February 28, 2014 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


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Allan Kirk
When he announced the introduction of the Emory Transplant Center's telemedicine program, Dr. Kirk said: "Anything that breaks down a barrier between a patient and a physician ultimately improves care."

Dr. Kirk returns to his alma mater

Dr. Kirk mentoring resident Steven Kim in the lab.
Dr. Kirk mentoring resident Steven Kim in the lab.

In early May, Dr. Allan Kirk will assume the chairmanship of the Department of Surgery of the Duke University School of Medicine and become surgeon-in-chief for the Duke University Health System, though he will remain an Emory adjunct volunteer faculty member to facilitate the continuation of several of his Emory-based clinical investigations.

"This is bittersweet news," says Dr. John Sweeney, interim chair of the Emory Department of Surgery. "Allan's drive to develop new therapies to improve the success of organ and tissue transplantation began at Duke. It's where he received his MD and his PhD in immunology; where he did his research fellowship and his residency. Clearly, this is a tremendous honor and reflects both his accomplishments and who he is as a person, and is also a strong endorsement of the great people we have here at Emory. However, I'm sure I speak for the entire department when I say how much we will miss Allan, both professionally and personally. He has become a great friend to me and I have grown to appreciate his counsel and advice."

When Dr. Kirk arrived at Emory in 2007 as a Georgia Research Alliance Eminent Scholar in Transplantation Immunology to be scientific director of the Emory Transplant Center and professor of surgery in the departments of surgery and pediatrics, he was already an internationally recognized surgical scientist and authority on transplant rejection and the development of less morbid therapies for transplant recipients. He had just completed four years as a senior investigator and founding chief of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) transplantation branch of the NIH, where he initiated several clinical trials aimed at reducing the need for immunosuppression in humans.

As he resumed his clinical practice in adult and pediatric kidney/pancreas transplantation at Emory, Dr. Kirk applied for grants from the GRA, NIH, FDA, DoD, and foundational and corporate sponsors. In the first award he received, submitted the day he arrived at Emory, Clinical Trials in Organ Transplantation in Children (CTOT-C) named him the national PI of a multi-center study that sought to develop alternatives that would make drug therapy safer for children requiring transplants. Operating on the premise that children are often over-immunosuppressed, the consortium is defining how pediatric kidney transplant patients' immune repertoires evolve so that therapy can be tailored to individual children over time. The additional awards that followed addressed methods of immune management in such surgically relevant conditions as transplantation and trauma. In 2011 and 2012 Dr. Kirk placed in the top 10 funded PIs in NIH annual awards as reported by the Blue Ridge Institute for Medical Research, though the substantial grants he received from other sources set the example for department faculty to seek alternate funding opportunities as much as possible to offset NIH budget reductions.

After being appointed vice chair of research of the Department of Surgery in 2009, Dr. Kirk focused on inspiring and galvanizing the department's pool of talented investigators, be they established or up-and-coming. "Dr. Kirk has fostered and nurtured numerous faculty members' research agendas," says Lisa Carlson, the department's director of academic affairs. "He has worked with them across divisions and at all levels through every step of the process, from brainstorming ideas to experiment planning to writing proposals. He dedicated himself to guiding people to define their strengths so they could translate their passions into science that makes a difference."

Emory became the home of the top transplantation journal in the world when Dr. Kirk was named editor-in-chief of the American Journal of Transplantation in 2010. The consistent impact factor and prodigious rate of Dr. Kirk's own publications undoubtedly qualified him for this honor. He has authored more than 200 original scientific manuscripts and is the lead editor of the upcoming Textbook of Organ Transplantation, which was prepared over the past two years and will be the most comprehensive educational book in the field to date.

A mentor, advisor, and teacher to new faculty, medical students, residents, and fellows, one of Dr. Kirk's crowning educational achievements was the 2012 competitive renewal of an NRSA Institutional Research Training Grant (T32), which remains the only pre-doctoral and post-doctoral surgical training grant in the country for transplantation. The T32 seeks to ensure that a diverse and highly trained workforce is available to assume leadership roles to advance the nation's biomedical and clinical research agenda. The grant gave medical students and residents the opportunity to assist Dr. Kirk and his colleagues in their labs and to participate in the rigor and reward of working towards expediting individualized immune therapies and improving transplant recipient outcomes.

