Inova Heart and Vascular Institute 2012 Cardiac Clinical & Surgical Outcomes Report ( B A S E D O N 2 0 1 1 DATA )

Inova Heart and Vascular Institute locations: • Inova Alexandria Hospital • Inova Fair Oaks Medical Campus • Inova Fairfax Medical Campus • Inova Loudoun Medical Campus – Lansdowne • Inova Mount Vernon Hospital For more information, visit inovaheart.org. To refer a patient, call 1-855-MY-INOVA (1-855-694-6682).

G31854/1-13/5,000

Table of Contents Letter from the Vice President ....................................................1 Our Award Winning Care ............................................................2 Innovation ........................................................................................3 Inova Heart and Vascular Institute Overview......................4-5 Acute Myocardial Infarction ....................................................6-7 Our Door-to-Ballon Times ............................................................8 Percutaneous Coronary Interventions......................................9 Cardiac Catheterization ..............................................................10 Cardiac Rhythm Disorders ..........................................................11 Collaborative Research..........................................................12-13 Valve Disease/Surgery ..........................................................14-15 Coronary Artery Bypass Grafting ........................................16-17 Atrial Fibrillation ......................................................................18-19 Thoracic Surgery ....................................................................20-21 Advanced Heart Failure ......................................................22-23 Cardiac Rehabilitation ................................................................24 Adult Congenital Heart Clinic ..................................................25 Pediatric Cardiology and Cardiac Surgery......................26-27 Research Presentations ......................................................28-29 Publications ..................................................................................30 Our Physicians ..............................................................................31

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Dear Physician:

Our Quality Commitment To promote quality improvement, Inova Heart and Vascular Institute offers our 2012 Cardiac Clinical and Surgical Outcomes Report. It contains highlights of our most recent surgical and medical advancements, data on patient volumes and outcomes, and an overview of our latest technology and innovations. We also share a summary of our groundbreaking research initiatives. At Inova Heart and Vascular Institute, safe, excellent care defines the patient experience and leads to exemplary outcomes. Our multidisciplinary, integrated approach coordinates the expertise of metro Washington’s largest team of cardiac specialists who collaborate to successfully treat the most challenging cases. Whenever possible, we offer a minimally invasive alternative to traditional surgery. The number of procedures performed this way continued to increase in 2011. As a result, patients recovered more quickly, left the hospital sooner and were more satisfied with their care.

I am pleased to present Inova Heart and Vascular Institute’s 2012 Cardiac Clinical and Surgical Outcomes Report. This year, we are combining our clinical and surgical outcomes data in a single report. Inova Heart and Vascular Institute is a seamless network of people, expertise and care throughout Inova, all working together to prevent and treat heart disease. Our consolidated format reflects this unity, while making the data more accessible to you. As major changes transform our nation’s healthcare system, outcomes data are an ever more important part of the cost and quality equation. IHVI is a leader in cutting-edge technology and quality improvements that refine and improve cardiovascular care. Our talented surgeons, interventional radiologists and cardiologists stand among the nation’s finest. Year in and year out, they provide unrivaled expertise, outstanding care and quality results that make IHVI the hospital of choice for patients throughout our region and beyond.

Our quality commitment extends beyond our hospital walls. In addition to measuring clinical outcomes, we share quality data externally to improve cardiac care nationwide by participating in several public reporting initiatives.

Sincerely,

The 2012 Cardiac Clinical and Surgical Outcomes Report demonstrates our commitment to quality improvement and is intended to help patients and referring physicians make more informed healthcare decisions. We hope you find it useful.

Patricia A. Knowles, BSN, RN, MS, CNOR Administrator, Inova Heart and Vascular Institute Vice President, Inova Health System

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Our Award-Winning Care

Innovation

Inova Heart and Vascular Institute is consistently recognized as one of the top cardiac programs in the country. Our national awards for services, treatment and results include:

Inova Heart and Vascular Institute leads the way in innovative, technologically advanced cardiovascular care in the Washington metro area. We offer some of the most exciting advancements in heart care, including:

• Top 50 ranking among hospitals nationwide for Cardiology and Heart Surgery by U.S. News and World Report • Gold Seal of Approval from The Joint Commission for treatment of acute myocardial infarction • Three-Star designation from the Society of Thoracic Surgeons • Gold Seal of Approval from The Joint Commission for the care of patients with Left Ventricular Assist Devices (VAD) • Beacon Award from the American Association of Critical Care Nurses for excellence in critical care nursing • Five-star ranking from Professional Research Consultants for both Nursing Care and Surgical Services • Silver Performance Achievement Award from the ACTION Registry® for maintaining a rate of performance of 90 percent or better for four consecutive quarters • 2012 Mission: Lifeline Bronze Receiving Quality Achievement award from the American Heart Association for commitment and success in implementing a high standard of care for heart attack patients

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• Minimally invasive cardiac surgery is our goal and we provide a less invasive alternative whenever possible. Advancements in this area mean we can achieve the same technical results with less trauma to the patient, resulting in shorter hospital stays, faster recovery and return to daily activities, and greater patient satisfaction. With a focus on new technology and innovation, we continue to increase the number of minimally invasive procedures we perform every year. • Inova’s new vascular program takes a pioneering approach to the treatment of peripheral arterial disease (PAD), uniting three kinds of specialists into one collaborative environment. Cardiologists, interventional radiologists and vascular surgeons work together to provide a higher standard of care. With all the right experts in one program, patients no longer have to coordinate multiple specialist referrals and appointments. They have immediate access to stateof-the-art diagnostic and therapeutic techniques from across the Inova system.

Hybrid Operating Room

• Inova’s state-of-the-art hybrid operating room allows cardiac surgeons, electrophysiologists and interventional cardiologists to operate together on the same patient. Different cardiac procedures, previously performed in three separate areas, are consolidated in one unique, specialized suite. This sophisticated cardiac interventional facility truly is the best of all worlds. Surgical time is reduced, patients doprocedures and recovery is faster, with less risk of complications.

Melody Transcatheter Pulmonary Valve

• Melody®, the first FDA-approved transcatheter heart valve, provides a nonsurgical option for the lifetime management of congenital heart disease in both adults and children. The device is used to open narrowed or failing pulmonary valve conduits that control blood flow from the heart to the lungs. With Melody transcatheter pulmonary valve therapy, patients avoid open-heart surgery.

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Inova Heart and Vascular Institute Overview The internationally recognized Inova Heart and Vascular Institute provides patients with state-of-the-art technology, innovative therapies and groundbreaking research, anchored by a dedicated team of more than 200 exceptional cardiovascular specialists.

Cardiology Procedures Inova Fairfax Hospital

Inova Alexandria Hospital

Inova Loudoun Hospital

IHVI Combined

Interventional Cardiology Diagnostic Cardiac Catheterizations

2,870

599

297

3,766

Percutaneous Coronary Interventions

1,753

259

244

2,256

18

0

0

18

Percutaneous Valvuloplasties Electrophysiology Electrophysiology Studies

722

110

40

872

Ablations

796

15

35

846

1,590

170

35

1,795

21

0

0

21

Device Implants Laser Device Lead Extractions

Data comparisons in this report represent Inova Heart and Vascular Institute outcomes compared with patients at hospitals included in the American College of Cardiology National Cardiovascular Data Registries. All comparison data are based on a one-year rolling average, except when otherwise noted. Therefore, there may be differences compared with totals reported elsewhere in this report. *Throughout this report, “IHVI” refers to all Inova hospitals, unless otherwise specified.

