VOLUME X ISSUE 3
A NEW ERA IN
CARDIAC SURGERY St. Clair Hospital welcomes pioneering cardiothoracic surgeon Andy C. Kiser, M.D., FACS, FACC, FCCP
NEW ERA IN CARDIAC SURGERY
2 I HouseCall I Volume X Issue 3
TRANSFORMING Cardiac Care
Cardiothoracic surgeon Andy C. Kiser, M.D., FACS, FACC, FCCP, learned at an early age to be a problem solver. Growing up on a tobacco farm in North Carolina, he witnessed his father’s practical approach to issues and took to heart his father’s advice. “When I was growing up, my Daddy always told me to think about what I was doing,” he says. “That was great advice and it’s been my approach to solving problems. When I see a challenge, I focus on it completely and think my way through it until I have a solution.”
t was a lesson well learned, and it has served Dr. Kiser well in an exceptionally accomplished career that now brings him to St. Clair Hospital as the newly appointed Chief of Cardiac Surgery. An internationally recognized leader in the highly specialized field of cardiothoracic surgery, Dr. Kiser has pioneered innovative approaches to heart surgery that are transforming the treatment of certain heart conditions, including atrial fibrillation, a disorder of the heart’s rhythm, as well as valve and coronary disease. He conceived and developed the innovative convergent hybrid ablation procedure for the treatment of persistent atrial fibrillation, the most common heart rhythm disturbance and a leading cause of stroke. He also has extensive experience in the surgical treatment of cardiac valve disease and coronary artery disease, and as a thoracic surgeon, in the treatment Andy C. Kiser, M.D., FACS, FACC, FCCP
of diseases of the lungs, chest wall and esophagus, including cancers. Continued on Page 4
Volume X Issue 3 I HouseCall I 3
NEW ERA IN CARDIAC SURGERY Continued from Page page 3
Dr. Kiser is the inventor of a number of medical devices, an entrepreneur and an educator. He is a Fellow of the American
and an invigorating sense of enthusiasm for the future of cardiac care at St. Clair. “St. Clair has a tradition of high quality cardiac
College of Surgeons, the American College of Cardiology and the
care,” Dr. Kiser says. “The program is well known and highly
American College of Chest Physicians. Dr. Kiser is the founder
regarded. I’m proud to build on the legacy of longtime St. Clair
and CEO of Advanced Cardiac Access Training Institute in North
cardiothoracic surgeon G. Frederick Woelfel, Jr. My job is to
Carolina, which has provided education and advanced training in
continue that excellence and advance it. I’ll be doing cutting-edge,
surgical skills and procedural simulation to other surgeons across
minimally invasive procedures. (Please see sidebar on Heart Valve
the United States and around the world. Dr. Kiser has authored
Problems, Page 7.) A lot of changes are on the horizon in cardio-
numerous scientific papers and textbook chapters on cardio-
thoracic surgery and I enjoy helping to usher in those advances
thoracic surgery and a wide range of other topics.
and that technology. I had positive expectations, but the first time
With his arrival at St. Clair, Dr. Kiser brings a wealth of capabilities: exemplary surgical skill, inspiring leadership, a fertile mind
I visited St. Clair, I was blown away by the quality of the institution, the staff and the administration.”
Targeting the highest caliber of cardiac care Cardiac care is one of the most critical services that a hospital can offer a community, and St. Clair has excelled in this regard. St. Clair’s highly respected cardiac care program features a spectrum of cutting-edge services that are continually being expanded and enhanced in a quest to improve, innovate and excel. Outstanding elements of the program include advanced emergency cardiac care; an expansive, first-rate, 24-hour cardiac catheterization lab that performs 2,000 procedures annually; and the latest cardiac diagnostics, including cardiac MRI, the most advanced imaging technology for diagnosing heart disease, under the direction of Christopher E. Pray, M.D., FACC, medical director of noninvasive cardiology. It also includes a comprehensive cardiac electrophysiology lab that provides the most progressive diagnostics and treatment to people suffering with cardiac rhythm disorders, also known as arrhythmias. At St. Clair, cardiothoracic surgeons perform open-heart surgery, including coronary artery bypass grafts and valve repair and replacement.