"Allan is a remarkable surgeon-scientist, one of the nation's best," says Dr. Christian Larsen, Dean of the Emory University School of Medicine and an equally renowned transplant surgeon-scientist who has worked alongside Dr. Kirk since he came to Emory. "He brought vision, energy, and action to bear as Emory's leader for research in surgery and transplant. We are proud that he has been selected to serve as chair of surgery at Duke, and I have no doubt that the department will flourish under his leadership."

Reflecting on his Emory years, Dr. Kirk says: "I have had an exceptional experience at Emory, driven by the collegial nature of the clinicians and scientists, and the unique intersection of outstanding clinical programs and world class scientists within a single institution. I look forward to continuing collaborations with many dear friends and colleagues. My family and I will miss Emory and Atlanta, and look forward to visiting professionally and socially."

Dr. Craig Coopersmith will take over as the new vice chair of research upon Dr. Kirk's departure. Details to follow in the next issue of Emory Surgery.

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John 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," said Dr. Puskas when reporting the interim results of the PROACT study.

Two decades on, Dr. John Puskas leaves Emory for Mount Sinai

Dr. Puskas met with current trial participants and patients consulting for future trials on a weekly basis.
Dr. Puskas met with trial participants and patients consulting for future
trials on a weekly basis.

Trail-blazing cardiothoracic surgeon scientist. Devout educator. Triathlon competitor. Dr. John Puskas is an ultra-achiever whose work is synonymous with results, progress, and questioning limits. His departure from Emory at the end of March to be chief of cardiac surgery at Mount Sinai Beth Israel Hospital and director of the Coronary Revascularization Reference Center, Cardiac Surgery Clinical Research Unit, and Cardiac Quality Teams of the Mount Sinai Health System will cap 18 years of faculty service to the Department of Surgery. During that time he averaged over 300 major cases per year, refined and evaluated innovative procedures, inspired scores of trainees, invigorated the clinical research arm of the division of cardiothoracic surgery, and led multidisciplinary efforts to systematically improve the quality of CT surgery care across Emory Healthcare.

Dr. Puskas' Emory years began with his cardiothoracic surgery residency and fellowship in 1993. "From his first days at Emory, John was a force to be reckoned with; he always wanted to push the envelope. His energy, his intellect, and his positive attitude led to tremendous contributions to surgical science, our teaching effort, and our patient care," says Dr. Robert Guyton, chief of the division of cardiothoracic surgery. "His international reputation as a leader in coronary revascularization is based on his aggressive but sound academic accomplishments as a leader on our faculty. We expect his contributions to continue."

An early advocate of off-pump cardiac surgery, Dr. Puskas began performing coronary bypass operations on beating hearts without using a heart-lung machine shortly after he joined the Emory faculty in 1996. In 1997, he performed the world's first triple off-pump bypass surgery using minimally invasive coronary artery bypass graft instrumentation. By the time he was named PI of the Surgical Management of Arterial Revascularization Therapies (SMART) trial in 2000, he was regarded as a national expert in the approach. SMART established the efficacy of off-pump coronary bypass to provide complete revascularization and restore blood flow rates equivalent to conventional coronary artery bypass graft surgery with less morbidity.

After a series of cadaver experiments, Dr. Puskas extended the closed chest, beating heart strategy to management of atrial fibrillation, and performed the world's first totally thoracoscopic pulmonary vein isolation procedure in 2006. The technique has since been adopted widely and is at the core of a novel hybrid approach for treating this most common type of adult arrhythmia.

In 2005, Dr. Puskas founded the CT Surgery Clinical Research Unit (CRU). The CRU combined the talents of such intrepid Emory CT surgeon-investigators as Dr. Omar Lattouf and Dr. Vinod Thourani into teams that could conduct progressive clinical and translational research and develop and investigate new surgical methods and technologies to inform evidence-based practice. Two years later, Dr. Puskas was named PI of the CRU as a funded clinical core center of the Cardiothoracic Surgical Trials Network (CTSN), a consortium of adult cardiac surgery centers supported by the NIH's National Heart, Lung, and Blood Institute. As a center in the network, the CRU began participating in multi-institutional prospective randomized trials that evaluated new surgical methods, technologies, devices, and pharmaceutical and bioengineered products.

In partnership with fellow CT surgeon Dr. Michael Halkos and Emory cardiologist Dr. Henry Liberman, Dr. Puskas helped drive the growth of robotic coronary bypass grafting at Emory in 2010. The trio's establishment of hybrid coronary revascularization as a safe and beneficial therapy for selected patients with coronary artery disease made Emory the busiest hybrid revascularization center in the United States by 2013.