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The Inova Heart and Vascular Institute boasts one of the largest Ventricular Assist Device programs in the country, and is home to one of the world's leading surgical atrial fibrillation programs. Additionally, IHVI’s volume and percent of minimally invasive surgical interventions for mitral valve repairs, aortic valve replacements and surgical Maze procedures is one of the largest in the region. All of Inova’s Northern Virginia hospitals are seamlessly connected to our flagship facility on the Inova Fairfax Hospital campus. This assures patients easy access and multiple entry points to a full range of cardiac and vascular services. Our expertise includes: • • • • •

The D.C. region's first successful heart transplant CMS-certified heart transplant program Dedicated cardiac care facility Hybrid operating room Adult Congenital Heart Clinic

Total Cardiac Surgery Volumes (IHVI) Adult Cardiac

1,214

Pediatrics

266

Thoracic

600

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Process of Care Indicators

Acute Myocardial Infarction Inova Heart and Vascular Institute is the largest heart attack care provider in Northern Virginia. Our ST-elevation myocardial infarction (STEMI) teams handle the most critical cases, including transfers from other hospital emergency departments throughout Virginia, Maryland and Washington, DC. Our successful acute myocardial infarction (AMI) program has one of the country’s lowest mortality rates. Our 30-day survival rates are above the national benchmark set by The Centers for Medicare and Medicaid Services (CMS).

STEMI Volume Combined Not Tranferred In

Transfers-In

Volume

226*

215*

Percentage of Total

51.2%

48.8%

*Source: ACTION Registry® - GWTG™ 2011 Q4 Outcomes Report

100 90 80 70 60 50 40 30 20 10 0

Acute Myocardial Infarction (AMI) 30-Day Survival

%

84.9%

86.6%

86%

85.4%

IFH

IAH

ILH

IHVI

84.5%

CMS Hospital Compare**

100 90 80 70 60 50 40 30 20 10 0

Overall AMI Performance Composite Score 2011*

%

97.6%

95.7%

IFH

IAH

90%

ILH

96.9%

IHVI

93.9%

CMS Hospital Compare**

Source: ACTION Registry® - GWTG™ * NCDR ACTION Registry-GWTG Overall AMI Performance Composite measures include: aspirin at arrival, evaluation of LV systolic function, reperfusion therapy (STEMI only), time to fibrinolytics (STEMI only), time to primary PCI (STEMI only), aspirin at discharge, beta blocker at discharge, ACE-I or ARB for LVSD at discharge, statin at discharge, adult smoking cessation advice, and cardiac rehab referral ** CMS Hospital Compare includes information about the quality of care at more than 4,000 Medicare-certified hospitals across the country. *** Data collected during Q4 2011 only

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Our Door-To-Balloon Times

Percutaneous Coronary Intervention

Inova Heart and Vascular Institute consistently surpasses national 90-minute doorto-balloon standards and is now pursuing a more aggressive goal of 60 minutes.

Consistent with a national downward trend in percutaneous coronary intervention (PCI) procedures, Inova Heart and Vascular Institute’s volume dropped in 2011. Even so, our mortality and complication rates remain low.

PCI volume - IHVI combined

3,000 2,500

2,491

90.9%

NCDR Participating Hospitals

14.8% 12.5

7.5

2,666

5

5.2% 2,300

2,000

IHVI Combined

%

15

10

Primary PCI Received Within 90 Minutes of Hospital Arrival - 2011

92%

Any Adverse Events (PCI WithSTEMI)

2,256

1,500

2.5 0 IHVI

1,000

NCDR Participating Hospitals

500

Door-To-Balloon Median Time (minutes) (Non-Transfer Patients) - 2008-2011

Any Adverse Events (PCI Without STEMI)

0 2008

2009

2010

%

2011 7.5

Inova Heart and Vascular Institute

NCDR Participating Hospitals

2008

69

69

2009

61

62

2.5

2010

65

66

0

2011

60

61

PCI Success

5

5.6% 2.3%

8

98.9%

99.1%

IHVI

NCDR Participating Hospitals

IHVI

NCDR Participating Hospitals

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Cardiac Catheterization

Cardiac Rhythm Disorders

Inova Heart and Vascular Institute continues to excel in cardiac catheterization procedures. Our innovative outpatient program blends convenient, comfortable care with the expertise of a multidisciplinary team. In 2011, outpatient procedures exceeded 43 percent due to early ambulation protocols, use of closure devices where appropriate and radial artery access for many patients.

A National Leader in Electrophysiology Inova Heart and Vascular Institute’s high-volume electrophysiology (EP) program provides the full spectrum of cardiac care for adult and pediatric patients. Our nationally recognized team uses a variety of novel imaging tools, ablation strategies, and devices to facilitate the management of simple and complex heart rhythm disorders. We offer the only comprehensive EP program in the region, with a broad scope of diagnostic and therapeutic procedures including cryoablation for atrial fibrillation (Afib), radiofrequency ablation, implantable cardioverter defibrillators (ICDs), pacemaker implants and devices for patients with heart failure.

A coordinated care approach, state-of-the-art catheterization labs, and a dedicated interventional cardiology admission and recovery suite staff all contribute to complication rates below the national average.

Electrophysiology Lab Volume

% 3

Any Adverse Event

Electrophysiology Studies Ablation Procedures Afib (including Radiofrequency and Cryo) AVN VT SVT Pacemakers ICD’s Biventricular Dual Chamber and Single Chamber Laser Device Lead Extraction Procedures

2.5 2 1.5

1.4% 1

1.0% 0.5 0 IHVI Composite

NCDR Participating Hospitals

Research Studies: • Coronary Stent Graft Use in Coronary Aneurysm, HDE Number H000001 Principal Investigator: Bryan Raybuck, MD Current Status: Patients enrolled as warranted based on specific criteria • Stenting and Angioplasty w/Protection in Patients at High Risk for Endarterectomy Principal Investigator: Albert Kim, MD Current Status: Enrolling

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Research Studies: • Subcutaneous Implantable Cardioverter Defibrillator (S-ICD®) System Clinical Investigation. Principal Investigator: Ted Friehling, MD. Current Status: In Follow-up • Continued Access Protocol for the Evaluation of Catheter Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation Principal Investigator: Marc Wish, MD Current Status: In Follow-up

Ted Friehling, MD

Inova Fairfax Hospital

Inova Alexandria Hospital

Inova Loudoun Hospital

IHVI Combined

722 796 184 63 48 419 852 738 215 377 21

110 15 13 2 0 0 140 30 12 18 0

40 35 32 3 0 0 20 15 11 3 0

872 846 229 68 48 419 1,012 783 238 398 21

• NAVISTAR® THERMOCOOL® Catheter for the Radiofrequency Ablation of Drug Refractory Recurrent Symptomatic Paroxysmal Atrial Fibrillation. PMA # P030031/S014 - Post Approval Registry. Principal Investigator: Ted Friehling, MD. Current Status: In Follow-up • Irrigated Ablation System Evaluation for AF (IRASE AF). Principal Investigator: Haroon Rashid, MD. Current Status: In Follow-up

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Collaborative Research Cardiac surgeons and cardiologists at the Inova Heart and Vascular Institute regularly collaborate with one another not only on their patient cases, but on research studies as well. This research has opened the doors to new means of interventional and surgical procedures. Below are some recent examples of the joint research conducted by our physicians.

