeuticsImplantable and external devicesImpact of novel treatment strategies on patient outcomes and quality of life

HIGHEST LEVEL OF RECOGNITIONTop quality award in heart failure carefrom the American Heart Association

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HEART FAILURE 30-DAY POST-DISCHARGE MORTALITY RATE

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Aortic Center

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In the CVI’s Aortic Center, highly skilled teams of vascular surgeons andcardiac surgeons provide collaborative care and innovative treatments foremergent and elective repair of aortic disease, including open surgeries,hybrid surgeries and minimally invasive procedures for complex aneurysms,dissections and transections.

Advanced interventions. Our faculty are leaders in advanced interventions for the treatmentof aortic disease, including the development of custom-built fenestrated stent grafts for complexanatomy. Our surgeons are also expert in technically challenging valve-sparing procedures torepair aneurysms at the aortic root, where the aorta meets the heart.

Sophisticated imaging. VesselNavigator, a 3D imaging system used to guide the minimallyinvasive repair of aortic aneurysms, was developed through the work of surgeons at BIDMC, one of the first institutions to use this state-of-the-art navigation technology.

Influential papers. Studies published by Aortic Center faculty in 2008, 2015 and 2016 in TheNew England Journal of Medicine have been integral in shaping clinical decisions in the field ofendovascular aortic repair.

Prolific outcomes research. Faculty research includes notable publications examining genderdifferences in the treatment of aortic disease.

COMPREHENSIVE AORTIC CAREAbdominal aortic aneurysmsAscending and descending thoracic aneurysmsAortic arch diseaseThoracoabdominal aorticaneurysmsAcute and chronic Type A and Type B aortic dissectionsRuptured abdominal and thoracic aneurysms

CONTINUOUS QUALITYIMPROVEMENT

Participant in the Vascular Quality InitiativeNational leader in outcomesresearch for aortic conditions

SPECIALIZED TREATMENTPROTOCOLS

Ruptured abdominal aorticaneurysmRuptured thoracic aortic aneurysmAortic dissectionSpinal drain management

VESSELNAVIGATOREnhances the accuracy of stent and graft placementReduces need for contrast agentResults in improved patientoutcomes Leads to enhanced efficiency and cost effectiveness

97%PERCUTANEOUS REPAIRBetween 2013 and 2017, 446 EVAR,TEVAR and FEVAR procedures wereperformed percutaneously, one of thelargest series in the world.

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The CardioVascular Institute’s patient care professionals collaborate acrossroles and divisions to ensure every patient receives exceptional care. Highlyskilled, knowledgeable and compassionate, the team includes hundredsof advanced practice providers, nurses, perfusionists, case managers andtechnicians.

Continuous quality improvement. A Daily Management System empowers front-line nursingstaff to identify opportunities to improve patient care and workflow. Through the system’s dailyhuddles, improvement is the work of everyone, every day.

MyICU. The CVI’s two critical care units participate in MyICU, an innovative program thathas led to improved patient care and satisfaction. CVI nurses helped develop the tablet-basedapplication, which provides families with timely information and a tool for asking questions andrequesting meetings.

Shock team. This multidisciplinary team provides expert group decision-making in criticalsituations when advanced mechanical support technology has the potential to save lives.

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IMPROVEMENTMany individual improvements add up to exceptional care.

Improving and standardizingcommunication among providers toensure patient safetyIncreasing availability of equipmentto allow staff to use time moreefficientlyReduced time-to-procedure starts

60ADVANCED PRACTICE PROVIDERSNurse practitioners and physicianassistants provide evidence-based care,problem-solving and communicationskills to achieve the best patientoutcomes.

50%FEWER READMISSIONSA 2015 CVI study published in theJournal of Cardiovascular Nursingshowed that myocardial infarction and heart failure patients whose careteam included a nurse practitionerwere 50% less likely to be readmittedwithin 30 days.

