February 2013 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine

 

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Emory Surgery Ranked #5 in NIH awards for FY2012

Dr. Lily Yang, cancer researcher of the Department of Surgery at Emory.
Multiple NIH and NCI grants fund Dr. Lily Yang's development of novel approaches for detection and treatment of human cancer.

Continuing the trend that began in fiscal year 2008, the Department of Surgery of the Emory University School of Medicine was ranked #5 in NIH awards for all departments of surgery nationwide in fiscal year 2012, the fifth year in a row it has achieved this level. The stats were obtained from the Blue Ridge Institute for Medical Research, which has published ranking tables online of annual NIH funding since 2006. The data is calculated from the NIH's Research Portfolio Online Reporting Tool (RePORT).

In a type of symbolic endorsement of his recent move from chair of the Department of Surgery to dean of the Emory University School of Medicine, Dr. Chris Larsen was listed as the top funded principal investigator in 2012, a placement befitting an internationally recognized leader in transplant surgery and immunology. Dr. Allan Kirk, vice chair of research of the Department of Surgery and fellow transplant surgeon-scientist, was listed in the 8th position. Additional Emory Surgery faculty listed in the top 250 funded PIs were Drs. John Calvert, Craig Coopersmith, Mandy Ford, David Lefer, Kenneth Newell, John Puskas, and Lily Yang.

While the ongoing ranking can be seen as a testament to the NIH's confidence in the vigor of the Department's research endeavors, it should not be interpreted as a sign of Emory Surgery's dependence on the agency's largesse. The Department has consciously worked towards diversifying away from NIH funding to sustain its substantial clinical portfolio, and our faculty have had great success in acquiring alternate funding sources such as the FDA, Department of Defense, Centers for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, American Society of Transplantation, Georgia Cancer Coalition, AVON Foundation, and numerous industry sponsors.

In fiscal year 2012, 38% of Department of Surgery faculty were PIs, up from 26% the prior year, and our faculty published approximately 195 peer-reviewed papers in 91 journals, also an increase from 2011. "The sustained success of our faculty is attributable to their embracing of a concept of collegial and team-oriented science," says Dr. Kirk. "We see this strong showing as a tribute to the faculty's willingness to support scientific investigation alongside clinical practice, and in doing so to providing the best treatment for the patients we see today and those we will see in the future."

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Dr. John Puskas
Dr. Puskas

CRU medical director Dr. Puskas leads three FDA-IDE trials

Founded only eight years ago by Dr. John Puskas, the Clinical Research Unit (CRU) of the Division of Cardiothoracic Surgery of the Emory University School of Medicine has quickly evolved into a distinguished center for innovative translational and comparative effectiveness studies in cardiothoracic surgery. The program's first major boost came in 2007 via an NIH National Heart, Lung, and Blood Institute U01 grant that named Dr. Puskas principal investigator of the CRU as a core clinical center within a collaborative, adult cardiac surgery research consortium. Additional highlights followed, including Dr. Michael Halkos' receipt of an NIH K23 grant—a first for an Emory Surgery faculty member—to support his evaluation of different clamping strategies during coronary artery bypass graft surgery (CABG), and Dr. Vinod Thourani's ongoing participation in the multi-center PARTNER trial examining transcatheter aortic valve replacement (TAVR). Today, the CRU is considered a go-to research group for entities that hope to bring new devices and ground-breaking technologies to surgical care, and Dr. Puskas' current undertakings as international PI of three separate FDA Investigational Device Exemption (IDE) trials underscores this status.

Representing a network of investigators from 36 cardiothoracic surgical centers in the U.S. and Europe, Dr. Puskas will report interim data from the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) at the upcoming 2013 annual meeting of the American Association for Thoracic Surgery. The trial is evaluating whether patients implanted with the On-X mechanical valve can be safely maintained with reduced levels of such anticoagulation drugs as warfarin, which are prescribed to prevent blood clots from developing on or around the valve but can increase risk of excessive bleeding.

"Several design features of the On-X valve differ from earlier mechanical valves, resulting in more laminar flow of blood through the valve, lower pressure gradients, smaller regurgitant closing volumes, and less hemolysis," says Dr. Puskas. "If longer term follow-up confirms what we've found so far, guidelines for anticoagulation could be re-written and patients may enjoy a more favorable trade-off between bleeding and clotting complications after mechanical valve replacement."