Cardiology-CV Surgery Studies: • Medtronic CoreValve® Study Inova Heart and Vascular Institute is currently enrolling patients with severe aortic stenosis who are not candidates for traditional surgery in the Medtronic CoreValve® Study. These patients are brought to the hybrid OR where a transcatheter valve is introduced through the femoral or subclavical artery or directly through the ascending aorta. Surgeons and interventional cardiologists work in tandem to replace the diseased aortic valve, which remains in place. Principal Investigators: Bryan Raybuck, MD, and Niv Ad, MD Current Status: Enrolling • Surgical Intervention for Moderate Ischemic Mitral Regurgitation Primary outcomes: Assess the degree of left ventricular remodeling (as assessed by LVESVI at 12 months) and degree of major adverse cardiac events as defined by death, stroke, worsening heart failure, CHF hospitalization, and MV re-intervention. Principal Investigators: Alan Speir, MD, and Todd Pulerwitz, MD Current Status: Enrolling • Evaluation of Outcomes Following Mitral Valve Repair/Replacement in Severe Chronic Ischemic Mitral Regurgitation Primary objective: Evaluate the safety and efficacy of mitral valve repair compared to mitral valve replacement. The outcome will focus on the degree of left ventricular remodeling, as assessed by LVESVI at 12 months. The principal secondary outcome is all cause mortality. Principal Investigators: Alan Speir, MD, and Todd Pulerwitz, MD Current Status: In Follow-up • Hybrid Atrial Fibrillation Ablation Study Primary objective: To determine the most beneficial ablation methodology for individual patients with paroxysmal or persistent atrial fibrillation (defined by the Heart Rhythm Society) as surgeons and electrophysiologists work together on a convergent procedure (hybrid) to place the epicardial and endocardial ablation lines. Principal Investigators: Niv Ad, MD, and Ted Friehling, MD Current Status: Enrolling

Left to right: Alan Speir, MD; Niv Ad, MD; Bryan Raybuck, MD; Harvey Sherber, MD

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

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Valve Disease/Surgery Inova Heart and Vascular Institute offers the most advanced surgical techniques available to repair and replace all heart valves: aortic, mitral, tricuspid and pulmonary. Recent innovations have increased patient options, with minimally invasive mitral valve repairs and aortic valve replacements now the mainstay of our robust destination valve center. For both these patient populations, our pioneering approach eliminates the need for lifelong anticoagulation therapies and helps patients recover faster with less pain.

VALVE VOLUME 2011 Total Valve

2010

Isolated Aortic Valve Replacement

2009

Isolated Mitral Valve Repair

2008

Isolated Mitral Valve Replacement

2007 0

50

100

150

200

250

300

350

400

450

500

Mitral Valve Replacement

600

Paul Massimiano, MD

2011 Mortality

Isolated Aortic Valve

550

IHVI

STS Benchmark

2.0%

2.6%

0%

5.4%

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Research Studies: • Patient Disposition and Long-Term Outcomes after Valve Surgery in Octogenarians Primary objective: to explore variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival. Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care. Principal Investigator: Niv Ad, MD Current Status: Data Analysis

• Do we Increase the Operative Risk by Adding the Cox-Maze III Procedure to Aortic Valve Replacement and Coronary Artery Bypass Surgery? Primary objective: to explore the potential impact of the addition of the Cox-Maze III procedure on short- and long-term outcomes of patients when combined with AVR or CABG. The addition of the Cox Maze III procedure to AVR or CABG did not convey an increase in major morbidity and perioperative risk. Patients who underwent the Cox Maze III procedure demonstrated similar survival over time with improvement in health-related quality of life. The Cox-Maze III should not be denied to patients in whom the cardiac surgical procedure does not include atriotomies because of the perceived increased operative risk. Principal Investigator: Niv Ad, MD Current Status: Data Analysis

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Pure CABG Mortality % 2.5

Coronary Artery Bypass Grafting Inova Heart and Vasular Institute is a leader in groundbreaking approaches to coronary artery bypass grafting (CABG) for the treatment of high-risk patients with cardiovascular disease. Over the past 35 years, our surgeons have moved from traditional open procedures to more innovative techniques, including off-pump bypass surgery. Benefits include fewer blood transfusions, quicker recovery and reduced LOS. Our mortality and 30-day readmission rates remain well below the national average. Also incidence of any major complication resulting from isolated CABG was half the STS national benchmark.

2.0 1.5 1.0 .50 0 2007

CABG AND CABG COMBINED VOLUME Pure CABG

Inova Mortality

2009

2010

2011

STS Benchmark

2011

CABG+ Aortic Valve Replacement

2010

CABG+ Mitral Valve Replacement

2009

CABG+ Mitral Valve Repair

2008

CABG+ Carotid

2008

CABG Post Operative Length of Stay Year

IHVI

STS Benchmark

2011

5 days

6 days

2007

Isolated CABG Readmission Within 30 Days 0

20

40

60

80

100

200

Intra-Op Blood Products Used

300

400

500

600

700

800

Post-Op Blood Products Used

Year

IHVI

STS Benchmark

Year

IHVI

STS Benchmark

2011

11.65%

34.8%

2011

13.86%

40.30%

2010

11.50%

NA

2010

10.92%

NA

2009

10.73%

NA

2009

12.18%

NA

2008

15.21%

NA

2008

16.10%

NA

2007

18.85%

NA

2007

27.81%

NA

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2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Year

IHVI

STS Benchmark

2011

10.04%

10.10%

Research Studies: • CorMatrix® ECM Objective: To determine whether the use of the CorMatrix® ECM will help reduce inflammatory markers after surgery, which can potentially lead to atrial fibrillation. This research study involves two groups of patients; the control group which does not receive the CorMatrix® ECM during surgery, and the other group which does receive the CorMatrix® ECM implant during surgery for the closure of the pericardium. Pericardial fluid and blood samples will be collected from both groups to identify inflammatory biomarkers. Principal Investigators: Niv Ad, MD Current Status: Data Analysis

Alan Speir, MD

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Atrial Fibrillation Revolutionary Care for Afib Patients Our surgical program for atrial fibrillation (Afib) remains one of the largest and most effective in the country, with 560 procedures in the last seven years. We offer patients both traditional open surgery, which is frequently performed with other cardiac procedures, and a more advanced minimally invasive version, which allows a much faster recovery. Central to the Maze procedure is cryoablation, which uses cold energy, rather than traditional heat, to electrically isolate lesions that cause arrhythmias. Inova Heart and Vascular Institute was first in the Washington metro region to use the Arctic Front® cryoballoon ablation system to treat Afib, and we remain one of the only heart centers in the country to offer this technology.