NATIONAL LEADERSHIPOur nurses are early adopters of andprovide other hospitals with trainingfor Cardiac Surgery Unit Advanced LifeSupport. These resuscitation protocolsare designed to save critical minuteswhen post-surgery patients experiencelife-threatening emergencies.

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Cardiovascular Health

Helping people attain the bestpossible health is our quest.Finding better ways to do thisis our passion. Our patientsinspire a spirit of inquiry thatinfuses everything we do, fromresearching cardiovascularmechanisms at the molecularlevel to developing newevidence-based clinical models.

Meet Our PatientBarak Nir, 59Attorney, financial consultant

Received emergency mitral valve replacementsurgery while visiting Boston from Israel

“I owe my life to the amazing skill and swift actions of BIDMC’s cardiac surgery team.”

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Photo: James Derek Dwyer

Barak Nir, 59Attorney, financial consultantAttorney, financial consulta

owe my life to the amazing skill “I owe my life to the amazing skilwift actions of BIDMC’sand swift actions of BIDMC’s

ardiac surgery teacardiac surgery team.”

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Cardiac SurgeryThe Division of Cardiac Surgery offers comprehensive, personalizedcare and excellent outcomes for conditions of the heart muscle, valvesand arteries. Surgical team members work closely with colleagues inCardiovascular Medicine, Vascular Surgery, Anesthesiology and otherdisciplines.

Quality. We are the recipient of the Society of Thoracic Surgeons’ top 3-Star rating for 2016.Only 12% to 15% of hospitals receive the 3-Star rating, which denotes the highest category ofquality (see detail on page 22).

Mitral valve therapies. We are the Boston-area leader in mitral valve repair and aortic valvereplacement.

Valve research. The Division is the co-founder, with Cardiac Anesthesiology, of BIDMC’s ValveResearch Group, exploring the use of 3D technology to fully capture the complex and dynamicbehavior of the heart’s four valves (see detail at right).

Joint programs. Multidisciplinary collaborations among divisions are formalized in the AorticCenter, the Heart Failure Program and the Structural Heart Center.

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VALVE RESEARCH GROUPWe are investigating the use of 3Dprinting to enhance surgical precision.

Precise replicas of a patient’s valve can be printed in three dimensions30 minutes after echocardiographyModels help distinguish need forvalve replacement vs. valve repairSurgeons visualize heart valves before entering operating room

FARR 8: A PLACE TO HEALPatient-friendly features of this post-surgical cardiac unit include:

Nearby nursing stationsPull-out beds for family membersDimmable lightingSpacious bathrooms and showers

PAPERS IN LEADING PUBLICATIONSAnnals of Thoracic SurgeryJournal of Thoracic andCardiovascular SurgeryJournal of the American College of Cardiology

ISOLATED CORONARY ARTERYBYPASS GRAFT (CABG)30-DAY MORTALITY

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Referral Sources

CDAC: THE FIRST SIX MONTHS

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Cardiac Direct Access UnitIn November 2016, the CardioVascular Institute reinvented thedelivery of urgent cardiac care in New England when it opened theCardiac Direct Access Unit (CDAc). During its first six months ofoperation, from November 2016 to May 2017, the CDAc treated 766 patients, 94% of whom avoided the emergency room for at least 30 days.

Bypassing the ED. Patients with non-life-threatening symptoms like chest pain, shortnessof breath, swelling, palpitations and syncope immediately see an attending physician,bypassing emergency room wait times and expense.

In-unit facilities. The outpatient unit includes a clinic, six observation beds, anoutpatient diuresis room, echocardiography, stress testing and labs.

Important. Physician referral is required. Colleagues, please call our attending physicianat 617-632-7777.

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Symptoms Driving Referrals

Diagnoses

Discharge Disposition

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VENTRICULAR TACHYCARDIA ABLATION OUTCOMES

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Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service

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RESEARCHOur innovative program includes pre-clinical development of newtechnologies, with the goal offinding new methods for arrhythmiaprevention and improved patient care.

