Duke University Hospital Program Earns Distinguished Three-Star Ratings

By Tracey Koepke, Duke Heart Center

We are pleased to share with you that our Adult Cardiac Surgery program at Duke University Hospital has, for the first time, earned three simultaneous distinguished three-star ratings from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in the following areas: isolated coronary artery bypass grafting (CABG) procedures; isolated aortic valve replacement (AVR) surgery, and isolated mitral valve replacement and repair (MVRR) surgery. The three-star rating, which denotes the highest category of quality, places our program among the elite for CABG, AVR and MVRR in the U.S.

“This is a significant validation of the quality and performance that we are able to deliver in cardiac surgery — the three-star rating means that our outcomes are in the top 10 percent of all centers in the United States,” said Peter K. Smith, MD, chief of the division of Cardiovascular and Thoracic Surgery and co-director of Duke Heart Center. “That we have achieved this within each of the three most important domains of cardiac surgery — bypass surgery, aortic valve replacement, and mitral valve repair or replacement – is a tribute not just to the surgeons but our entire team of dedicated health care professionals in our Operating Room, Intensive Care Unit, and Step-down Units.”

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs in the U.S. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database (ACSD) participant. We achieved a two-star rating in each of the remaining two areas of reporting: AVR+CABG and MVRR+CABG.

“Any scoring system has its limitations, but this is one of the most scientifically validated systems for heart surgery. It involves a huge amount of data from almost all centers in the U.S. and a very complicated and well thought out risk-adjustment model,” according to Carmelo Milano, MD, Chief of the Section of Adult Cardiac Surgery in the division of Cardiovascular and Thoracic Surgery. “Not only are they looking at raw outcomes like survival, but they take into consideration the pre-operative conditions that may make certain cases much higher risk. This is a very well respected grading system for heart surgery.”

The latest analysis of data for CABG covers a 1-year period, from January 2019 to December 2019; the analysis of data for isolated AVR, isolated MVRR, AVR+CABG and MVRR+CABG surgeries covers a 3-year period, from January 2017 to December 2019.

Mihai V. Podgoreanu, MD

Mihai V. Podgoreanu, MD

“Achieving the elite STS three-star rating, one of the most sophisticated and highly regarded overall measures of quality in health care, is a testament to our program’s commitment to quality improvement and safety across the cardiac surgical patient journey – from careful preoperative planning and optimization, to relentless attention to detail and coordination of intraoperative and postoperative decision making among multi-disciplinary heart team members,” added Mihai Podgoreanu, MD, chief of Cardiothoracic Anesthesiology and Critical Care. “In these unprecedented times, we are united in our dedication, resilience, compassion, and innovative spirit to continue pursuing our highest purpose – excellence and quality care for patients in need of cardiac surgery and their families.”

“As an organization and a group – the STS three star rating is evidence of the dedication of our entire Heart Center around how we care for our patients with multi-disciplinary teams that start with the evaluation and identification of patients needing coronary revascularization or valve surgery all the way through recovery, rehab, and return to life,” said Manesh Patel, MD, chief of the division of Cardiology and co-director of Duke Heart Center. “I am excited that during these challenging times our teams have continued the dedication and work to stay focused on patient outcomes.”

The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The STS ACSD houses approximately 6.9 million surgical records and gathers information from more than 3,800 participating physicians, including surgeons and anesthesiologists from more than 90 percent of groups that perform heart surgery in the US. The Database includes three other components: the Congenital Heart Surgery Database (CHSD), the General Thoracic Surgery Database (GTSD), and the mechanical circulatory support database (Intermacs). Duke has participated in the STS National Database since its inception.

Stacey HiltonDuke University Hospital Program Earns Distinguished Three-Star Ratings
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Dr. Ghadimi Earns Mentored Research Award

Kamrouz Ghadimi, MDDuke Anesthesiology’s Kamrouz Ghadimi, MD, has been awarded the 2020 International Anesthesia Research Society (IARS) Mentored Research Award ($175,000, two-year grant) to study “Right Ventricular Metabolic Dysregulation after Surgery for Heart Failure.”