Trends in Minimally Invasive Stand-Alone Cox Maze III Procedure

Surgery for Atrial Fibrillation 2007-2011

100 2011

90

92%

80

80%

70

2010

69%

60 50

91%

61%

2009

40 2008

30 20

2007

10 0 2007

18

Niv Ad, MD

2008

2009

2010

2011

Research Studies • Anti-Arrhythmic Medication (Amiodarone) Post-Surgical Ablation for Atrial Fibrillation: Is it Necessary? Primary objective: Assess if the drug Amiodarone is necessary as a treatment during the first three months after surgical ablation. Being off anti-arrhythmic medication is important as these drugs carry significant side-effect profiles. Principal Investigator: Niv Ad, MD Current Status: Enrolling

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

0

10

20

Concomitant Cox Maze Procedure

30

40

50

Stand-Alone Cox Maze Procedure

60

70

80

Concomitant Left Atrial Ablation

19

Thoracic Surgery The thoracic surgery program’s integrated treatment team works together to perform sophisticated procedures for patients with lung and esophageal disease. Using the most advanced minimally invasive techniques whenever possible, including robotics, our specialists perform lung resections, esophageal resections, diaphragmatic hernia repairs, biopsies and other resections within the chest, surgery for reflux disease and more. Inova Heart and Vascular Institute’s thoracic surgery program is a standout among medical centers nationally and worldwide. There are fewer than 25 such programs in the United States that offer a comparable depth and breadth of services. The nationally recognized lung transplant program has consistently surpassed the national average for survival statistics. The program’s current 1-year survival is ranked among the top three programs nationally. In 2011, the program performed 20 transplants.

Daniel Fortes, MD

Thoracic Surgery Volume

2011 Procedures 700 Case Type

Volume

Lung

328

Esophagus

70

Other

202

2011 Overall Mortality

2.3%

694 675

650

652

600

600 550 500

493 450 400 2007

2008

2009

20

2010

2011

Sandeep Khandhar, MD

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

21

Advanced Heart Failure Inova’s heart failure program is a leader in Northern Virginia and one of the Washington region’s only CMS-certified heart transplant programs. We offer state-of-the-art care for patients with heart failure, including those with advanced disease for whom standard medical care has proved unsuccessful. Options include specialized testing, medical therapies, surgical interventions and palliative care. Transplant Pioneer Since we performed the region’s first successful heart transplant in 1986, our transplant program has grown to become one of the most active in the Washington area. Our surgeons, cardiologists and transplant center staff offer clinical expertise and a multidisciplinary support system to integrate every aspect of care before, during and after the transplant procedure. Educating Caregivers Inova Heart and Vascular Institute clinicians share their expertise with physicians and cardiology fellows at local hospitals. We provide mentoring and training in heart transplant, heart failure therapies and ventricular assist devices (VAD). This community-wide education helps improve access to advanced treatments for heart failure patients throughout our region. VAD Leader Inova Heart and Vascular Institute is a leader in the development and use of VADs for patients living with end-stage heart failure. Our program is one of the largest and busiest Nelson Burton, MD

Total Volume VAD Year

Volume

2008

41

2009

50

2010

38

2011

53

in the Mid-Atlantic, and earned The Joint Commission’s Gold Seal of Approval for exemplary care and service. For more than 20 years, Inova has participated in research to develop improved devices for both bridge-to-transplant and destination therapy.

Improving Care Through Technology Inova Transitional Care Management (TCM) assists heart failure patients as they transition home following their hospital stay. TCM is a free, 30-day, phonebased coaching program in which patients receive support through a series of phone calls to address medication reconciliation, timely medical follow up, and self management of their health. The TCM program enables case managers and health coaches to care for the patients more effectively, and families find reassurance knowing they have another set of eyes watching out for their loved ones.

Top: (standing l to r) Kathy Briggs – Social Worker; Carolyn Rosner – Heart Failure/Transplant NP; Sarah Scott – Transplant Office Team Leader; Lori Edwards – VAD Coordinator; Maria Binetti – VAD NP. (sitting l to r) Shashank Desai, MD – Transplant Medical Director; Debbie Campbell – Director of the Transplant Center; Christopher May, MD – Transplant Center Cardiologist.

Research Studies: • Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) Principal Investigator: Shashank Desai, MD Current Status: Enrolling • Evaluation of the Levacor™ Ventricular Assist Device as a Bridge to Cardiac Transplantation Principal Investigator: Nelson Burton, MD Current Status: Closed • A multicenter, Double-Blind, Randomized Study to Evaluate Hemodynamic Effects of Riociguat and Safety and Kinetics in patients with Pulmonary Hypertension associated with Left Ventricular Systolic Dysfunction (Bayer LEPHT) Principal Investigator: Shashank Desai, MD Current Status: In Follow-up • VADWatch™ Telehealth Monitoring of Patients on a Ventricular Assist Device in a Residential Setting©: Pilot Program Principal Investigator: Christopher May, MD Current Status: Closed • Development and Resolution of Anti-human Leukocyte Antigen Antibodies in Patients Implanted with Continuous Flow Ventricular Assist Devices as a Bridge to Heart Transplantation: A Retrospective Cohort Review Principal Investigator: Shashank Desai, MD Current Status: Not applicable • A Prospective, Randomized, Controlled, Un-blinded, Multi-Center Clinical Trial to Evaluate the HeartWare® Ventricular Assist System for Destination Therapy of Advanced Heart Failure (HW-004) Principal Investigator: Anthony Rongione, MD Current Status: In Follow-up • Integrating Supportive Cardiology into the Assessment and Treatment of Patients Evaluated for and Supported by Ventricular Assist Devices as Destination Therapy Principal Investigator: Christopher May, MD Current Status: Enrolling • Evaluation of the HeartWare® Left Ventricular Assist Device (LVAD) System for the Treatment of Advanced Heart Failure (HW-003) – Continued Access Protocol (CAP) Principal Investigator: Anthony Rongione, MD Current Status: Enrolling in CAP only • Novel Use of Epigenomics to Predict Outcome in Patients Receiving Left Ventricular Assist Device (LVAD) Therapy Principal Investigator: Shashank Desai, MD Current Status: Enrolling • Acute Cardiac and Allograft Cellular Rejection and Cardiac Allograft Vasculopathy: Identification of Diagnostic Biomarkers and Target Pathways for Preventive Therapy Co-Investigators: Andrew Keller, MD; Shashank Desai, MD Current Status: Enrolling

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23

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Cardiac Rehabilitation Inova Heart and Vascular Institute offers a three-phased cardiac rehabilitation program for patients with heart disease. In Phase I, a cardiac rehab staff member visits patients before they leave the hospital to provide discharge activity guidelines and help identify an appropriate outpatient program. In 2011, these visits increased 300 percent – a direct result of inpatient referral becoming an integral part of acute MI core measures. Research Studies: • Patent Foramen Ovale closure with the AMPLATZER PFO OCCLUDER in Patients with Recurrent Cryprogenic Stroke due to presumed paradoxical embolism through a Patent Foramen Ovale who have failed conventional drug therapy (PFO ACCESS Registry) Principal Investigator: James Thompson, MD Current Status: Enrolling

Phase II is outpatient rehabilitation. Featuring medically supervised exercise and education, it helps patients increase strength and endurance after a cardiac event, and address ongoing risk factors. In 2011, Phase II enrollment increased 25 percent. Phase III is an unmonitored program for patients who want to continue to work on their risk factors. In 2011, the cardiac rehab program received its fourth AACVPR recertification and enrolled its first VAD patient. Overall patient satisfaction is high, with 94 percent saying they received “excellent” care.

