3 Indications For VAD Implant Bridge to Transplant (BTT)NYHA Class III-IV end-stage left ventricular failureReceived optimal medical therapy for at least 60 of the last 90 daysLife expectancy of less than two yearsDestination Therapy (DT)All of the aboveNot candidates for cardiac transplantationBridge to RecoveryAcute events ie. MI, viralBridge to DecisionUnknown eligibility for cardiac transplantationShort term devices
4 Center for Circulatory Support Goals The Center for Circulatory Support will:Be a leading program world-wide for the treatment of cardiogenic shock and advanced heart failure with MCS therapyProvide best practice care that is integrated across disciplines offering optimal support of patients and their familiesBe a world leader in research for MCS technologies. As new devices become available, both in clinical trials and after FDA approval, UM patients will be the first to benefit from their useRefine our techniques and procedures as a leader in setting the standard for MCS technologiesBe recognized as the center that “trains the trainers” while training physicians and healthcare providers from around the world
5 Adult VAD Program Ancillary Groups Support VAD Team CardiovascularCenterCV SurgeonsJonathan Haft, MDMatthew Romano, MDCenter for Circulatory SupportDirectorFrancis Pagani, MD, PhDMedical Director of OutpatientMechanical CirculatorySupportJennifer Cowger, MDSupervisorVAD ProgramMaureen Daly-MyersRN, BSNAdvanced Practice ProfessionalKevin Knott, MS, PA-CVAD ResearchSarah Fox, BALydia McGowan, MSNurse ManagerSpecial ProgramsJanice Norville, RNMSN, MSBA,VAD TeamAdvance Heart Failure ProgramAncillary GroupsSupportVAD CoordinatorsDeb Blissick, RNTeresa Colaianne, RN, BSNRena Lucier, RN, MSTerry Mayville, RN, BSNAdministrativeSpecialistMark White, B.S.,MBAAdministrativeAssistantLori BrennemanPre & PostTransplantNursesHeartFailureNursesPharmacyAngela Clark, PharmDSimona Butler, PharmDUjjaini Khgnderia, PharmDPhysical &OccupationalTherapyDietarySocial WorkRuth Halben, MSWJennifer Reinstein-Campbell, LLMSWErin Spangler. LLMSWFinancialAnne MaskillBiomedicalDavid Marlow, CBETNursingCardiac PerfusionJan Aukerman, CCPRussell Butler, CCPJackie Conliffe, CCPKevin Griffith, CCPCVICU (CVC 4)Unit ManagerJole’ Mowry,RN, MSN4CUnit ManagerBethany Lee-Lehner,RNReferringPhysiciansEMSFamilyExtendedCareFacilitiesHomeHealthCardiacRehab
6 Program History1996: Program established under the direction of Dr. Pagani; First HeartMate IP implant1997: First patient to be discharged to home on LVAD support2000: Participated in REMATCH Trial (use of VADs for permanent therapy)2002: First 100 implanted patients2003: First patient to be discharged to an Extended Care Facility2004: First implant of the HeartMate II LVAD; Training center for Thoratec Inc2007: First implant of the DuraHeart LVAD; Training center for TerumoHeart Inc2008: >300 long-term LVAD implants; Program achieves Advanced Certification from The Joint Commission2009: First implant of the HeatWare LVAD2010: Awarded $14.9 million dollar contract from the NHLBI to study the use of LVADs in less advanced stages of heart failure2011: 100+ ongoing patients at home; > 430 primary implants2012: Longest surviving patient in the world on continuous support with the HearMate II LVAD (8 years) was on the initial pump (7 years).
7 Total Long-term VAD Implants Includes re-implantsData taken from 10/4/11
8 Highly skilled and experienced team Program StrengthsHighly skilled and experienced teamLongevity of staff in multiple disciplinesInternationally recognized faculty and staffMultidisciplinary team approachParticipation and leader in clinical trialsExceptional patient outcomes
9 Program Advancements & Improvements Device Proficiency review bi-annually.Outreach Program development in process.Internal web page to share and disseminate programand device information.New VAD Support Group (Meets 2x/month).Enhanced Outpatient Ambulatory Services through ashared collaborative model with Heart FailureCardiologist and Cardiac Surgeons.Anything else?Need to work on wording of each pointThink about things we need to do before then (projects, etc…)
10 INTERMACSINTERMACS® (Interagency Registry for Mechanically Assisted Circulatory Support)National registry for patients who are receiving FDA approved mechanical circulatory support device therapy to treat advanced heart failure. Registry was devised as a joint effort of the National Heart, Lung and Blood Institute (NHLBI), the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), clinicians, scientists and industry representatives.
11 INTERMACSParticipation in INTERMACS is MANDATORY to receive CMS reimbursement for Destination Therapy (DT)Participation as a center in good standing is required by The Joint Commission for Advanced Certification
12 The Joint Commission Advanced Certification For the adult VAD DT population.Requires strong infrastructure and support from program administration.Must be an active continuous member of a national registry (INTERMACS).Have a Board Certified Cardiac Surgeon who has implanted at least 10 devices over the last 36 months.Certification requires on site survey every 2 years with an intra-cycle review during the off year.Monthly data collection with quarterly data submission on four performance measures.Show continuous improvement activities through regular clinician & DSC program staff meetings.
13 Performance MeasuresPatient 1yr Survival RateLength of Stay (Post-op Index Hospitalization)Major BleedingMajor Device Infection
21 Program Challenges Dissemination of knowledge within institution Hospital Policy Development (Transport, ACMS, MPU)Maintaining competency/trainingEducationPatientHealthcare ProvidersReferral PhysiciansCommunityContinual communicationAllowing team to optimize careMaintaining operational and service management with increasing patient volume100+ patients at home.