Sutter HealthSutter Heart & Vascular Institute5301 F Street, Suite 304Sacramento, CA 95819ADDRESS SERVICE REQUESTED

Sutter Heart & Vascular Institute is the proud sponsor of

the Go Red for Women movement

Sutter Medical Center, SacramentoSutter Auburn Faith HospitalSutter Davis HospitalSutter Roseville Medical CenterSutter Amador HospitalSutter Solano Medical Center

Michael T. Ingram Sr., MD, FACSAssociate Director - Sutter Heart & Vascular InstituteCardiovascular Surgery

Maxine Barish-Wreden, MD Medical Director - Women’s Heart Health ProgramInternal Medicine

John Chin, MD, FACCMedical Director - Transplant and Advanced Heart Therapy ServicesGeneral Cardiology

Jeffry Jones, MDMedical Director - Cardiac Critical Care Medicine and the Ventricular Assist Device Program

Robert Kincade, MD, FACSSurgical Director - Transplant and Advanced Heart Therapy ServicesCardiovascular Surgery

James Longoria, MD, FACSSurgical Director - Ablation ProgramCardiovascular Surgery

Teimour Nasirov, MDMedical Director - Pediatric Cardiovascular Surgery and Adult Congenital Heart Disease

Diane Sobkowicz, MD, FACCMedical Director - Women’s Heart Health Program General Cardiology

Stephen Stark, MD, FACCMedical Director - Electrophysiology ProgramGeneral Cardiology

Zi-Jian Xu, MD, FACC, PhDMedical Director - Non-invasive Adult Cardiology and Inpatient Advanced Heart Therapy Services

w w w . s u t t e r h e a r t . o r g

Sutter Heart & Vascular Update a publication of Sutter Heart & Vascular Institute - Sutter Medical Center, Sacramento

Spring 2010

If you have questions or comments regarding this publication, we would like to hear from you. Please direct your inquiries and suggestions to Update, Sutter Heart & Vascular Institute, 5301 F Street, Suite 304, Sacramento, California, 95819. You may also e-mail us at sutterheartinstitute@sutterhealth.org; reach us by phone at 916.733.1777 or fax to our attention at 916.733.0980.

Research UpdateDavid Roberts, MD, FACCBeverly Seiler, RN

Sutter has been able to provide patients who are at high risk for surgery and have carotid disease with carotid stenting by participating in post-market studies looking at clinical outcomes. We are currently participating in two high risk carotid stent registries.

The Abbott CHOICE registry is a worldwide post-market registry that will include both of Abbott’s carotid artery stenting and embolic protection systems. CHOICE may include as many as 5,000 patients and will be conducted at several hundred clinical sites in the United States and Europe. Primary endpoints for CHOICE are stroke, death and MI at 30 days. The study will also help gather additional and more extensive clinical data to broaden patient access to carotid stenting procedures. Data from CHOICE will also provide a deeper and broader understanding of carotid stenting in international clinical settings.

The Cordis SAPPHIRE WW registry is an observation registry designed to characterize the outcomes of carotid artery stenting with embolic protection in high surgical risk patients and will provide prospective data for up to 10,000 real-world patients across 275 clinical practices. Patient outcomes will be assessed at selected intervals up to one year post-procedure and will provide valuable clinical data contributing to the understanding of the disease.

High risk criteria includes, but is not limited to:

x congestive heart failure (CHF) class III/IV

x left ventricular ejection fraction (LVEF) <30%

x unstable angina

x contralateral carotid occlusion x recurrent stenosis and/or previous radical neck dissection

x previous CEA with recurrent stenosis

x recent myocardial infarction (MI) x prior radiation treatment to the neck

and other conditions that were used to determine patients at high risk for CEA in the prior CAS trials and studies, such as ARCHER, CABERNET, SAP-PHIRE, BEACH, and MAVERIC II.

Stroke CertificationDavid Roberts, MD, FACC Margaret Mette, Assistant Administrator, SMCS

Sutter Medical Center Sacramento is pleased to inform you that both SGH and SMH campuses are now Stroke Certified by the Joint Commission. This certification will now allow us to receive patients through the county EMS system. This certification pro-cess will also be initiated in all the Sutter Health Sacramento Sierra Re-gion Hospitals under the leadership of our Regional Stroke Medical Director, Dr. Mohammad (Asim) Mahmood who will be joining Sutter in July, 2010.

In addition to this certification, a team is also working on our emergency chest pain process. This team, under the leadership of Brenda McCulloch, Clinical Nurse Specialist and Doug Schuch, M.D., is developing a plan for SMCS to seek chest pain certification from the Society of Chest Pain Cen-ters. We believe that these certifica-tion processes validate the excellent care provided by our team at the Sut-ter Heart and Vascular Institute.