Dr. Puskas and the Emory CRU are also leading a multicenter, international randomized trial of a novel nitinol mesh to provide external support and prolong the patency of the saphenous vein grafts used in CABG surgery. Nitinol is a durable, extremely elastic, biocompatible metal with a long history of safety in medical devices. If proven effective in minimizing degeneration of saphenous vein grafts, Dr. Puskas believes this new technology could be a game-changer in the treatment of coronary artery disease.

For the third trial, Dr. Puskas and his research team are testing the ability of Edwards GLX next-generation tissue treatment platform to prevent calcification in the bovine pericardial tissue used to manufacture prosthetic heart valves. Calcification is one of the primary causes of deterioration in these valves. "If approved by the FDA, this technology would be applied across the entire field of bioprosthetic heart valves, potentially prolonging the durability of those valves and allowing thousands of patients worldwide to avoid reoperation," says Dr. Puskas.

Dr. Puskas is quick to acknowledge that sustaining the level of research activity the CRU has become accustomed to would be impossible without its support staff. "When our administrative director Kim Baio, MSN, came aboard in 2005, she understood that building the program's organizational team was essential, and we now have 18 full-time research staff members. That includes nurses, coordinators, database personnel, and biostatisticians, all of whom excel at tackling the details that allow the researchers to focus on what they do best."

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Dr. William Wood
Dr. Wood

Dr. William Wood to be honored with 2013 Second Century Award

Since 2006, Emory Healthcare has honored distinguished health care and community leaders at the Second Century Awards Dinner, recognizing physicians and community philanthropists at Emory University Hospital and Emory University Hospital Midtown. This year, EHC will broaden the significance of this acknowledgement by adding Emory Johns Creek Hospital and Saint Joseph's Hospital and designating one leader from each of the four hospitals. Honorees are selected for their significant impact on the care of countless Georgians, as nominated by supporters of the participant hospitals and previous award recipients.

At this year's celebration on March 21st, acclaimed surgical oncologist and researcher Dr. William C. Wood, chair of the Department of Surgery of the Emory University School of Medicine and EUH's chief of surgery from 1991-2009, will be presented with the Lettie Pate Whitehead Evans Award for Emory University Hospital.

During his tenure as chair, Dr. Wood raised the Department of Surgery to new heights of excellence in clinical care, education, and research. He guided the Department from having no NIH grants in 1991 to being ranked the 5th leading academic department of surgery in NIH funding nationwide in fiscal year 2008, finding time along the way to mentor literally hundreds of surgical residents.

After the chairmanship, Dr. Wood intensified his focus on scholarly activities related to innovation in cancer treatment. He retired from The Emory Clinic in August 2011 to become more active in global health. He was appointed the first academic dean of the Pan African Academy of Christian Surgeons and now travels periodically to Africa to assist the program directors of various surgical residencies. One of these is Dr. Jon Pollock, who leads Emory Surgery’s Global Surgery program at Soddo Christian Hospital in Ethiopia.

Invitations to the event will be mailed to all Emory Department of Surgery faculty.

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Dr. Ravi Rajani
Dr. Rajani

First patient treated in TRANSFIX study for blunt thoracic aortic injury at Grady Memorial Hospital

Dr. Ravi Rajani, director of the vascular and endovascular surgery program at Grady Memorial Hospital, has enrolled and treated the first patient in the TRANSFIX study for blunt thoracic aortic injury (BTAI). Dr. Rajani and his Grady team recently began participating in the FDA-approved, prospective, multicenter, nonrandomized study, which is assessing the safety and effectiveness of the Zenith® TX2® Low Profile Endovascular Graft in the treatment of patients with BTAI of the descending thoracic aorta. The study is sponsored by Cook Medical.

"The study is expected to enroll up to 50 participants in up to 30 institutions in the U.S., with approximately ten patients participating from Grady," says Dr. Rajani. "I'm honored to have implanted the first device nationally for this important trial."