ADVANCED TECHNOLOGYOur electrophysiologists helped todevelop new methods of mapping theheart’s electrical system leading toimproved procedural outcomes.

INFLUENTIAL ARTICLESHigh-Resolution Mapping ofPostinfarction Reentrant VentricularTachycardia: ElectrophysiologicalCharacterization of the Circuit. Anter E, Tschabrunn CM, Buxton AE, JosephsonME. Circulation. 2016 Jul 26; 134(4):314-27.

Substrate Mapping for VentricularTachycardia: Assumptions andMisconceptions.Josephson ME, Anter E. JACC: ClinicalElectrophysiology. 2015; 1(5)341-352.

Treatment of Obstructive SleepApnea Reduces the Risk of AtrialFibrillation Recurrence FollowingCather Ablation. Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S,Kumar K, Kramer DB, Zimetbaum PJ, Buxton AE,Josephson ME, Anter E. Journal of the AmericanCollege of Cardiology. Jul 2013; 62(4):300-5.

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Electrophysiology at BIDMC has long been recognized for its pioneering andinnovative role in the treatment of heart rhythm disorders. Faculty membersare internationally known for leadership across the entire spectrum ofelectrophysiology.

Ventricular tachycardia. This high-volume program has an exceptional track record in complexprocedures such as epicardial mapping and ablation, use of leading-edge technologies and modulation ofthe autonomic nervous system.

Atrial fibrillation. Our personalized approach to atrial fibrillation management is noted for safety,success and management of complex cases. We focus on the modulation of risk factors like sleep apneaand ablation of non-pulmonary vein triggers. Our group has extensive experience with the study and useof new oral anticoagulant medications and device-based therapy for reduction of stroke risk.

Device management. This highly developed program is one of New England’s busiest centers forexpert management of cardiac arrhythmia devices. Services include implantation of standard and novelleadless pacemakers, transvenous and subcutaneous implantable cardioverter defibrillators (ICDs) and acomprehensive multidisciplinary approach to device lead extraction.

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NATIONAL LEADERSHIP INCLINICAL RESEARCH

SURTAVI trial, evaluatingtranscatheter aortic valvereplacement (TAVR) for severeaortic stenosis patients atintermediate surgical riskMedtronic Low Risk trial,evaluating TAVR for patientswith low surgical riskPIONEER trial, evaluating majorbleeding risk reduction in atrialfibrillation patients undergoingstenting for coronary arterydisease

Interventional CardiologyInterventional cardiologists at BIDMC pioneered many of the catheter-based therapies that have saved and improved the lives of millionsof patients everywhere. Faculty continue to play a major role in thepre-clinical and clinical development and evaluation of leading-edgetechnologies for the treatment of complex cardiovascular disorders.

Wide range of services. Cath Lab faculty perform a full range of interventional proceduresand are nationally noted for transcatheter aortic and mitral valve replacement, percutaneouscoronary intervention (PCI) for chronic total occlusion (CTO) and important medical strategiesthat reduce the risk of major post-procedure bleeding.

High volume. The laboratory is a high-volume center, performing more than 4,000 proceduresper year for the growing BIDMC network and patients from across the region and the nation.

Clinical research. Many of our interventional cardiology patients are enrolled in clinicaltrials, providing them with access to investigational treatments including drug-eluting stents,temporary heart pumps and anti-coagulant and anti-platelet medications.

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CARDIAC CATHERIZATIONRADIAL ACCESS

Diagnostic Procedures

PCI

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Endovascular SurgeryIN

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NOver the past decade, the CVI’s Division of Vascular and Endovascular Surgeryhas pushed forward the frontiers of the discipline, developing minimallyinvasive techniques for aortic aneurysm, carotid disease and lower extremityarterial disease. Guided by this work, our skilled surgeons are uniquelyequipped to determine the best treatment for each patient, whether opensurgery or endovascular surgery.