ANDY C. KISER, M.D., FACS, FACC, FCCP Dr. Kiser earned a B.S. in biology with honors and distinction, and a medical degree with honors from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason-Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser is employed by St. Clair Cardiovascular Surgery Associates, part of St. Clair Medical Services. To contact Dr. Kiser, please call 412.942.5728.
4 I HouseCall I Volume X Issue 3
Dr. Kiser, center, gestures as he introduces himself to fellow physicians and other clinicians in an Operating Room at St. Clair.
Dr. Kiser is best known for his pioneering work on minimally invasive valve surgery and coronary artery surgery, along with his hybrid procedure to treat atrial fibrillation. His procedures for valve repair, including the
“
A LOT OF CHANGES ARE ON THE HORIZON FOR CARDIOTHORACIC
suprasternal (above the sternum, or breastbone) transcatheter (via a
SURGERY AND I WANT TO HELP USHER
flexible catheter inserted through the skin) aortic valve replacement,
IN THOSE ADVANCES AND THAT
known as TAVR, make it possible to avoid sternotomy, the large chest incision of open-heart surgery that has been the standard for valve surgery. Dr. Kiser played a primary role in developing and perfecting the suprasternal TAVR procedure in 2015 and performed the world’s first one on a human patient.
TECHNOLOGY.
”
ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL
Continued on Page 6
Volume X Issue 3 I HouseCall I 5
NEW ERA IN CARDIAC SURGERY Continued from Page 5
THE CONVERGENT PROCEDURE FOR ATRIAL FIBRILLATION avoids incisions in the chest
TRADITIONAL SURGERY
Open Chest
MINOR ENTRY PROCEDURE During minimally invasive procedures, Dr. Kiser approaches the heart through a two- or three-inch incision, at the top or the bottom of the sternum. For the patient, the advantages of the minimally invasive approach over open-chest procedures are substantial: traditional open-chest surgery entails cutting through the breastbone and opening up the chest. It involves greater blood loss; a longer hospital admission, including an intensive-care stay; greater post-operative pain and a higher risk of complications. Aortic valve surgery, whether it is performed with a minimally invasive approach or open-chest approach, requires stopping the heart while placing the patient on a heart-lung bypass machine. Although not everyone is a candidate for the minimally invasive approach, Dr. Kiser
Between the Ribs
believes that it will become more customary as new technologies emerge and openheart surgery will be less common in the future.
Transforming the treatment of arrhythmia As the inventor of the paracardioscopic (directly visualizing the heart with a camera from inside the pericardium, the sac around the heart) convergent hybrid ablation
discipline. “Treating atrial fibrillation means starting with medications to regulate
“
the heart rate and thin the blood,” Dr. Kiser says. “The next step is catheter ablation,
WILL BE LESS COMMON IN
which is less invasive than surgery. St. Clair Hospital’s Dr. (Jeffrey C.) Liu performs
THE FUTURE.
procedure to treat atrial fibrillation, Dr. Kiser is transforming the treatment of this arrhythmia. “Convergent” means a converging of both expertise and technology from cardiothoracic surgery and cardiac electrophysiology; it combines the strengths of each
cryoballoon and radiofrequency catheter ablations at St. Clair to target a precisely mapped area of tissue in the heart muscle to create a controlled scar, which blocks abnormal electrical signals that trigger episodes of atrial fibrillation, thus restoring a normal heart rhythm. Our surgery is for those who are difficult to treat, because of a large heart, long-standing atrial fibrillation, or a need for a repeat ablation. Ablation targets the pulmonary veins, isolating them because they have an irritable focus that sparks the arrhythmia. We plan to start a program for this at St. Clair and Dr. Liu will be a great partner.” (Please see sidebar on Atrial Fibrillation, Page 8.) Continued on Page 9
6 I HouseCall I Volume X Issue 3
OPEN-HEART SURGERY
”
ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL
TREATING HEART VALVE PROBLEMS WITH ADVANCED TECHNOLOGIES
Open-heart surgery without opening the chest Picture yourself traveling to the city on the
Parkway West, inbound. Traffic is flowing, but
then, just ahead, sit the dreaded orange cones
Most heart valve problems involve the aortic and mitrial valves.