Perioperative right heart failure (RHF) is the leading cause of death within 30 days of left ventricular assist device and heart transplant operations. The objective of Ghadimi’s research is to identify cardiometabolic pathways that underlie early RHF after these operations due to changes in right ventricular (RV) afterload and heterogeneity in response to inhaled pulmonary vasodilators (iPVD). Supported by preliminary metabolomic analyses, the central hypothesis posits that RV-pulmonary arterial (PA) coupling is optimized in the responder phenotype, which signals efficient fatty acid oxidation in RV myocardium. Study aims include 1) quantifying differences in key metabolites using targeted mass spectrometry in serial plasma and RV myocardial samples to determine cardiometabolic pathways, including dysregulated fatty acid oxidation, that underlie early RHF and heterogeneity in response to iPVD, and 2) identifying baseline biomarkers reflecting fatty acid oxidation defects that are associated with RV-PA coupling status, iPVD response phenotypes, and early RHF development to create an integrated clinical-molecular model for outcome prediction in critically-ill patients.

The foundation for this mentored research training grant is embedded in the INSPIRE-FLO clinical trial that Ghadimi has led since 2017 and the biospecimen repository that derived from trial patients undergoing advanced heart failure surgery, such as left ventricular assist device insertion and heart transplantation. As part of this award, Ghadimi and his research team plan to enroll patients undergoing routine cardiac operations by utilizing the vast resources available through Duke Anesthesiology’s Clinical Research Unit. As a member of the Shah laboratory at the Duke Molecular Physiology Institute, Ghadimi is being mentored by laboratory principal investigator (PI) and associate dean of genomics, Dr. Svati Shah, to accomplish the aims of this investigation and to acquire the necessary experiential training to become an independent clinical and translational investigator. As a previous recipient of the NIH T32 award (sponsored by the National Institutes of General Medical Sciences, PI: David Warner, MD), Ghadimi will obtain a Master in Health Science (MHSc) from the NIH-Duke Clinical Research Training Program and pursue additional coursework in precision medicine during this award.

“Receiving this grant is the next step in achieving my long-term goal of using translational methods to identify molecular pathways of right heart failure that will lead to potential novel therapeutic strategies and biomarker discovery for personalized patient care,” says Ghadimi, associate professor of anesthesiology and critical care. “With a large sense of gratitude, being named an award recipient has helped validate (1) the countless hours of hard work and sacrifice that were required to mature this project with my group of mentors and advisors, (2) the time my research team and I have utilized to coordinate multiple resources at Duke that are essential for proper acquisition and storage of biospecimens associated with our parent clinical trial, INSPIRE-FLO, and (3) the importance of ongoing professional development through enrollment in formal research training.”

Stacey HiltonDr. Ghadimi Earns Mentored Research Award
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Transition in Leadership Roles Announced

Drs. Dongiguez, Jones, and Olufolabi

Please join us in extending our congratulations to Drs. Jennifer Dominguez and Adeyemi Olufolabi on their new diversity and inclusion leadership roles within Duke Anesthesiology, effective October 1.

Dominguez now serves as chair of our Anesthesiology Inclusivity Committee (AIC). Olufolabi serves as the committee’s senior advisor. They transitioned into these leadership roles previously held by Dr. Mandisa-Maia Jones, who has been with our department for six years and has accepted an opportunity at Cornell. We would like to express our gratitude for her dedication and commitment to launching and leading this departmental program.