Preventing amputation. The Division has significantly expanded the use of primary endovasculartherapy for critical limb ischemia, leading to low mortality and exceptional amputation-free survival.We have one of the world’s largest experiences with tibial angioplasty, performing 945 proceduresbetween 2004 and 2017.

Percutaneous AAA repair. Our program has pioneered the use of ultrasound-guided femoral accessfor totally percutaneous endovascular AAA repair, helping to eliminate the need for incisions andassociated complications.

Influential research. Our active research program includes extensive clinical research focused onpatient outcomes and new technologies. In addition, five investigators oversee National Institutes ofHealth-funded basic science research.

ENDOVASCULAR AND OPENVASCULAR SURGERY AT BIDMC

HYBRID OPERATING ROOMSVersatile operating roomsare used for open, minimallyinvasive, percutaneous and hybridprocedures.Advanced imaging system allowssimultaneous multiple images.

600+ PUBLICATIONSOver the past decade, our facultyhave routinely published in influentialjournals including The New EnglandJournal of Medicine, Journal ofVascular Surgery and JAMA Surgery.

38 CLINICAL TRIALSOver 300 subjects enrolled in clinicaltrials, including those focused on:

Aortic aneurysmsCarotid artery diseaseLimb preservation

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RICH DATA RESOURCES INCLUDECenters for Medicare & MedicaidServices (CMS) database of40 million patients and 10,000procedure codesNationwide readmission data fromapproximately 15 million annualdischarges, representing half of allU.S. hospitalizations

KEY COLLABORATIONSOur academic and industry partnersinclude the Harvard T.H. Chan Schoolof Public Health, the Baim Institute forClinical Research, Boston Scientific,Abiomed, Medtronic and SymphonyHealth.

INFLUENTIAL STUDIES IN:The New England Journal ofMedicineJournal of the American MedicalAssociation (JAMA)CirculationAnnals of Internal Medicine

Richard A. and Susan F. Smith Center forOutcomes Research in CardiologyThe Smith Center was launched in 2015 to understand and improve patientoutcomes and advance healthcare delivery. It is the first center of its kind inBoston and one of only a few in the country.

Unique approach. The Smith Center’s multidisciplinary team brings together clinical specialistsin coronary artery disease, cardiac electrophysiology, valvular heart disease and heart failure, withscientists skilled in clinical trial design, observational studies and biostatistics. The center alsoprovides interdisciplinary educational and mentorship opportunities, drawing on rich intellectualand clinical resources at BIDMC and within the Harvard system.

High-profile research. Our studies, funded in part by the National Institutes of Health, focus onkey issues impacting cardiovascular medicine.

• Healthcare reform. A large-scale analysis showed that Centers for Medicare & MedicaidServices (CMS) penalties contributed to a decrease in hospital readmissions.

• Public reporting. A pivotal study showed that public reporting may disincentivize physiciansfrom offering potentially life-saving treatments when patients are at risk of poor outcomes.

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RESEARCH MOVES TOWARDPERSONALIZED MEDICINE

The Smith Center’s analytic approaches are used to identify patients with the most to gain or lose from treatment.

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Personal Genomics and Cardiometabolic Disease

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The CVI’s research program in Personal Genomics and CardiometabolicDisease is a national leader in metabolomics, the biochemical analysis ofmetabolites, small molecules that determine how the body burns fuel. Theinfluential program is paving the way for the development of personalizedtherapies for cardiovascular disease through the following key lines ofresearch.

Exercise. By understanding and identifying the molecular pathways by which exercise confers itsbeneficial effects, CVI scientists are building a biochemical roadmap for the creation of precision cardiovascular exercise programs.

Early disease diagnosis. CVI investigators have discovered novel biomarkers that indicate whichindividuals are destined to develop diabetes and heart disease—more than a decade before diseaseonset.