Joint CommissionMargaret Mette, Assistant Administrator, SMCS

Sutter Medical Center Sacramento has completed a week-long survey by the Joint Commission. The medical center received another 3-year certifica-tion and we want to thank all the physicians and staff who prepared and then met with the Joint Commission during their visit. The surveyors com-mented on the excellence that was demonstrated in cardiology services, noting that our VAD program was one of the best they have ever reviewed. An area noted for improvement was the process used for updating histories and physicals on patients that are transferred into SMCS for a procedure. The Joint Commission noted that in addition to examining the patient prior to the scheduled procedure, the physi-cian must note in the medical record the wording “examined the patient” as this is a CMS require-ment on all history and physical updates. We ap-preciate your complying with this request.

Medical Directors of SMCS’ Women’s Heart Programare Honored by the American Heart Association!David Roberts, MD, FACCMargaret Mette, Assistant Administrator, SMCS

Dr. Diane Sobkowicz and Dr. Maxine Barish-Wreden, co-Medical Directors of SMCS’ Women’s Heart Program, and warmly known as ‘Dr. Diane’ and ‘Dr. Max,’ have been given the Communication and Cause Marketing award from the American Heart Association (AHA).

As the Go Red For Women Cause sponsor, Sutter Heart & Vascular Institute has demonstrated their commitment to educating and empowering women through-out the Sacramento Valley. But, we could not do this without the strong commit-ment of these two Cause champions. This prestigious award

is reserved for outstanding communications or cause marketing efforts by indi-vidual volunteers, working with the AHA to build healthier lives free of cardio-

vascular diseases and stroke. Dr. Diane and Dr. Max were selected because of their work and dedi-cation related to the Go Red For Women movement. They have been available for media, group presentations, and coaching and counseling at community outreach events – encouraging healthy lifestyles. They are truly the face of Go Red in Sac-ramento! An award reception will be held on June 2 in San Francisco.

David K. Roberts, MD, FACC Medical Director - Sutter Heart & Vascular Institute Interventional Cardiology

Margaret Mette, RN, MS Assistant Administrator - SMCS

Diane Sobkowicz, MD, FACC

Maxine Barish-Wreden, MD

Sutter Medical Center Sacramento Goes REDPam Jones, Sutter Heart & Vascular Institute

As the regional sponsor of the American Heart Association’s Go Red For Women movement, Sutter Heart & Vascular In-stitute encouraged SMCS to “Go RED” in recognition of Heart Month and the na-tional kickoff of the 2010 Go Red For Women movement in February. Sixteen depart-ments within our facilities competed for prizes by de-picting the Go Red theme in their work areas. There was much camaraderie

and teamwork, but the contest revealed a solid understanding of the factors that contribute to heart health. One department’s employees logged their exercise for one month, while another demonstrated heart-healthy exercise for the judges. Heart-healthy foods were contrasted with those that are heart disease contributors, and educational information was distributed. Selecting winners was a challenge, but the Cath Lab at Sutter Memorial and the Telemetry Unit at Sutter General displayed the greatest under-standing of the pro-gram, with creativity and teamwork. The Communica t ions Center at the Sutter Cancer Center and the Maternal/New-born department at Sutter Memorial both came in 2nd place. We were all reminded that al-though heart disease is America’s No.1 killer, there are many steps that can be taken to fight it.

Introducing: “Sutter Transplant and Advanced Heart Therapy Services”Robert Kincade, MD, FACS John Chin, MD, FACCKelley Jaeger-Jackson, RN, MSN, Nursing Director

The Transplant & Outpatient Heart Specialty Clin-ics have changed their name! Now known as “Transplant & Advanced Heart Therapy Services,” the new name was selected to better encompass the continuum of care that these programs pro-vide. The patient populations served are kidney and pancreas transplant, heart transplant, heart failure, congenital heart disease, and ventricular assist device recipients. The new name also more accurately reflects the philosophy of therapeutic disease management for which the service is well known.

Margaret Mette, Assistant Administra-tor; Elizabeth Young, RN, SGH Telemetry staff members - SGH First Place Winners

Drs. Sailesh Shah and Robert Kincade placing the first sur-gical Impella 5.0 at SMCS.

What Can 12 Weeks Do For You?Dene Franklin, Sutter Heart & Vascular Institute

Simply put, they can make you better – a BetterU! Sutter Heart & Vascular Institute recently spent 12 weeks working with six ladies from our community who partici-

pated in the American Heart Association’s (AHA) BetterU program.

The object of the program is to learn ways to be more heart-healthy by making better food choices, becoming more physically active and under-standing what your numbers (BP, cholesterol, etc.) mean to your health.