Adult Congenital Heart Clinic 2008-2011 2008

2009

2010

2011

Total Patients

49

78

78

88

New Patients

13

14

16

xx

Follow Up Patients

36

64

62

xx

Cardiac Rehabilitation Patient Visits 2008-2011 Patient Visits

2008

2009

2010

2011

Phase I

482

379

543

1,839

Phase II

10,791

10,144

8,857

11,052

Phase III

1,406

1,025

814

1,023

Cardiac Rehabilitation outcomes – 2011 Total Enrollment

Under 39 Years of Age

40-59 Years of Age

60-79 Years of Age

80-99 Years of Age

Compliance

405

3.2%

34.1%

55.3%

7.4%

73%

Adult Congenital Heart Clinic Adults with congenital heart disease require ongoing subspecialty care and lifelong surveillance to ensure continued good health and quality of life. The Adult Congenital Heart Clinic at Inova Heart and Vascular Institute serves the unique healthcare needs of this patient population. Our multidisciplinary team of specialists offers comprehensive evaluation and ongoing management for all forms of congenital disease.

• Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the AMPLATZER PFO Occluder compared to Medical Management (PREMIUM) Principal Investigator: James Thompson, MD Current Status: Enrolling • Melody® Transcatheter Pulmonary Valve Therapy Humanitarian Use Device (HUD/HDE also available to pediatrics) Principal Investigators: James Thompson, MD/Sherif Tawfik, MD Current Status: Patients enrolled as warranted based on specific criteria

As a trailblazer in Northern Virginia, the clinic provides the latest surgical, non-surgical and minimally invasive treatment options. One of our most exciting new therapies is the Medtronic Melody® Transcatheter Pulmonary Valve, the first FDA-approved device to treat pulmonary valve conduit failure without open-heart surgery. To refer a patient, call 703.776.3599.

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25

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Interventional Catheterization Volume by Procedure 2009-2011

Inova Heart and Vascular Institute offers world-class care for the smallest, most vulnerable patients. Our nationally recognized pediatric cardiovascular program is one of the largest and most successful in the mid-Atlantic region. We have an outstanding reputation for successfully handling the most complex cases of heart disease in children. In 2011, we performed 276 cardiac surgeries on children of all ages, including 121 fragile infants weighing less than five kilograms. Our multidisciplinary team of pediatric heart surgeons and cardiologists is supported by pediatric cardiac anesthesiologists, cardiac perfusionists and cardiac operating room nurses, as well as a specially trained post-operative intensive care team.

VOLUME

Pediatric Cardiology and Cardiac Surgery

70 65 60 55 50 45 40 35 30 25 20 15 10 5 0

69

48

48

48

39

38 34

32 20

1

5 5

Hybrid Procedures

4

7

7 2

11

2

Coil Occlusion Atrial of Vessels Septostomies

Balloon Dilations

ASD Device Closures

PDA Occlusions

Type of Procedure

2009

2010

2011

Pediatric Procedures Procedure

Electrophysiology Volume by Procedure 2009-2011

Ventricular Septal Defect (VSD)

80

69

70

56

Volume

60

49

50 40 30 20 10

13 7

14

10

5 7

12

15 18

2009 Volume Survival

2010 Volume Survival

2011 Volume Survival

24

100%

27

100%

14

100%

Tetralogy of Fallot (TOF)

7

100%

10

100%

11

91%

Atrial Septal Defect

6

100%

4

100%

6

100%

Arterial Switch for TGA

4

100%

9

78%

6

100%

Valves/Conduits

31

100%

20

100%

13

100%

Atrioventricular Canal Repair (ACR)

8

100%

6

100%

7

100%

Total Anomalous Pulmonary Venous Return (TAPVR)

4

75%

2

100%

3

100%

Partial Anomalous Pulmonary Venous Return (PAPVR)

5

100%

5

100%

2

100%

Caval Pulmonary Connections (Glenns and Fontans)

18

100%

7

100%

17

100%

Coarctation of the Aorta

15

93%

9

100%

10

100%

Systemic-Pulmonary Shunt

2

100%

10

80%

9

100%

Pacemakers and ICDs (primary and replacements)

14

100%

20

100%

13

100%

Norwood/Damus-Kaye-Stansel/Hybrids

7

85%

10

80%

15

93%

ECMO Support

5

60%

12

55%

12

58%

0

ICDs

Pacers

EP

Ablations

Type of Procedure

2009

26

2010

2011

Research Studies: • Closure of Atrial Septal Defects with the AMPLATZER Septal Occluder Post Approval Study (ASD PMS II, also available to adults) Principal Investigator: James Thompson, MD Current Status: Enrolling

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Irving Shen, MD

27

Research Presentations Cardiac Surgery Research Research Presentations – Poster 1) Ad N, Henry L, Hunt S. Atrial Fibrillation Burden Perception and Improved Health Related Quality of Life Following the Cox Maze Procedure for Atrial Fibrillation. Boston AF Symposium 2011, Boston, MA, January 2011. 2) Hebsur S, Hunt S, Holmes S, Renard B, Henry L, Ad N. Clinical Outcomes and Quality of Life Assessment of Patients with Diabetes Mellitus Undergoing Surgical Ablation of Atrial Fibrillation. CRT 2011, Washington DC, February 2011. 3) Stone L, Holmes S, Martin L, Hunt S, Henry L, Ad N. The Advantage of Marital Status in Cardiac Surgery. American Psychosomatic Society 69th Annual Meeting, San Antonio, TX, March 2011. 4) Holmes S, Martin L, Henry L, Hunt S, Woolfolk C, Ad N. Psychosocial Experience and Impact of Recovery after Cardiac Surgery: Preliminary Analyses. American Psychosomatic Society 69th Annual Meeting, San Antonio, TX, March 2011. 5) Martin C, Holmes S, Desai S, Martin L, Hunt S, Henry L, Ad N. The Effect of Depressive Symptons on Blood Markers and Glucose Control in Isolated Coronary Artery Bypass Surgery Patients. American Psychosomatic Society 69th Annual Meeting, San Antonio, TX, March 2011. 6) Woolfolk C, Holmes S, Martin L, Henry L, Hunt S, Ad N. Measuring Sympton Burden in Valve Surgery Patients. American Psychosomatic Society 69th Annual Meeting, San Antonio, TX, March 2011. 7) Yang T, Henry LL, Nellmeyer M, Yonish K, Emmerson B, Seifert P. The Circulating Nurse’s Role in Error Recovery in the Cardiovascular Operating Room. AORN 58th Congress, Philadelphia, PA, March 2011. 8) Stone L, Holmes S, Martin L, Hunt S, Ad N. The Effects of Regular Exercise and Gender on Mood and Quality of Life in Cardiac Surgery Patients. Nutrition, Physical Activity and Metabolism and Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions, Atlanta, GA, March 2011. 9) Hebsur S, Desai S, Henry L, Holmes SD, Hunt SL, Ad N. The Role of the Hemorrhagic Score as a Predicator of Major Bleeding following Surgical Ablation for Atrial Fibrillation. American College of Cardiology Annual Meeting 2011, New Orleans, LA, April 2011. 10) Hebsur S, Willcox ME, Holmes SD, Speir A, Rongione AJ, Henry L, Hunt SL, Ad N. Evaluation of Four Risk Models inOperative and 1 Year Mortality in Patients Undergoing Aortic Valve Replacement. American College of Cardiology Annual Meeting 2011, New Orleans, LA, April 2011.