Sophisticated technologies. The program is at the forefront in testing and developing highlysensitive proteomics technologies that can help clinicians more precisely diagnose, monitor andscreen for cardiovascular risk.

BLOOD TEST OF THE FUTUREThe program’s comprehensive analysisof tens of thousands of blood samplesfrom individuals of different races,genders, ages, ethnic groups andfitness levels is the first step in thedevelopment of a new generationof blood tests to one day guideprecision diagnoses and treatments forcardiovascular disease.

PRESTIGIOUS SUPPORT INCLUDES$11 million Molecular Transducersof Physical Activity Consortium(MoTrPAC) grant from the NationalInstitutes of Health (NIH) toinvestigate and map molecularchanges in the body during and after exercise.Partnership with NIH’s Trans-Omics for Precision Medicine(TOPMed) Initiative to collectvast amounts of genomic data and’omics analyses to guide precisionmedicine.

ACADEMIC COLLABORATIONSBroad InstituteFramingham Heart StudyJackson Heart StudyDiabetes Prevention ProgramTIMI Study Group

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Meet Our PatientRichard “Sonny” Lepore, 84Barbershop owner

Peripheral artery disease patient underwent

bypass surgery for critical limb ischemia

“Both of my legs were saved by BIDMC’sVascular Surgery team, so I can continueto run my business and enjoy life.”

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Continuous Improvement

The CVI’s relentless focus onhealthcare quality is assured bythe three divisions’ membershipsin organizations that allow themto benchmark their surgical andprocedural outcomes againstnational standards.

Photo: James Derek Dwyer

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CVI Total Cases CVI Total Clinic Encounters

Volume at the CardioVascular Institute is growing.

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Volume

CY 2014 CY 2015 CY 2016

Cases* Cath Lab 4,342 4,360 4,794Transcatheter aortic valve replacement 85 107 170Electrophysiology Lab 2,022 2,167 2,299Cardiac Surgery 905 1,020 1,128Vascular Surgery 2,131 2,041 2,060CVI total cases 9,485 9,695

10,451

Clinic Encounters Cardiovascular Medicine 32,488 34,375 37,351Cardiac Surgery 1,742 1,997 2,091Vascular Surgery 7,919 7,758 8,544CVI total clinic encounters 42,149 44,130 47,986

*These numbers include all procedures performed by the respective services.

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Cardiac SurgeryVolume and Quality Measures

Society of Thoracic Surgeons3-Star Quality Rating forIsolated Coronary BypassGrafting Calendar Year 2016

The Society of Thoracic Surgeonshas developed a comprehensiverating system that allows forcomparisons regarding the qualityof cardiac surgery among hospitalsacross the country. Only 12% to15% of hospitals receive the 3-Starrating, which denotes the highestcategory of quality. In the currentanalysis of national data coveringthe period from January 1, 2016,through December 31, 2016,BIDMC’s cardiac surgery programwas found to lie in the highestquality tier, thereby receiving thesociety’s 3-Star rating.

Volume by Case Type

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Cardiac SurgeryVolume by Case Type

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Cardiac SurgeryVolume by Case Type

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Cardiac Surgery

Coronary Bypass Graft Quality Measures

CY 2014 CY 2015 CY 2016

BIDMC prolonged ventilation (intubated for 24 hours after surgery) 8.4% 6.5% 5.8%

