The Washington DC VA Medical Center (DCVAMC) has a long, proud history of performing cardiac surgery dating from the early 1960's. The Cardiothoracic Surgery program, part of Surgical Service, took a dramatic turn in the early 1990's under the leadership of Chief of Cardiology, Dr. Ross D. Fletcher, our current Chief of Staff, and Dr. Benjamin Aaron, then Chief, Cardiothoracic Surgery at The George Washington University.
Currently, an innovative and dynamic young cardiac surgeon, Dr. Gregory Trachiotis, is the Chief of Cardiac Surgery for VISN 5, leads the cardiac surgical team at DCVAMC, under the direction of internationally recognized surgeon, Dr. Anton Sidawy, Chief, Surgical Service.
Dr. Pendleton Alexander, who was recruited by Dr. Aaron in 1990, provides tools for safe and effective surgery and resident training at our facility and helps create a culture of consistent quality patient care. Dr. Gregory Trachiotis was recruited in 1998 due to the ever increasing demands for cardiac surgical services.
Along with Drs. Alexander and Trachiotis, the team consists of 3 physician assistants, two perfusionists, three dedicated cardiovascular OR nurses, 2 dedicated cardiac anesthesiologists, and 6-8 dedicated cardiac ICU nurses.
In the past three years, referrals for cardiac surgery have consistently increased. Over 35% of patients come from the VA Maryland Health Care System (VAMHCS), 30% come from the Martinsburg VAMC, and the remainder come from the Washington, DC area. Approximately 10-15% of all of our patients are referred beyond 150 miles. Therefore, our role as a leader in cardiac surgery is regional in perspective.
Since 2001, the program has developed the highest percentage of beating heart procedures (70%) of all cardiac cases in the Washington, DC area. The surgical team is a model of excellence in areas such as: atrial fibrillation using radiofrequency bipolar ablation (RFA) techniques (a less invasive surgical method to treat arrhythmia) and high risk surgical revascularization (complex treatment of coronary artery disease associated with abnormal heart muscle function.
The team has expanded operations to heart failure patients, including; refining valve repair and reconstruction techniques and, since 2004, utilizing mini-circuit cardiopulmonary bypass. DCVAMC operates the only cardiac program in the area to use this technology.
We are able to provide complete cardiac surgery care to patients including coronary artery by-pass graft (CABG), valve surgery, aortic root reconstruction, aneurysm surgery, arrhythmia surgery, high risk surgery for heart failure, and more.
Our cardiac surgery program is actively involved in clinical research and participated in the VA Cooperative ON versus Off Pump trial. DCVAMC is the only Medical Center participating in the Rheos Device Feasibly Trial, a study of an implantation device to help control refractory hypertension. Dr. Trachiotis was part of the team that published the techniques and outcomes of this implantable device showing a significant impact on lowering refractory hypertension.
Through encouraging creativity and independent career growth in combination with team building and support, DCVAMC has attracted and retained among the most highly trained and skilled physicians and colleagues in the nation and our performance data proves this to be true.
VA’s electronic medical record system (EHR) is an exceptional tool for providing excellence in practice, as it relates to surgery. EHR ensures accuracy in identifying patients, screening and tracking their illnesses, reviewing local or distant facility data, and coordinating care with all providers. Moreover, through the use of EHR, we can ensure our patients are being treated with the proper medication and doses. EHR is one factor in our success in exceeding targets for cardiac disease risk factors.
Great staff work and VA’s world-renown electronic health records system have proven to be instrumental in the vital area of surgical antibiotic dispensing, where DCVAMC surpasses the private sector in the three most significant measures.
|Antibiotics in Surgical Care||DCVAMC||Private Sector|
|Antibiotic Selection Rate||100%||91%|
|Antibiotic Received within 1hr.||95%||73%|
|Antibiotic Stopped within 24 hrs.||79%||62%|
The VA national database (CICSP) confirms that VA and VISN5 are among the top 5 of all 42 cardiac programs in the VA system with regard to mortality and morbidity figures. These results compare more than favorably to Medicare or university hospital outcomes. For example, in the area of CABG mortality, once again, DCVAMC significantly beats the private sector.
|Un-adjusted Mortality (FY2007)||.90%||1.5%|
|O/E ratio (Observed over Expected)||.64%||1.0%|
|CABG un-adjusted mortality (First half of FY07)||0%||2.06%|
|CABG un-adjusted mortality (Second half of FY07)||0%||1.5%|
O/E: The ratio between the observed un-adjusted mortality for the Medical Center and the expected mortality rate adjusted based on the profile of patients undergoing surgery.
CABG: Coronary Artery Bypass Graft
Currently, the cardiac surgical team is working on expanding the Medical Center’s heart failure program to include mechanical assist device therapy. And, we are developing a hybrid operating room suite for minimally invasive procedures. This operating room will have full connections to electronic health records, cameras, and video conference capabilities; all to enhance training and education for our students, residents, and colleagues, and ultimately to offer better and safer care to veterans.
Members of our Surgical Service and the Cardiothoracic Surgery team have a passion for their profession, their fellow team members, and most importantly for providing excellent health care to our nation's veterans. Veterans and their families can be assured that this cadre of high-performing clinicians will continue to reach out to them and their families by providing excellent quality care utilizing state-of-the art equipment and technical support.