11) Halpin L, Henry L, Holmes S, Desai S, Hebsur S, Speir A, Ad N. Patient’s Discharge Disposition and Survival following Coronary Artery Bypass Surgery: Does it Really Matter? American College of Cardiology Annual Meeting 2011, New Orleans, LA, April 2011.

21) Henry S, Halpin L, Hunt S, Holmes SD, Hebsur S, Ad N. The Impact of Elevated Preoperative HgbA1c on Outcomes Following Valve Surgery. Society of Heart Valve Disease and Heart Valve Society of America 2011, Barcelona, Spain, June 2011.

4) Ad N, Hunt S, Holmes SD, Henry L. Concomitant Valve and Cox Maze Procedure is Safe and Effective in Treating Atrial Fibrillation – A Propensity Score Matched Analysis. Society of Heart Valve Disease and Heart Valve Society of America 2011, Barcelona, Spain, June 2011.

12) Ad N, Holmes SD, Henry L, Hunt S. Addition of the Cox Maze Procedure Does Not Increase Risk for Morbidity/Mortality following Surgery Involving the Mitral Valve. American College of Cardiology Annual Meeting 2011, New Orleans, LA, April 2011.

22) Hebsur S, Desai S, Steiner JM, Holmes SD, Henry L, Halpin L, Hunt SL, Ad N. Postoperative Outcomes and Survival in Patients with Aortic Valve Replacement with the Medtronic Mosaic Valve. Society of Heart Valve Disease and Heart Valve Society of America 2011, Barcelona, Spain, June 2011.

5) Henry L, Halpin L, Hunt SL, Holmes SD, Ad N. Patient Disposition and Long Term Outcomes Following Valve Surgery in Octogenarians. Society of Heart Valve Disease and Heart Valve Society of America 2011, Barcelona, Spain, June 2011.

13) Tran HA, Holmes SD, Martin LM, Henry LL, Desai S, Prall B, Lee J, Patel K, Stone LE, Martin CT, Hunt SL, Ad N. Weight, Dietary, and Quality of Life Changes Following CABG Surgery. Society of Behavioral Medicine 32nd Annual Meeting & Scientific Sessions, Washington DC, April 2011.

23) Martin L, Holmes SD, Henry L, Stone L, Martin C, Woolfolk C, Frazier A, Ad N. Predictors of Long-Term Quality of Life in Cardiac Surgery Patients. 18th Annual Conference of the International Society for Quality of Life Research, Denver, CO, October 2011.

6) Ad N, Henry L, Hunt SL, Holmes SD, Halpin L. Successful Cox Maze Procedure During Mitral Valve Surgery Restores Patient Survival Without Increasing Operative Risk. Society of Heart Valve Disease and Heart Valve Society of America 2011, Barcelona, Spain, June 2011.

14) Henry LL. A Multidisciplinary Development and Implementation of a Blood Conservation Program Among Coronary Artery Bypass Patients.American Association of Critical-Care Nurses Exposition, Chicago, IL, April 2011.

24) Halpin L, Henry L, Martin L, White J, Weaver L, Vourlekis J, Ad N. Use of the STS Database and Qualitative Research to Improve the Extubation Process and Outcome. The Society of Thoracic Surgeons Advances in Quality and Outcomes: A Data Managers Meeting, Atlanta, GA, October 2011.

7) Fortes DL, Khandhar SJ, Kiernan PD. Early Experience of a Robotic-Assisted Minimally Invasive Esophagogastrectomy Technique. Oral presentation at the International Society for Minimally Invasive Cardiothoracic Surgery Annual Scientific Meeting, Washington, D.C. June 2011.

25) Henry L, Hunt S, Stone L, Ad N. How Well Does Patient Self Report of Rhythm Following the Cox-Maze Procedure Fair When Tested Against Long Term Monitoring at 6 Months? American Heart Association Scientific Sessions 2011, Orlando, FL, November 2011.

8) Boyle A, Desai S, Salerno C, Teuteberg J. Expert Roundtable. New Left Ventricular Assist Devices for Bridge to Transplantation and Destination Therapy: Patient Selection and Outcome. The Medical Roundtable: Cardiovascular Edition. Fall 2011.

26) Ad N, Desai S, Holmes SD, Hunt S, Speir A, Henry L. The Impact of PeriOperative Blood Transfusion in Patients Undergoing Isolated Coronary Artery Bypass Grafting Surgery. American Heart Association Scientific Sessions 2011, Orlando, FL, November 2011.

9) Ad N, Sarin E, Holmes SD, Speir A, Choi E, Fitzgerald D, Halpin L, Hunt SL. The Impact of a Multidisciplinary Blood Conservation Protocol on Patient Outcomes and Cost Following Cardiac Surgery. 25th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Lisbon, Portugal, October 2011.

15) Ad N, Holmes SD, Hunt S, Stone L, Martin L, Henry L. How Well Does Return of Sinus Rhythm As Captured By Long Term Monitoring Translate to Improvement in Quality of Life of Patients Following Surgical Ablation. Heart Rhythm 2011 32nd Annual Scientific Sessions, San Francisco, CA, May 2011. 16) Ad N, Henry L, Hunt SL, Holmes SD. Left Sided Surgical Ablation with Concomitant Cardiac Surgery – What are the Results? Heart Rhythm 2011 32nd Annual Scientific Sessions, San Francisco, CA, May 2011. 17) Hebsur S, Holmes SD, Speir A, Rongione A, Henry L, Hunt S, Willcox M, Ad N. Aortic Valve Replacement: The Society of Thoracic Surgeons Risk Prediction of Mortality and One-Year Survival. ISMICS, Washington DC, June 2011. 18) Ad N, Hunt S, Henry L, Martin L. Surgical Ablation for Atrial Fibrillation: A Single Center’s Five Year Experience in 500 Patients. ISMICS, Washington, DC, June 2011. 19) Ad N, Henry L, Hunt S, Holmes SD. Deviations of the Cox Maze III/IV Lesion Set Documented By a Standardized Electronic Form Provides Detailed Outcomes. ISMICS, Washington, DC, June 2011. 20) Ad N, Hunt S, Henry L. Surgical Treatment For Atrial Fibrillation Using the New Generation Argon Based Cryoprobes: A Single Center’s Experience. ISMICS, Washington, DC, June 2011.

28

Research Presentations – Oral 1) Desai S, Henry L, Holmes SD, Hunt SL, Hebsur S. Strict Versus Liberal Target Range for Postoperative Glucose in CABG Surgery Patients. 91st Annual Meeting of the American Association for Thoracic Surgery, Philadelphia, PA, May 2011. 2) Ad N, Hunt S, Henry L, Holmes SD. Minimally Invasive Cox Maze III/IV Procedure Results- A Propensity Matched Study. International Society for Minimally Invasive Cardiothoracic Surgery Annual Scientific Meeting, Washington, DC, June 2011.