Dr. Halkos began working on Dr. Puskas' research teams when he was a CT surgery resident. In 2011, two years after joining the faculty, Dr. Halkos received a mentored patient-oriented research career development award from the NIH to study operative strategies that reduce the incidence of complications that can follow coronary artery bypass surgery. "It was an honor for me to have John, one of the world's best coronary surgeons, serve as my mentor for this grant," says Dr. Halkos. "His expertise in clinical research has been instrumental in its ongoing success. Not only has he played a large supporting role, he also contributed robust patient enrollment."

In 2013, Dr. Puskas was the international PI of three separate FDA Investigational Device Exemption trials: the On-X Life Technologies' Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT), which evaluated whether patients implanted with the On-X mechanical valve could be safely maintained with reduced levels of such anticoagulation drugs as warfarin; a randomized trial of a novel nitinol mesh to provide external support that could prolong the patency of the saphenous vein grafts used in CABG surgery; and an investigation 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.

While enthusiastic about the new opportunities Mount Sinai will offer, Dr. Puskas will always treasure Emory's supportive and empowering environment. "There are literally hundreds of people in numerous departments and divisions with whom I have partnered productively and joyfully during my years here. I will miss them all," he says. "In particular, I will always cherish the friendship and willingness to collaborate displayed by my colleagues in the division of cardiothoracic surgery."

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2013 Emory Surgery NIH ranking affirms wider funding options

Research rankings image.

From 2008-2012, the Department of Surgery of the Emory University School of Medicine ranked fifth in NIH awards for all departments of surgery nationwide. According to the Blue Ridge Institute for Medical Research, which publishes ranking tables online of annual NIH funding, the department dropped to sixth in funding for 2013 with a total of $11.1 million in NIH awards.

While indicative of the effect of massive NIH budget cuts, the 2013 ranking is also evidence of the diversification of our faculty researchers' funding streams, an objective that was originally set by School of Medicine Dean Dr. Christian Larsen when he was executive director of the Emory Transplant center, then chair of the Department of Surgery. Overall, the department's federal portfolio remains strong and has been augmented with significant grants from such agencies as the Agency for Healthcare Research and Quality, the FDA, and the Department of Defense.

Dr. Stuart Knechtle was listed as the fifth top-funded investigator in the 2013 rankings, and Drs. John Calvert, Craig Coopersmith, Mandy Ford, Chris Larsen, Allan Kirk, Kenneth Newell, John Puskas, and Lily Yang placed in the top 250.

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Dr. Tom Pearson
Tom Pearson

Dr. Pearson elected to national transplant post

The Organ Procurement and Transplant Network and United Network for Organ Sharing (OPTN/UNOS) announced that Dr. Thomas Pearson, executive director of the Emory Transplant Center, has been elected incoming associate councillor of OPTN/UNOS Region 3 for a two-year term that will begin July 1. He was elected by transplant and organ donation professionals at Region 3 transplant organizations within Georgia, Florida, Alabama, Mississippi, Louisiana, and Arkansas as well as Puerto Rico.

Each of the 11 OPTN/UNOS regions has an associate councillor who serves as the regional representative to the national Membership and Professional Standards Committee (MPSC), which oversees transplant community membership, policy, and regulatory compliance, and makes recommendations to the board regarding policy violations. The MPSC is charged with insuring that OPTN/UNOS member clinical transplant centers, independent organ procurement organizations (OPOs), independent tissue typing laboratories, and non-institutional members meet and remain in compliance with OPTN/UNOS Criteria for Institutional Membership.

In addition to his Emory clinical, administrative, and leadership background, Dr. Pearson brings skills honed as an associate medical director (2000-2013) and current medical director of LifeLink of Georgia, the OPO that serves Georgia. These posts require knowledge of all aspects of organ donation, including managing individual donors and improving the donor process.

Dr. Pearson has also been active in UNOS, serving as Region 3 representative to the kidney committee (2005-2007), as a member of the scientific advisory committee (1997-1999), and as an at-large member of the histocompatibility committee (1996-1998). He currently is a board member of the American Society of Transplantation and has been a member of the Board of Governors of LifeLink Foundation since 1996.

After Dr. Pearson’s term as associate councillor ends in 2016, he will assume the role of councillor for an additional two-year term of service, representing Region 3 on the board of directors of the OPTN/UNOS.

