Valve Clinic Tour: Led By Dr. Ad and Dr. Massimiano, Inova Harnesses Surgical Competency, Innovation & Patient Research
By Adam Pick on November 19, 2010
Recently, I spent two days at Inova’s Heart & Vascular Institute in Falls Church, Virginia — which is about 10 miles from downtown Washington, D.C. in Northern Virginia. It was my first visit to the new $150 million facility that (i) holds a #1 ranking from HealthGrades for Virginia hospitals and (ii) a 5-Star excellence rating for heart valve replacement surgeries.
Dr. Paul Massimiano, Me, Dr. Niv Ad
I have to admit… The four-story cardiac center was immaculate… and BIG. To give you some idea about the facility size, consider that it maintains 13 catheter labs, 6 cardiac operating rooms, over 200 patient rooms and an impressive cardiac rehab center.
However, what struck me most about the Inova Heart & Vascular Institute had little to with architectural design or hospital feng shui. Instead, I was most impressed by a unique approach to cardiac care nurtured by Dr. Niv Ad, the chief of cardiac surgery, and Dr. Paul Massimiano, the president of CVTSA, the private surgeon group at Inova.
Let me explain…
CONSIDER THAT INOVA IS A MAJOR CARDIAC SURGERY CENTER
During my brief 48-hour stay in Falls Church, I observed a (i) stand-alone mitral valve repair, (ii) a stand-alone MAZE procedure, (iii) a minimally invasive mitral valve repair and MAZE procedure, and, of all things, (iv) an actual heart transplant.
Needless to say, seeing a transplanted heart (shown below) beat for the first time is something I will never forget. I’ll also never forget seeing the patient’s old heart and dissected pump that was keeping him alive.
Transplanted Heart Beating For The First Time
“Dr. Lefrak and Dr. Speir did the region’s first heart transplant back in the 1980s at Inova,” Dr. Massimiano told me in the operating room. “Only a few thousand transplants occur each year in the United States. It was a privilege to be part of this life-saving operation.”
While Inova performs only a handful of heart transplants each year, the volume of patient cases that occur within the four walls of this facility is significant. According to reports, the physicians at Inova:
- Treat 2,500 heart rhythm disturbances every year
- Perform 120 maze surgeries per year with 30% being stand alone and 90% being minimally invasive; success rate is 90% at 24 months
- Perform 5,000 diagnostic and interventional cardiac catheterizations annually
- Complete more than 1,700 adult and pediatric cardiac surgeries each year including heart valve repair and heart valve replacement procedures
Inova Heart & Vascular Institute also received a 3-Star rating (the best rating) from The Society of Thoracic Surgeons last year. Specific to heart valve surgery, select surgical statistics include:
- 450 valve surgeries per year
- 150 mitral valve repairs per year
- 0% mortality for isolated mitral valve repairs in 2009
- 2.8 days length of hospital stay for minimally invasive mitral valves
- For minimally invasive maze and mitral valve repair, 0 conversions to sternotomy and no strokes or TIAs
“I’m lucky to work with a great team of surgeons, anesthesiologists, perfusionists, nurses and assistants,” Dr. Ad mentioned to me. “Consider that only 11% of our CABG patients require blood products during their stay in the hospital. The national average is 44%. This is a critical because we know that patients do better without transfusions.”
CONSIDER THAT INOVA FUNDS INNOVATIVE APPROACHES TO CARDIAC CARE & COMMUNITY EDUCATION
While the statistics above are impressive, I would quickly learn that innovation is a key element of Inova’s strategy to enhance cardiac care.
“The last thing we can do is get complacent,” Dr. Massimiano shared with me during dinner. “Our surgical outcomes are in the past. Going forward, the only way can attract the best surgeons… the best cardiologists… the best team… is to provide an innovative platform and dedicated resources to take cardiac care to the next level.”
Inova’s new hybrid cardiac operating room is a testament to Dr. Massimiano’s belief. With a rumored price tag of $7 million, this one-of-a-kind room leverages the best in cardiac technology to treat patients in a collaborative environment.
“I believe the new hybrid room will create a frontier whereby many cardiac disciplines – cardiologists, electro-physiologists and surgeons – will come together for the benefit of patients,” Dr. Ad shared with me. “Now, this… This is exciting.”