10) Ad N, Henry L, Hunt S, Holmes SD. The Outcome of the Cox Maze III Procedure for Atrial Fibrillation: A Propensity Match Analysis to Compare High Risk and Low Risk Patients. 25th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Lisbon, Portugal, October 2011. 11) Ad N, Henry L, Hunt S, Holmes SD. Should High Risk Patients Undergoing Cardiac Surgery With or Without Concomitant Cox Maze Procedure Expect Different Outcomes? A Propensity Score Matched Analysis. 58th Southern Thoracic Surgical Association Annual Meeting, San Antonio, TX, November 2011.

3) Ad N, Henry L, Hunt SL, Holmes SD. Do We Increase Operative Risk by Adding the Cox-Maze III Procedure to Aortic Valve Replacement and Coronary Artery Bypass Surgery? Western Thoracic Surgical Association 37th Annual Meeting, Colorado Springs, CO, June 2011.

29

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)

Publications

Physicians

Inova Heart and Vascular Institute’s specialists are among the world’s leading authorities on cardiovascular disease and author or co-author more than 30 articles annually.

Cardiac Surgeons Niv Ad, MD Nelson Burton, MD Lucas Collazo, MD John Garrett, MD Kai Ihnken, MD Paul Massimiano, MD John Rhee, MD Anthony Rongione, MD Eric Sarin, MD Irving Shen, MD Alan Speir, MD

Albert Del Negro, MD James Duc, MD Sarfraz A.K. Durrani, MD Margaret Bell Fischer, MD Ted D. Friehling, MD Abdul Haji, MD Denise Hurst, MD Robert L. McSwain, MD Haroon Rashid, MD Chirag M. Sandesara, MD David A. Strouse, MD Marc H. Wish, MD

Thoracic Surgeons Daniel Fortes, MD Sandeep Khandhar, MD Paul Kiernan, MD

Cardiology/ Cardiovascular Disease Khalid A. Abousy, MD Marjaneh Akbari, MD Muhammad Ali, MD Ather Anis, MD Walter L. Atiga, MD Michael R. Banihashemi, MD Subash B. Bazaz, MD Kambeez Berenji, MD Rachel L. Berger, MD Steven F. Berman, MD George A. Besch, MD Carl Bon Tempo, MD Kenneth M. Brooks, MD Christine D. Bussey, MD Dean Carpousis, MD Felix Castro, MD Eric J. Chan, MD Anthony C. Chang, MD Tania Chao, MD Keith H. Chu, MD Mariano D. Chutuape, MD Nicholas A. Cossa, MD Robert E. Cunnion, MD Anna Teresa Czajka-Giermasz, MD Stephen M. Day, MD Shashank S. Desai, MD Paul E. DiLorenzo, MD Thien M. Do, MD James Duc, MD Sarfraz A.K. Durrani, MD Michael G. Escano, MD Aldo R. Esposito, MD Cleveland Francis, MD William G. Franklin, MD Ted D. Friehling, MD Rajat Garg, MD Mohammad R. Ghafouri, DO John S. Golden, MD Michael H. Goldman, MD Tariq M. Haddad, MD

Recent publications include: Journal Articles (published or accepted for publication) 1) Ad N, Henry L, Hunt S. The Impact of Surgical Ablation in Patients with Low Ejection Fraction, Heart Failure and Atrial Fibrillation. The European Journal of Cardio-Thoracic Surgery. 2011 Jul;40(1):70-6. Epub 2010 Dec 18. 2) Ad N, Henry L, Hunt S, Holmes SD. The Outcome of the Cox Maze Procedure in Patients with Previous Percutaneous Catheter Ablation to Treat Atrial Fibrillation. The Annals of Thoracic Surgery. 2011 May:91(5):1371-7; discussion 1377. Epub 2011 Apr 1. 3) Holmes SD. American Heart Association Guidelines for Depression Screening in Heart Disease: Call to Action for the Research Community? J. Psychosom Res 2011 Jul;71(1):1-2. Epub 2011 Apr 22. 4) Ad N, Henry L, Hunt S. The concomitant cryosurgical Cox-Maze procedure using Argon Based Cryoprobes: 12 month results. J Cardiovasc Surg (Torino). 2011 Aug;52(4):593-9. Epub 2011 May 30. 5) Hunt S, Henry L, Ad N. Using Multiple Databases to Produce Comprehensive Follow-Up In An Effort to Enhance Evaluation of Outcome Measurements: Surgical Ablation (Maze) Exemplar. Journal for Healthcare Quality, Volume 33, Issue 3, pages 50-63, May-June 2011. 6) Abraham WT, Nademanee K, Volosin K, Krueger S, Neelagaru S, Raval N, Obel O, Weiner S, Wish M, Carson P, Ellenbogen K, Bourge R, Parides M, Chiacchierini R, Goldsmith R, Goldstein S, Mika Y, Burkhoff D, Kadish A.   Subgroup Analysis of a Randomized Controlled Trial Evaluating the Safety and Efficacy of Cardiac Contractility Modulation In Advanced Heart Failure. Journal of Cardiac Failure.  In Press. June 2011. 7) Goudarzi M, Ross MM, Zhou W, Van Meter A, Deng J, Martin LM, Martin C, Liotta L, Petricoin E, Ad N. Development of a Novel Proteomic Approach for Mitochondrial Proteomics from Cardiac Tissue from Patients with Atrial Fibrillation. J Proteome Res. 2011 Aug 5;10(8):3484-92. Epub 2011 Jul 8. 8) Fortes DL, Tomaszek SC, Wigle DA. Early experience with robotic-assisted lung resection. Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery, 2011 Jul/Aug;6(4):237-242. 9) Goldstein N, May C, Meier D. A Comprehensive Care for Mechanical Circulatory Support A New Frontier for Synergy with Palliative Care. Circulation: Heart Failure. 2011; 4:4 519-527. 10) Kiernan PD, Khandhar SJ, Fortes DL, et al: Thoracic Esophageal Perforation: CVTSA/Inova Fairfax Hospital Experience, 1988-2009. The American Surgeon, 76: 1355-62, 2011.