and barrels of a construction zone. Both lanes are forced to merge into a much smaller space; before
AORTIC VALVE
AORTA
long, traffic is backed up and congested, and
between the left ventricle and the aorta
you’re late for work, or school, or a game.
Blood flows through your heart like vehicles
LEFT ATRIUM
traveling on a highway. The blood flows through
the heart’s chambers, the atria and the ventricles.
RIGHT ATRIUM
The atria are the receivers — blood returns to
MITRIAL VALVE
LEFT VENTRICLE
them from the body and the lungs, while the
ventricles are the heart’s primary pump, rhyth-
between the left atrium and the left ventricle
RIGHT VENTRICLE
mically propelling the blood to the lungs and the body. The heart’s blood flow is regulated by
four valves — structures that open and close to
allow the passage of fluid in one direction only.
Together, the valves enable a healthy, one way
NORMAL
Aortic STENOSIS
Mitral REGURGITATION
flow: the flaps on the valves close after the blood
flows through, preventing blood from being forced backward.
Valve problems usually involve the aortic and
mitral valves. When they are damaged, two conditions can result: stenosis, or narrowing; and regurgitation, or backflow. Stenosis means less
open
closed
The valve fully opens and closes.
open
closed
The valve doesn’t open enough.
At St. Clair Hospital, open heart valve surgery
is performed by cardiothoracic surgeons when
blood can flow to its destination and the heart
the valves are diseased or damaged and causing
is usually due to calcium deposits that thicken
diseased valve is preferred to replacement of the
mitral valve becomes weakened, it fails to close
cutting through the sternum (breastbone) and
atrium. This condition, mitral valve regurgitation,
a heart-lung bypass pump. This device takes
open
closed
The valve doesn’t fully close and leaks.
artery in the groin and guiding it to the aortic valve to place it. Dr. Kiser has further refined this procedure, facilitating TAVR by developing a
will pump harder, eventually weakening. Stenosis
worsening symptoms. Usually, repair of the
suprasternal approach that accesses the aortic
the valve tissue and narrow the opening. If the
valve with a prosthetic. The procedure involves
TAVR approach avoids large chest incisions as
completely and may prolapse back into the
stopping the heart while placing the patient on
is often asymptomatic, but it also allows blood
over the function of perfusion, the process in
to leak backward. In both cases, one is likely to
experience symptoms such as shortness of
which oxygenated blood is delivered to the
body’s tissues. Post-operatively, the patient will
valve from above the sternum. “The suprasternal
well as femoral punctures; it results in many
advantages for the patient: a shorter procedure,
faster ambulation, less discomfort and earlier discharge,” Dr. Kiser explains.
More than 5 million people are diagnosed with
valve disease every year in the U.S. Some have a
breath, fatigue, leg swelling and chest pain, and
recover in St. Clair’s Cardiovascular Surgical Unit.
Valve disease can be asymptomatic or very
some pioneered by Andy C. Kiser, M.D., FACS,
the result of age- and lifestyle-related changes in
at St. Clair, employ minimally invasive technology
risk factors for coronary artery disease, including
your doctor may be able to hear a heart murmur.