Another innovative element nascent to Inova is its educational initiatives. For example, the Cardiac Observation Dome provides 4,000 annual visitors a top-down view of surgical procedures. Ten flat screen displays and two-way communications capabilities are utilized to foster real-time information sharing among the surgical team and the observers.
During a MAZE procedure, I looked up to see an entire high school class looking down excitedly as Dr. Ad restored the normal cardiac rhythm of a patient suffering from atrial fibrillation. Later, Dr. Ad met with the students to discuss the case, heart anatomy and risk factors (shown below).
Dr. Ad Meets With High School Class After Surgery
“Great surgery is the basis for what we do,” Dr. Ad shared with me. “But, we need to remember our responsibility to the community, to the kids and to the next generation of surgeons. Demand for the Dome is quite amazing… It’s booked one year in advance for events like this.”
CONSIDER THAT INOVA’S APPROACH TO PATIENT RESEARCH IS UNIQUE
Although Dr. Ad is best known for his surgical competence relative to the MAZE procedure, I would learn that the married, father of four also maintains human interests in The Beatles and Pilates. During our first morning together, Dr. Ad stretched and sighed as I got into scrubs. “My Pilates instructor really got me last night. I’m really going to be sore for the next few days. But, at least… Now… I can touch my toes.”
Dr. Ad, who has operated in 60+ operating rooms across 15+ countries, is also incredibly passionate about patient research. That said, Dr. Ad maintains a ten-person research staff tasked with the complex mission of understanding the patient experience — both before and after surgery. The highly educated research team is comprised of social scientists, bio-statisticians, internal medicine research fellows, PhDs, MBAs and more.
According to Dr. Lisa Martin, the administrator of the group, the research team developed a unique protocol for patient research five years ago to better understand what contributes to successful patient outcomes. Today, a massive internal database tracks over 11,555 patients with 6,579 fields of information over a five-year horizon. Current research topics include:
- The Implementation of a Comprehensive Clinical Protocol Improves Long Term Success Following Surgical Treatment of Atrial Fibrillation
- Study of Coumadin Usage
- Health-Related Quality of Life After Cardiac Surgery
After years of data collection, Inova’s research is now being featured in reputable medical journals. For example, Dr. Ad, Dr. Linda Henry, Sharon Hunt and Lori Stone recently published, “The implementation of a comprehensive clinical protocol improves long-term success after surgical treatment of atrial fibrillation” in The Journal of Thoracic and Cardiovascular Surgery.
Dr. Niv Ad Discusses The Data Collection Processes at Inova
“Thanks to Dr. Ad’s vision, we are learning the medical and social factors that enhance patient outcomes,” Dr. Martin shared with me. “When we see the data, understand the data, and clinically apply the data, the net result is healthier patients.”
CONSIDER THAT INOVA HOSTS PATIENT REUNIONS
The final point that continues to excite me about Inova is its ongoing interaction with its patient community.
Now in its fifth year, the Inova Heart & Vascular Institute hosts a wonderful, annual reunion for its surgical Maze patients. These reunions — which feel like a relaxing cocktail party — offer patients a special opportunity to enjoy a glass of wine, eat tasty appetizers and, most importantly, connect with fellow patients in the company of their medical team.
Over 100 Patients, Caregivers, Doctors, Nurses & Researches Connect
At Inova’s 5th Annual Reunion
After the reception, Dr. Ad and his research team discuss their latest research findings and hold panel discussions with its research team and special guests.
A Panel of Surgeons, Cardiologists and Patients Answer
Questions From The Audience
I’ve been fortunate to attend and speak at the 4th and 5th annual patient reunions. The events are fun, interactive and meaningful. For me, it’s a real honor to be a part of these events.
As my time with Dr. Ad, Dr. Massimiano, Dr. Speir, Lisa, Jill, Linda, Sharon, Shrin, Sari, Lori and so many others came to a close, I was ab-sooooo-lutely…. exhausted. But, it was a great type of exhaustion knowing that Inova is transforming cardiac care on a continuous basis to improve patient’s lives.
Thanks to everybody at Inova for providing me with a wonderful opportunity to learn more about you, your results, your innovation, your research and your patients.
Keep on tickin!