11) Kiernan PD, Khandhar SJ, Fortes DL. et al: Thoracic Surgery in Octogenarians – CVTSA/Inova Fairfax Hospital Experience, 1990-2009. The American Surgeon, 77: 675-80, 2011. 12) Ad N. The Challenge of Defining Procedural Endpoints for the Surgical Treatment of Atrial Fibrillation. European Journal of Cardio-Thoracic Surgery. 2012; 41(1):19-20. 13) Ad N, Henry L, Hunt S, Holmes S. The Impact of Surgical Ablation for Atrial Fibrilllation in High-Risk Patients. The Annals of Thoracic Surgery. 2012; 93(6):1897-903. Abstract Publications (published or accepted for publication) 1) Tran HA, Holmes SD, Martin LM, Henry LL, Desai S, Prall B, Lee J, Patel K, Stone LE, Martin CT, Hunt SL, Ad N. (2011). Weight, Dietary, and Quality of Life Changes Following CABG Surgery. Annals of Behavioral Medicine, 41 (S1), s163. 2) Holmes SD, Martin LM, Henry LL, Hunt SL, Woolfolk C, Ad N. (2011). Psychosocial Experience and Impact of Recovery After Cardiac Surgery: Preliminary Analyses. Psychosomatic Medicine, 73(3), A101. 3) Martin CT, Holmes SD, Desai S, Martin LM, Hunt SL, Henry LL, Ad N. (2011). The effect of Depressive Symptons on Blood Markers and Glucose Control in Isolated Coronary Artery Bypass Surgery Patients. Psychosomatic Medicine, 73(3), A43-A44. 4) Stone LE, Holmes SD, Martin LM, Hunt SL, Henry LL, Ad N. (2011). The advantage of Marital Status in Cardiac Surgery. Psychosomatic Medicine, 73(3), A-80. 5) Woolfolk C, Holmes SD, Martin LM, Henry LL, Hunt SL, Ad N. (2011). Measuring Sympton Burden in Valve Surgery Patients. Psychosomatic Medicine, 73(3), A101. 6) Hebsur S, Holmes SD, Speir A, Rongione A, Henry L, Hunt SL, Willcox M, Ad N. Aortic Valve Replacement: The Society of Thoracic Surgeons Risk Prediction of Mortality and One-Year Survival. Innovations. In Press. 7) Ad N, Hunt SL, Henry L, Martin L. Surgical Ablation for Atrial Fibrillation: A Single Center’s Five-Year Experience in 500 Patients. Innovations. In Press. 8) Ad N, Henry L, Holmes SD, Hunt SL. Do We Increase the Operative Risk by Adding the Cox-Maze III Procedure to Aortic Valve Replacement and Coronary Artery Bypass Surgery? The Journal of Thoracic and CardioVascular Surgery. In Press.

Vascular Behdad Aryavand, MD Maseer Bade, MD Sandeep Bagla, MD Kambeez Berenji, MD Steven Busuttil, MD James Cooper, MD Alain Drooz, MD John Edwards, MD Rajat Garg, MD Homayoun Hashemi, MD Hong Lim, MD Allen Joseph, MD Mike Karnaze, MD Charanjit Khurana Albert Kim, MD Salman Mufti, MD Dipankar Mukherjee, MD Calvin Neithamer, MD Richard Neville, MD Dimitrios Papadouris, MD Craig Powell, MD Rodeen Rahbar, MD Bryan Raybuck, MD Ken Rholl, MD Tariq Shahab, MD Rahsaan Smith David Spinosa, MD Keith Sterling, MD Hamid Taheri, MD Arina van Breda, MD Jay Varma, MD Shahram Yazdani, MD Cardiac Electrophysiology Walter L. Atiga, MD Anthony C. Chang, MD

Afsane Haddad-Mashad, MD Abdul Haji, MD Richard J. Hart, MD Jack D. Horton, MD Denise L. Hurst, MD Jeffrey A. Jackman, MD George O. Jones, MD Jeanne M. Kairouz, MD Laurance W. Kam, MD Robert D. Kelberg, MD Andrew J. Keller, MD Sateesh Kesari, MD Fareeha I. Khan, MD Charanjit S. Khurana, MD Joseph M. Kiernan, MD Albert Kim, MD Gulam-Mohmed M. Kolia, MD Bhanu Krishnan, MD Sara Kulangara, MD Cynthia Lee, DO Todd C. Lewis, MD Yaning Liu, MD Jeffrey S. Luy, MD Shahryar Mafi, MD P.F. Adrian Magee, MD Alireza Maghsoudi, MD Ara M. Maranian, MD Carey Marder, MD Christopher May, MD Robert L. McSwain, MD Stuart A. Meyers, MD Lawrence A. Miller, MD Azita Moalemi, MD Jason M. Morda, MD Alfred C. Myaing, MD Pradeep Nayak, MD Minh Van Ngo, MD Michael P. Notarianni, MD John T. O’Brien, MD Paul J. O’Brien, MD Antonio R. Parente, MD Young D. Park, MD Dhaval Patel, MD Richard P. Perrin, MD Paula Pinell-Salles, MD Pio F. Poblete, MD Dean M. Pollock, MD Ashok J. Prasad, MD Todd C. Pulerwitz, MD Narian P. Rajan, MD Gautam Ramakrishna, MD Devanhalli Ramaswamy, MD Haroon Rashid, MD Bryan D. Raybuck, MD Archana Reddy, MD

Kevin M. Rogan, MD Arnold J. Rosenblatt, MD Stephen P. Rosenfeld, MD Lawrence R. Rubin, MD Anne M. Safko, MD Chirag M. Sandesara, MD Richard A. Schwartz, MD S. Tariq Shahab, MD Rishabh Sharma, MD Stuart Sheifer, MD Harvey S. Sherber, MD Robert A. Shor, MD Padma Shukla, MD Balbir S. Sidhu, MD James N. Sipes, MD Tseday E. Sirak, MD Prachak Siriprakorn, MD Tina L. Slottow, MD Rahsaan C. Smith, MD Michael A. Solomon, MD David A. Strouse, MD Anne E. Summers, MD Hassan Tabandeh, MD Raghu R. Tadikamalla, MD Hamid Taheri, MD Mark P. Tanenbaum, MD Naghmeh Tebyanian, MD Eric M. Thorn, MD Ketan K. Trivedi, MD Constantine J. Tziros, MD Raymond Vergne, MD Mark C. Vives, MD Marc H. Wish, MD Jerzy W. Wrobel, MD Jonathan E. Yager, MD Shahram Yazdani, MD Kambiz Yazdani-Najafabadi, MD M. Rafiq Zaheer, MD Interventional Cardiology Khalid A. Abousy, MD Marjaneh Akbari, MD Tariq A. Aziz, MD Kambeez Berenji, MD George A. Besch, MD Carl Bon Tempo, MD Kenneth Brooks, MD Mariano D. Chutuape, MD Nicholas A. Cossa, MD Stephen M. Day, MD Paul E. DiLorenzo, MD Aldo R. Esposito, MD William G. Franklin, MD Rajat Garg, MD John S. Golden, MD

Michael Goldman, MD Jack Horton, MD Andrew Keller, MD Charanjit S. Khurana, MD Joseph M. Kiernan, MD Albert Kim, MD Warren Levy, MD Todd C. Lewis, MD P.F. Adrian Magee, MD Stuart Meyers, MD Lawrence A. Miller, MD John T. O’Brien, MD Antonio Parente, MD Richard Perrin, MD Dean M. Pollock, MD Narian P. Rajan, MD Bryan D. Raybuck, MD Kevin M. Rogan, MD Stephen Rosenfeld, MD S. Tariq Shahab, MD Harvey S. Sherber, MD Robert Shor, MD Balbir Sidhu, MD Prachak Siriprakorn, MD Tina L. Slottow, MD Rahsaan C. Smith, MD Hamid Taheri, MD Raymond Vergne, MD Jerzy W. Wrobel, MD Shahram Yazdani, MD M. Rafiq Zaheer, MD Interventional Radiology Sandeep Bagla, MD James Cooper, MD Alain Drooz, MD Allen Joseph, MD Mike Karnaze, MD Hong Lim, MD Salman Mufti, MD Calvin Neithamer, MD Dimitrios Papadouris, MD Ken Rholl, MD David Spinosa, MD, Keith Sterling, MD Arina van Breda, MD Jay Varma, MD

31

30

2012 Cardiac Clinical & Surgical Outcomes Report (based on 2011 data)