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Expansion of the Surgery IT Team

Surgery IT team.
Willie Washington, Carlos Carter, and Stanley Baker.

Due to its size and range of clinical, academic, and research locations, the Department of Surgery is one of the few departments in the Emory School of Medicine that has its own dedicated IT team. After several years of retaining a series of techs from an off-campus vendor, the department initiated its in-house IT support by hiring Emory Healthcare techs Rik Szefel and Carlos Carter in 2003. Rik and Carlos quickly became known for their grace under pressure and ability to juggle multiple, diverse, and simultaneous service requests from facilities that could be miles apart.

When Rik left the team in March 2012 to become a lead field services technician for EHC IS, Carlos was joined by Trevor Keane. Carlos and Trevor resumed the level of efficiency that the department's faculty and staff had become accustomed to, though the team's routine was interrupted when Trevor relocated to Mississippi with his family in August 2013.

Before Trevor's departure, the decision had been made to expand the team to three techs to compensate for the rapid proliferation of device and systems options and the department's expansion to such facilities as Saint Joseph's Hospital. Shortly after Trevor left, Marine Corps veteran Willie Washington joined Carlos. Willie's extensive desktop support experience across a variety of environments—including Sony Pictures Entertainment, CallTech Communications, and three years of IT support for Emory University Hospital—and his problem solving acumen made him a valuable addition to the team.

The new team was rounded out with Stanley Baker's hire in late 2013. Stanley also has a military background, having served in the U.S. Army Signal Corps from 1980-1995, and a resume that lists such positions as General Dynamics contractor for both the Army Corp of Engineers in Kabul, Afghanistan, and the United States Africa Command's headquarters in Stuttgart, Germany.

To request Carlos, Willie, and Stanley's services, faculty and staff of the Department of Surgery should file a ticket with the Emory IT Help Desk at 8-HELP (778-4357), or click the "Remedy Request for Service" icon on the EHC VDT.

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Save the Date: Emory Surgery Faculty Boot Camp Seminar

April 16, 2014, 3:00 pm–8:00 pm, H Wing Education Classroom, EUH

This boot camp/overview event for the 2014 faculty development seminar series is open to all faculty. Particularly, faculty who are relatively new to the Department of Surgery are strongly encouraged to attend, as the series is dedicated to equipping faculty with the tools to be successful. The boot camp session will introduce the primary components of faculty life via snapshot summaries delivered by seasoned faculty and staff. Agenda items will include promotions, education, research, clinic operations, quality, and communications resources (download the agenda here). Dinner will be provided. In the months that follow, separate seminars will be held that concentrate on a single facet of what it takes to build a solid academic-research-clinical portfolio.

Please RSVP to surgery.facultydevelopment@emory.edu if you plan to attend.

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Upcoming events

Robert A. Bays Lectureship
Obstructive Sleep Apnea: Surgical Treatment Options and Long Term Outcomes

Presented by Peter D. Waite, MPH, DDS, MD
– Professor and Charles A. McCallum Chair, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham
7:00-8:00 a.m., March 6, 2014 EUH auditorium
Palliative Care
Presented by Debbie Gunter, RN/NP
– Palliative Care Nurse Practitioner, Emory Palliative Care Center
7:00-8:00 a.m., March 13, 2014 EUH auditorium
Emory Core Day
Emory researchers can learn what's available to support their research from core services throughout Emory.
Poster presentations, 3:00-6:00 p.m., March 18, 2014 SOM lobby
Department of Surgery Division Chiefs Meeting 5:30-7:00 p.m., March 18, 2014 H Wing Education Classroom, EUH
"If You Cannot Measure It, You Cannot Improve Upon It" — Data Drives Quality
Presented by Matthew M. Hutter, MD, MPH
– Assistant Professor in Surgery, Harvard Medical School
– Associate Visiting Surgeon, Massachusetts General Hospital
– Medical Director, Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, MGH
7:00-8:00 a.m., March 20, 2014 EUH auditorium
Atlanta Science Festival March 22-29, 2014 Event details
8th Annual Robert B. Smith, III, Visiting Professorship
Law & Order: Medical Intent

Presented by Ruth L. Bush, MD, JD, MPH
– Interim Vice Dean, Bryan-College Station Campus, Texas A&M Health Science Center College of Medicine
7:00-8:00 a.m., March 27, 2014 EUH auditorium
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