Diversity and inclusion are essential components of academic medicine, both to promote equity and fairness among us, and to fulfill our School of Medicine’s mission for excellence in education, research, and clinical care. Our Diversity and Inclusion Program within Duke Anesthesiology is a group of faculty and trainees that works on various initiatives to promote the recruitment, retention, and career development of faculty and trainees who identify as women, LGBTQ or with racial and ethnic groups that are underrepresented in medicine. The AIC accomplishes these goals through recruitment, education, outreach, advocacy, and by promoting an inclusive culture within the department that positively impacts how we teach, learn and serve. We are committed to building an environment where we all feel we belong, and are engaged and productive.

Dominguez joined our department in 2013 as an assistant professor of anesthesiology. She graduated from the Yale School of Medicine, where she also completed residency training, followed by a fellowship here at Duke. She currently serves as the director of our Obstetric Anesthesiology Fellowship Program.

“I have enjoyed being a member of the AIC for several years, and am also grateful to Dr. Jones for her leadership. I look forward to working with Dr. Olufolabi and this committed and vibrant group of faculty, residents and fellows to move these vital initiatives forward,” says Dominguez. “Recent events from the disproportionate impact of the COVID-19 pandemic on communities of color, to heinous acts of police brutality have prompted an openness to acknowledge and dialogue about systemic race, ethnic and gender based discrimination that I have not seen previously in my lifetime. I hope that this momentum will continue so that we can make impactful and lasting changes that will benefit our profession, our patients, and our communities.”

Olufolabi joined our department in 1997 as a visiting associate. He received his MBBS at the University of Ibadan in Nigeria and went on to complete his specialist registrar training at the University of Southampton. He has served as an affiliate for the Duke Global Health Institute for the past decade, and leads our department’s Global Health Program.

“I believe the country is birthing a new fair and equitable society for all Americans. And like natural birth, it is fraught with pain and a prolonged period of uncertainty. But history tells us that we will evolve and will get there,” says Olufolabi. “We just need to keep banging on the door and believing in the creed that we all are created equal.”

On behalf of our department, we wish Drs. Dominguez, Jones and Olufolabi the best in their new roles and future endeavors.

Stacey HiltonTransition in Leadership Roles Announced
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Dr. Terrando Awarded Grant for COVID-19 Related Research

Niccolò Terrando, BSc (hons), DIC, PhDThe National Institutes of Health has awarded Duke Anesthesiology’s Niccolò Terrando, BSc, DIC, PhD, a one-year, $322,620 supplement grant to his R01-funded project, titled “Delirium Superimposed on Dementia Intersects with COVID-19.”

Delirium has become a common complication of COVID-19 that further impairs the recovery of already debilitated patients, in particular older adults. Terrando and his co-investigators are studying the role of neuroinflammation as a putative driver of delirium pathogenesis. For this supplement, they will explore how lung injury, akin to COVID-19 infection, leads to delirium by impairing the blood-brain barrier and triggering immune cell trafficking into the brain.

Terrando aims to develop a model of COVID-19 lung injury that activates the immune system to damage the brain, affecting areas that serve attention, memory, and thinking, and reverse these changes with an experimental drug in development. Findings from this research supplement will address this serious public health concern by providing fundamental knowledge on the pathogenesis of delirium following COVID-19-like infection. Such work has the potential to reduce the health care burden of COVID-19 associated with delirium and related neurologic complications, such as Alzheimer’s disease and related dementias (ADRDs).

“We are thrilled to develop this project in collaboration with Dr. Purushothama Rao Tata in the Duke Department of Cell Biology, an expert in murine lung injury models, and Dr. Harris A. Gelbard in the Center for Neurotherapeutics Discovery at the University of Rochester Medical Center that developed new therapeutics effective in resolving neuroinflammation, which we are currently testing in the R01 funded project,” says Terrando, associate professor in anesthesiology. “We are grateful for the National Institute on Aging’s continuous support, and we are looking forward to providing timely results that may curtail pathologic hallmarks of delirium and neurodegeneration resulting from COVID-19.”

Stacey HiltonDr. Terrando Awarded Grant for COVID-19 Related Research
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