STS prolonged ventilation 8.2% 8.2% 7.9%

BIDMC renal failure 1.7% 0.9% 1.4%

STS renal failure 2.0% 2.1% 2.1%

BIDMC deep sternal wound infection 0% 0% 0%

STS deep sternal wound infection 0.3% 0.3% 0.3%

BIDMC cerebral vascular accident (stroke) 1.1% 0.7% 0.4%

STS cerebral vascular accident (stroke) 1.3% 1.3% 1.3%

BIDMC any reoperation after initial surgery 2.5% 3.7% 2.9%

STS any reoperation after initial surgery 3.5% 3.5% 3.6%

BIDMC post-procedure length of stay (LOS) (mean) 5.8 days 5.7 days 5.9 days

STS post-procedure LOS (mean) 6.8 days 6.9 days 6.9 days

BIDMC post-procedure LOS (median) 5 days 5 days 5 days

STS post-procedure LOS (median) 6 days 6 days 6 days

BIDMC isolated CABG operative mortality (within 30 days or same hospital stay) 2.0% 1.2% 0.7%

STS isolated CABG mortality (within 30 days or same hospital stay) 2.1% 2.2% 2.2%

CY 2016

5.8%

7.9%

1.4%

2.1%

0%

0.3%

0.4%

1.3%

2.9%

3.6%

5.9 days

6.9 days

5 days

6 days

0.7%

2.2%

CY 2014

8.4%

8.2%

1.7%

2.0%

0%

0.3%

1.1%

1.3%

2.5%

3.5%

5.8 days

6.8 days

5 days

6 days

2.0%

2.1%

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Society of Thoracic Surgeons (STS) data provide a national comparison.

Lower scores are better.

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Vascular and Endovascular Surgery

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Vascular Surgery Overall Volume

Carotid Artery Stent Volume

Perioperative stroke or mortality rate = 0%

Carotid Endarterectomy VolumePerioperative stroke or mortality rate = 0%Median post-opertive length of stay = 1 day

Procedure Volumes

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Vascular and Endovascular SurgeryO

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Fenestrated Endovascular Abdominal AorticAneurysm Repair (FEVAR) Volume

Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Volume

Aortic Procedures

Aorta Procedures Volume

Perioperative mortality rate 0.4%Length of stay > 2 days 18% (vs. expected 32%)

The endovascular approach provides patients with a shorter length ofstay, less post-procedure pain and increased mobility—all resulting infewer complications.

FEVAR offers patients a customized endovascularapproach to aneurysm repair.

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Vascular and Endovascular SurgeryO

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Lower Extremity CasesLower Extremity Endovascular Procedures Volume

Perioperative mortality rate = 0.7%

Lower Extremity Infrainguinal Bypass Volume

Perioperative mortality rate = 1.3%

Lower Extremities

28 29

Vascular and Endovascular Surgery

OU

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Lower Extremity CasesLower Extremity Endovascular Procedures Volume

Perioperative mortality rate = 0.7%

Lower Extremity Infrainguinal Bypass Volume

Perioperative mortality rate = 1.3%

Lower Extremities

Cardiovascular Medicine

Procedures Volume

CY 2014 CY 2015 CY 2016

Coronary revascularization (PCI) 1,121 1,078 1,159

Endomyocardial biopsy 32 45 53

Other intervention 13 17 2

Peripheral interventions (all types) 1,008 922 937

Pericardiocentesis 37 49 44

Patent foramen ovale/atrial septal defect (PFO/ASD) closure 8 24 14

Pure diagnostic or intra-aortic balloon pump 1,964 2,032 2,327

Valvuloplasty 97 133 206

Electrophysiology studies 102 81 89

Cardioversions 569 583 643

Cardiac ablations 576 581 573

Pacemaker implants (generators, leads or systems) 333 409 399

Implantable cardioverter defibrillator implants (generators, leads or systems) 202 231 250

Vascular encounters 468 295 255

Cardiac magnetic resonance imaging 680 731 723

Echocardiography (includes stress echo) 15,123 15,794 16,649

Electrocardiography 64,980 68,703 75,077

Stress total (nuclear, exercise, stress echo and other) 4,811 4,590 4,696

Holter and King of Hearts monitors 2,819 2,806 3,074

Device monitoring 3,369 4,601 5,698

Other (includes left atrial appendage closure, implantable loop recorder and lead removals) 209 248 336

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Cardiovascular Medicine

Radial Access Use for Cardiac Catheterization

Diagnostic Procedures Percutaneous CoronaryIntervention

Gaining access to the heart through the radial arteryin the wrist decreases complications, improves patientcomfort and reduces costs without affecting proceduralsuccess rates.