Sutter staff met with these ladies every other week and, with the support of Dr. Maxine Barish-Wreden, Dr. Diane Sobkowicz, Sara Born (nutrition) and Linda Mariano (physical activity), as well as staff from AHA, the par-ticipants were coached and mentored on how to live a longer, healthier life. The results were remarkable! In just 12 weeks cholesterol levels were decreased an average of 10 points, triglycerides by an average of 25 points, and more than 94 inches and 70 pounds were lost!

You, too, can be a BetterU! For more information click here: http://www.goredforwomen.org/BetterU/index.aspx.

Poster Presentation: SMCS VAD Program Brenda McCulloch, RN, MSN, CNS

Brenda McCulloch, Cardiovascular Clinical Nurse Specialist, and Kelley Jaeger-Jackson, Director of Transplant and Advanced Heart Therapy Ser-vices, were recently invited to present a poster on SMCS’s Impella ventricu-lar assist device program (VAD) at the American College of Cardiovascular Administrator’s (ACCA) annual national leadership conference in Atlanta, Georgia. Brenda and Kelley’s poster, “Percutaneous VADs: A Programmatic

View Toward a New Standard of Care,” reviewed the train-ing, clinical, financial, and marketing aspects of SMCS’s suc-cessful Impella program since its inception in April 2008. The poster was well received by the ACCA membership, which is an organization comprised of accomplished leaders from many outstanding cardiovascular service lines throughout the country.

Top, the poster presented by Brenda McCulloch and Kelley Jaeger-Jackson at the ACCA annual leadership conference in Atlanta, GA. Bottom, Brenda (left) and Kelley with the poster.

Keep Your Patients Safe on AnticoagulationBrenda McCulloch, RN, MSN, CNS

Anticoagulation therapy has long been recognized as risky for some patients. Literature demonstrates that the use of standardized practices for anticoagulation therapy reduces the risk of adverse drug events associated with heparin, lovenox, and coumadin. The safe administration of anti-coagulation is now a Joint Commission National Patient Safety Goal. So what does this mean to physicians at SMCS? They use hospital-approved protocols for therapeutic anticoagulants, such as the pre-printed heparin protocol orders and order Coumadin per Pharmacy Protocol when ap-propriate. Prior to initiating therapeutic anticoagulation, a baseline INR for coumadin therapy and platelet count prior to unfractionated and low molecular weight heparin is required.

Impella 5.0Robert Kincade, MD, FACSBrenda McCulloch, RN, MSN, CNS

Working collaboratively with Dr. Sailesh Shah, the cath lab staff, and the cardiovascular surgery team, we recently placed the first surgical Impella 5.0 used in a patient on the West Coast. The cath lab staff did a stellar job working together with us and getting the job done. The patient had developed post-pericardiotomy shock a few hours after bypass surgery with an estimated EF of only 5%. The patient remained on the Impella 5.0 while he stabilized. A few days later, the patient had improved and his EF increased to 30%.

The Impella 5.0 is a surgically placed short-term ventricular assist device made by Abiomed. It can provide flows up to 5LPM at its maximum performance level. Approved by the FDA in April 2009 for six hours of support, the longest a pa-

tient has remained on Impella 5.0 support worldwide is 23 days.

The Impella 5.0 device is comprised of a miniaturized continuous axial flow pump located within a catheter. The impeller pump is located at the distal end of a 9 Fr catheter. At its largest outside diameter, which con-tains the pump housing, the Impella measures 21 Fr. There are currently 2 options available for the 5.0 design: one is implanted via direct placement into the left ventricle, and the other is placed percutaneously through a femoral artery cut down and positioned in the left ventricle.

Sutter Medical Center Sacramento has had its Impella 2.5 program in place for about 2 ½ years. To date, over 40 Impella 2.5 devices have been placed and SMCS continues to be the highest volume user in the Western United States. The Impella 5.0 joins our full arsenal of ventricular assist devices, providing cardiologists and cardiothoracic surgeons with the clinical flexibility to select and place circulatory support devices for patients based on the severity of cardiac disease, the amount of flow needed to support the patient, and the preferred implant approach. To view a video on the Impella 2.5 with Sutter’s Dr. Michael Fugit, click here: http://www.checksutterfirst.org/heartandvascular/videolibrary/impella.html.

� July 15 - 17, 2010 Head to Toe Cardiovascular Interventions The Meritage Resort - Napa, CA To register, click here: http://www.h2tmeeting.org/ Call 415.233.2999 for more information

� September 18, 2010 American Heart Association Heart Walk William Land Park - SacramentoTo register, click here: www.sacramentoheartwalk.orgCall 916.733.1777 for more information

� October 18, 2010 BEST PRACTICES In Cardiovascular Nursing Hilton Sacramento - Arden WestCall 916.733.1777 for more information

C A L E N D A R

Corissa Pederson, CV Tech and Thomas Rhodes, Nursing Direc-tor - Cardiac Cath & Non-Inva-sive - SMH First Place Winners