Progressive approaches to valve surgery,
mild, even when the heart is working extra hard
FACC, FCCP, the new Chief of Cardiac Surgery
valve. Eventually, though, the heart may begin
and will soon be an option at St. Clair. Dr. Kiser,
manage symptoms: diuretics to remove excess
primary role in developing the new technologies
to compensate for a narrowed or malfunctioning
congenital predisposition to valve problems, but
more often valve stenosis and regurgitation are
the heart. Infections can scar the heart valves, and obesity, diabetes, high blood pressure and
to decompensate. Medications can be helpful to
an inventor as well as a surgeon, has played a
smoking, can contribute. Many people with valve
fluid; anti-arrhythmics to regulate the heart
and surgical devices that have made these
those who do can rest assured that they will find
and promote good blood flow. If left untreated,
transcatheter aortic valve replacement, or TAVR,
therapy, the “traffic” congestion of heart valve
sudden cardiac death.
taining a bioprosthetic valve through the femoral
and one can live a healthy, long life. n
rhythm; and medications to control blood pressure
valve disease can lead to heart failure, stroke and
breakthroughs possible. One of these options,
treats atrial stenosis by inserting a catheter con-
disease do not need surgery, but in Pittsburgh state-of-the-art care at St. Clair. With specialized
disease can be returned to a more normal flow
Volume X Issue 3 I HouseCall I 7
NEW ERA IN CARDIAC SURGERY Continued from Page 6
St. Clair is among the nation’s leaders for treatment of
ATRIAL FIBRILLATION Atrial fibrillation, often called AFib, is the most common form of arrhythmia, or heart rhythm disorder, affecting millions of Americans. It can be a challenge to diagnose and treat, but St. Clair Hospital is at the cutting-edge of AFib care, with a highly
what is AFib? Atrial fibrillation, or AFib, is an irregular heartbeat, or a condition in which the atria fail to contract in a strong, rhythmic way. When the heart is in AFib, it may not be pumping enough oxygen-rich blood out to the body. COMMON SYMPTOMS OF A FIB
specialized electrophysiology (EP) lab and a dynamic team with nationally recognized expertise. Jeffrey C. Liu, M.D., FHRS, the
medical director of St. Clair’s EP Lab, has been offering advanced, state-of-the-art
care to St. Clair patients since 2013. Now he has been joined by renowned cardiothoracic surgeon Andy C. Kiser, M.D., FACS,
FACC, FCCP, the newly appointed Chief of Cardiac Surgery at St. Clair, who has
advanced AFib treatment with approaches that combine surgical and ablation technologies. Dr. Kiser and Dr. Liu will partner to offer the convergent hybrid procedure, a collaborative approach pioneered by Dr. Kiser that is among the newest and most
Racing, fluttering or palpitations of the heart
Lightheadedness
2.7 MILLION PEOPLE IN THE U.S. HAD
AFIB IN 2010
12 MILLION PEOPLE COULD HAVE
AFIB BY 2050
Shortness of breath
9%
OF PEOPLE AGE 65 AND OLDER HAVE BEEN DIAGNOSED WITH THE CONDITION
Sometimes there are no noticeable symptoms and diagnosis is by exam.
5x
The greatest risk of AFib is stroke. A patient with AFib is 5 times more likely to have a stroke than someone who doesn’t have atrial fibrillation.
innovative treatments for persistent AFib. AFib is primarily a disease of aging, Dr. Kiser explains, and the incidence is likely to rise as the U.S. population ages. According to the Centers for Disease Control and Prevention, 9 percent of people age 65 and older have been diagnosed with the condition. There are degrees of severity, but it is never a benign diagnosis: AFib is a complex and chronic condition that can be debilitating, severely impacting quality of life. Furthermore, it is potentially deadly, as one of the leading causes of stroke. AFib occurs when the heart’s upper chambers,
8 I HouseCall I Volume X Issue 3
the atria, beat erratically, so that blood does
because every patient presents in a unique
not flow as it should. Blood pools in the
way. Some have no symptoms and find out
heart and this stasis can produce clots which
they have AFib when they are in the hospital
may travel to the brain, causing a stroke,
for another reason; they may never need
which can have devastating consequences,
treatment. Others are more symptomatic,
including blindness, paralysis and even
and when symptoms are severe, it can be
death. As the heart quivers and races, it
profoundly life altering.” Symptoms of AFib
cannot pump effectively, and it works harder
may include a racing heart, palpitations
and harder in an attempt to compensate.