After head injury, BTAI is the second most common cause of death in trauma patients and is often caused by motor vehicle accidents and falls from great heights. While open surgical repair had been the standard of care for patients with BTAI, it has been associated with high mortality and morbidity rates. In recent years, endovascular repair has emerged as a treatment option and has been reported to exhibit lower rates of mortality and morbidity compared to open repair in several meta-analyses. However, challenges also exist with currently available thoracic endovascular grafts in the treatment of patients with BTAI. On average these patients are much younger than those treated for other thoracic aortic diseases such as aneurysms, and require smaller diameter endovascular grafts with better arch conformability.

"The TX2 low-profile device may allow surgeons to treat patients with difficult or tortuous arterial access who might otherwise have been ineligible for endovascular aortic repair," says Dr. Rajani. "Trauma patients often include women and smaller-bodied adults with more narrow and angulated arteries that can impede the accurate positioning of an endovascular graft using currently available, larger-diameter delivery systems."

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Dr. Ravi Veeraswamy
Dr. Veeraswamy

Emory the only site in Georgia for trial of new branched aortic stent graft

Emory University vascular surgeon and associate professor of surgery Dr. Ravi Veeraswamy is the local PI of a multi-center, FDA-approved clinical trial for a new stent graft designed as a minimally invasive option for patients with juxtarenal (JAA) and pararenal (PAA) aortic aneurysms. Sponsored by Endologix, Inc., the trial will evaluate the safety and efficacy of the Ventana™ Fenestrated System for these patients. Emory is the only site in Georgia for the trial.

"Early clinical experience outside of the United States with the device has been promising," says Dr. Veeraswamy. "Until now, there has not been an 'off the shelf' graft that could treat these complex aneurysms that involve the renal arteries. We had to burn holes in existing grafts, which is obviously less than ideal, or have customized devices made by the graft companies for each patient, which takes time, labor, and expense."

Open repair for patients with JAA or PAA—who represent approximately 20% of AAA patients—can result in significant blood loss, complication rates, and long hospital stays

"Open surgical repair of JAA or PAA is one of the most invasive procedures we perform," says Dr. Veeraswamy. "We're hopeful this new device will permit a less invasive treatment to be extended to a much larger group of patients."

The distinguishing characteristics of the Ventana system include a main column intended to protect the aorta and exclude the aneurysm from blood flow, and two branched renal stent grafts that are inserted through the main device and into the renal arteries to maintain blood flow to the kidneys.

Dr. Veeraswamy and his team are actively screening and enrolling eligible patients for the Ventana trial at Emory. Patients and referring physicians interested in learning more about the trial may contact Dr. Veeraswamy at 404.778.3191 or rveeras@emory.edu.

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Emory Medishare feature documents the success of an uncommon mission/education fusion

Emory 4th year medical student Ira Leeds has traveled to Haiti three times for Emory Medishare surgical missions.
Emory 4th year medical student Ira Leeds has traveled to Haiti three times for Emory Medishare surgical missions.

"A win for all: Faculty-student partnerships in surgical humanitarianism," coauthored by participants in the project and published in the February 2013 Bulletin of the American College of Surgeons, compellingly describes the benefits Emory Medishare brings to patients, its faculty and student collaborators, and the field of surgical missions. Displaying true faith in the validity of their method, Emory medical student Ira Leeds, general and GI surgeon Dr. Jahnavi Srinivasan, and urology surgeon-scientist Dr. Viraj Master also address the perceived limitations of the program, the criticisms that cite these limitations, and Emory Medishare's ongoing attention to developing solutions that will not damage its goals.

As Emory Medishare prepares for its 5th annual trip to Haiti’s Hôpital St. Thérèse from June 13-July 2, this timely retrospective serves as both an informative primer for those that aren't familiar with the history, ethos, and structure of the Emory faculty-student collaboration, as well as a reminder of just how special and unique the program is. Despite the increase of surgical humanitarian efforts that incorporate educational features, medical students are rarely included. Beyond the objective of providing the highest quality care possible to the rural Haitian patient population, the heart of Emory Medishare remains the interaction between its faculty, who provide appropriate clinical supervision and perform all surgical procedures, and its medical students, who manage virtually all other components of the missions.