Studies have proved that for properly selected patients, same-day PCIsare safe, cost effective and more convenient for patients.

Heart Failure 30-Day Post-Discharge Mortality Rate (Adjusted)Transcatheter Aortic Valve Replacement Volume

Percutaneous Coronary Intervention (PCI)Same-Day Procedures

The CVI offers Boston’s widest array of surgical andnon-surgical therapies for cardiac valve conditions.

BIDMC’s Advanced Heart Failure Program has the lowestmortality rate of any major Boston referral center.

Source: Hospital Compare

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Cardiovascular Medicine

Percutaneous Coronary Intervention (PCI) Quality Measures

Post-PCI Composite DischargeMedications in Eligible Patients

PCI In-Hospital Risk-Adjusted Mortality

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A higher number is better. A lower number is better.

The Highest Standards

Our board-certifiedspecialists combine clinicalexpertise, academic rigor anda spirit of inquiry to providepatients with extraordinarycare for the heart andvascular system.

Meet Our PatientJulie Ross, 40Certified public accountant and mother of two

Cardiac arrest patientTreated with advanced mechanical life support andimplantable cardioverter defibrillator

“When my heart stopped, my husbandsaved my life with CPR and the CVI expertstook it from there.”

Photo: James Derek Dwyer

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32reerooto tht to .rethmfrofriook it from there ””i

my xpCCaved my life with CPR and the CVI expertssaved my life with CPR and the CVI expertsaved my life with CPR and the CVI expemy my ppopped, andusben my heart stopped, my husbanmy hn my hWhWhen my heart stopped, my husband““

pC other of twoc accountant andubertified public accountant and mother of twr ofic accountant and mothfied publertified public accountant and mother of twoifii

,Julie Ross, 404ie Rlie Ross, 40i

Chantel N. Hile, MD

Raul J. Guzman, MDChristiane Ferran, MD,PhD

Marc L. Schermerhorn,MD, Chief

V. Senthilnathan, MD

Kamal R. Khabbaz, MDChief

Cardiac Surgery

Louis M. Chu, MD

David C. Liu, MD

Vascular and EndovascularSurgery

David R. Campbell, MDElliot L. Chaikof, MD,PhD, Chief of Surgery

Allen D. Hamdan, MDVice Chair, Departmentof Surgery

Andy M. Lee, MD

Mark C. Wyers, MDDirector, EndovascularTherapy

Heart Failure

Lisa M. Fleming, MD

Robb D. Kociol, MDDirector, Advanced HeartFailure Program

Shweta R. Motiwala, MD

Pablo A. Quintero Pinzon,MD

Marwa Sabe, MD

E. Wilson Grandin, MD,MPH

Jacques Kpodonu, MD Sidney Levitsky, MDSenior Vice Chairman,Department of Surgery

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Frank W. LoGerfo, MD Leena Pradhan-Nabzydk,PhD

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Cardiovascular Medicine

Scott D. James, DO

Clinical Cardiology

Anne-MarieAnagnostopoulos, MD

Aarti H. Asnani, MD James D. Chang, MDDirector, Cardio-Oncology

Loryn S. Feinberg, MDDirector, Women’sCardiovascular HealthProgram

Airley E. Fish, MD, MPH Michael C. Gavin, MD,MPH, Director, CardiacDirect Access Unit