On the 2010 trip to Haiti, Dr. Srinivasan and Dr. Master perform an ultrasound evaluation of an abdominal mass while teaching medical students Lee Hugar and Pete Creighton the diagnostic technique.
On the 2010 trip to Haiti, Dr. Srinivasan and Dr. Master perform an ultrasound evaluation of an abdominal mass while teaching medical students Lee Hugar and Pete Creighton the diagnostic technique.

Enjoy the following excerpts from the article, or click here to read the entire feature.

"It is important to note that this program does not simply provide medical students with the opportunity to obtain international experience. Instead, it is a surgical mission that authentically integrates medical education into its greater humanitarian objectives. In the strictest sense, these trips demand far more of medical students than just 'showing up.' Such a program is a radical departure from the typical role of medical students in international health.

"Students have routinely reported that the empowering roles they hold as nonclinical trip leaders and the intensely fulfilling mentoring relationships formed in the months preceding the trip are unseen elsewhere in the traditional medical student curriculum. These trips also mark one of the few times in their medical school clinical training where students meet patients at first presentation and diagnosis, follow them to the operating room, coordinate all facets of postoperative care, and then provide for discharge. Consistent with today's trends in health care systems training, students are encouraged to consider the optimal care pathway given the patient's limited external resources and the lack of access to further diagnostic testing.

"One of the most surprising benefits of this program has been the degree to which attending surgeons find personal development from the experience. With unnerving consistency, each year produces a few clinical cases that push the attending faculty to balance their surgical scope of expertise with the utter lack of resources or support if unexpected problems arise. The participating faculty have noted that opportunity to perform these types of procedures in settings that do not otherwise lend themselves to surgical care is immensely rewarding and is part of what motivates them to make the sacrifices of time and personal resources that are a consequence of participating in these missions."

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Upcoming events

EVENT DATE/TIME LOCATION
Financial Aid: Moral Imperative, Competitive Tool, or Unsustainable Burden?
Sponsored by the University Senate
Presented by Sandy Baum, PhD
– Professor Emerita of Economics at Skidmore College
– Senior Fellow at the George Washington University School of Education and Human Development
– Senior Associate at the Institute for Higher Education
4:00 p.m., Mar. 5, 2013 Jones Room, Woodruff Library
SURGICAL GRAND ROUNDS
7th Annual Robert B. Smith, III, Visiting Professorship
Hemodynamics for Surgeons

Presented by David Nelson Ku, MD, PhD
– Regents' Professor of Mechanical Engineering, Lawrence P. Huang Chair Professor of Engineering Entrepreneurship, George W. Woodruff School of Mechanical Engineering and Scheller College of Business, Georgia Institute of Technology
7:00 - 8:00 a.m., Mar. 7, 2013 EUH auditorium
SURGICAL GRAND ROUNDS
Adolescent Bariatric Surgery: Food for Thought
Presented by Drew Rideout, MD
– Pediatric Surgery Fellow, Division of Pediatric Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Mar. 14, 2013 EUH auditorium
SURGICAL GRAND ROUNDS
Robert A. Bays Lectureship
Temporomandibular Joint Reconstruction: A Paradigm Shift

Presented by Gary F. Bouloux, DDS, MD, MDSc
– Associate Professor of Surgery and Director of Research, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine
– Chief, Oral and Maxillofacial Surgery Section, Grady Memorial Hospital
7:00 - 8:00 a.m., Mar. 21, 2013 EUH auditorium
Surgery Division Chiefs Meeting 5:30 - 7:00 p.m., Mar. 26, 2013 EUH Whitehead Room
EUH Surgical Services Performance Day
A quarterly review and analysis of surgical services performance among anesthesia, surgery, and OR staff of Emory University Hospital.
7:00 - 8:00 a.m., Mar. 28, 2013 EUH auditorium
Novel Signalling Networks that Prevent the Development of Autoimmune and Inflammatory Diseases
Sponsored by the Department of Biochemistry
Presented by Sir Philip Cohen, FRS
– Foreign Associate of the National Academy of Sciences, Professor of Enzymology, Medical Research Council Protein Phosphorylation Unit, University of Dundee, Scotland
4:00 - 5:00 p.m., Apr. 8, 2013 Ground Floor Auditorium, WHSCAB
     
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