Eli V. Gelfand, MDSection Chief, GeneralCardiology

Robert E. Gerszten, MDChief, CardiovascularMedicine

Thomas H. Hauser,MD, MPH, MMScDirector, NuclearCardiology

Peter Kang, MD Joseph P. Kannam, MDChief, Cardiology,BID-Needham

Warren J. Manning, MDSection Chief,Non-InvasiveCardiac Imaging

Michael G. McLaughlin,MD

Murray A. Mittleman,MD, DrPH

J. Peter Oettgen, MD Carl A. Rasmussen, MD,PhD

Anne B. Riley, MD Jordan B. Strom, MD

Connie W. Tsao, MD Francine K. Welty, MD,PhD

Jill B. Whelan, MD Meghan York, MD

Cardiovascular Medicine

Ernest V. Gervino, ScDDirector, ClinicalPhysiology Laboratory

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Mark D. Benson, MDDirector, CardiovascularPrevention

Brett J. Carroll, MDDirector, VascularMedicine

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CardiovascularMedicine Researchers

In addition, most ofour clinical physiciansparticipate in basic,translational and/or clinical research.

Reza Nezafat, PhDMaria I. Kontaridis, PhD

Chad A. Cowan, PhD Ary L. Goldberger, MD

Jeffrey Saffitz, MD, PhDChief of Pathology

Richard Verrier, PhD

Electrophysiology

Elad Anter, MDDirector, ClinicalElectrophysiologyLaboratory

Alfred E. Buxton, MD

Fernando M. ContrerasValdes, MD

Charles I. Haffajee, MDDirector, ElectrophysiologyNetwork and Device Trials

Daniel B. Kramer, MD,MPH Director, PacemakerandICD Service

Panos Papageorgiou,MD, PhD

Jonathan W. Waks, MD Peter J. Zimetbaum, MDAssociate Chief andDirector, Clinical Cardiology

Interventional Cardiology

David J. Cohen, MD,MSc

Kalon K. L. Ho, MD, MSc

Donald E. Cutlip, MDVice Chair, Departmentof Medicine

C. Michael Gibson, MD

Roger J. Laham, MDDirector, StructuralHeart Center

Eric A. Osborn, MD,PhD

Duane S. Pinto, MD, MPHSection Chief,Interventional Cardiology

Jeffrey J. Popma, MDDirector, InterventionalCardiology ClinicalService

Samuel J. Shubrooks,Jr., MD

Hector Tamez Aguilar,MD

Robert W. Yeh, MD,MSc, MBASmith Center for OutcomesResearch in Cardiology

Cardiovascular MedicineM

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Changyu Shen, PhD

CardioVascular Institute at Beth Israel Deaconess Medical Center

CardioVascular Institute atBeth Israel Deaconess Medical Center330 Brookline AvenueBoston, MA 022151-888-99-MYCVI (888-996-9284)bidmc.org/cviAffiliate Locations: See bidmc.org/cvinetwork

Contact Us

Appointments

Cardiovascular MedicineBoston 617-667-8800Chelsea 617-975-6096Chestnut Hill 617-667-8800Lexington 781-528-2410Milton 617-632-9209Needham 781-453-5238Plymouth 508-746-2900Sharon 617-667-8800

Cardiac Surgery617-632-8383

Vascular and Endovascular Surgery617-632-9959 (all sites)

Boston (BIDMC, HVMA Kenmore, Joslin Clinic)CambridgeChelseaChestnut HillDedhamEverett

FraminghamLexingtonNeedhamSomerville

Cardiovascular Medicine Referrals and Transfers

Cardiac Direct Access Unit617-632-7777 (attending cardiologist)

Transfer to BIDMC Emergency Department from outside617-754-2494 (attending emergency physician)

Cardiac interventions: admissions, transfers and elective procedures617-CAR-DIAC (617-227-3422)

Electrophysiology procedures: elective and outpatient617-632-7459

36

Aortic Center617-632-7070

Design: Paul Montie; Photos: Danielle Duffey, James Derek Dwyer, Michael Fein, Michael Prince

21

CardioVascular Instituteat Beth Israel DeaconessMedical Center