(fluttering feeling in the chest), shortness
Eventually, that can produce heart failure.
of breath, anxiety and severe fatigue that
“AFib is very common; I see it more than
is out of proportion to one’s activities,
any other condition,” says Dr. Liu. “The
which results from a lack of oxygen to
treatment of AFib has to be individualized,
the body’s cells.
Continued from Page 6
Dr. Liu, a board-certified specialist in cardiac electrophysiology, is the medical director of St. Clair’s Electrophysiology Lab. “St. Clair provides cardiac care at a level that is usually found at academic Treatment includes medication to control heart rate and rhythm; blood thinners to prevent clotting and reduce stroke risk; a procedure known as catheter ablation, which
medical centers,” Dr. Liu says. “We offer the people of this community access to state-of-the-art cardiac care, close to home, including cardiac ablations for arrhythmias. “No doubt, to be able to recruit a surgeon of Dr. Kiser’s reputation
Dr. Liu performs; and surgery. Ablation is a precise and
will only enhance what we do. He brings a progressive approach to
strategic creation of scar tissue within the heart to interfere
valve work and will bring a lot of surgical advances to St. Clair. He is
with the conduction of the chaotic electrical impulses
an innovator and a pioneer; he is modest about his accomplishments,
that cause the atria to fibrillate.
but he actually invented the surgical tool used in the hybrid ablation
There are two kinds of ablation procedures: cryoballoon, which uses freezing technology, and radiofrequency, which uses heat. Surgery for AFib is essentially surgical ablation; it can be an open-heart procedure called the Cox Maze, which creates a maze of scars by cutting,
procedure for atrial fibrillation. We have a robust atrial fibrillation program at St. Clair and it continues to grow. The high caliber of our program is among the attractions that brought Dr. Kiser to St. Clair and with his experience, credentials and vision, he will definitely help us further advance the program to new levels.”
burning or freezing; or the Mini-Maze, a minimally invasive procedure performed via a two-inch incision at the bottom of the sternum. Dr. Kiser performs the procedure using the Subtle Cannula, a tool that he designed from an airway tube; it consists of a hollow, semi-rigid tube through which he passes a camera and the ablation device. The convergent hybrid procedure employs the best
Continued on Page 10
“
DR. KISER’S EXPERIENCE AND CREDENTIALS,
elements of ablation and Mini-Maze surgery in a single
PLUS HIS VISION, WILL
operation. “‘Convergent’ means a converging of expertise
DEFINITELY HELP US
and technology from cardiothoracic surgery and electrophysiology,” Dr. Kiser explains. “We will start a program
TAKE THE PROGRAM
for this procedure at St. Clair.”
TO THE NEXT LEVEL.
Another option for treating AFib is an implanted device called a Watchman™ that is placed percutaneously (through the skin) and guided through a catheter into the left
JEFFREY C. LIU, M.D., FHRS, ELECTROPHYSIOLOGIST, ST. CLAIR HOSPITAL
”
atrium. “Some patients with AFib cannot take oral blood thinners,” Dr. Kiser says. “This is an alternative which reduces the risk of stroke for those people. The Watchman
Jeffrey C. Liu, M.D., FHRS
does not change the electrical impulses; it’s a mesh closure device that occludes the left atrial appendage, a small muscular pouch in the upper left atrium that functions as
JEFFREY C. LIU, M.D., FHRS
a decompression chamber. The left atrial appendage is
Dr. Liu earned a B.S. in general science while studying in the accelerated six-year B.S./M.D. program at The Pennsylvania State University, State College, before earning his medical degree at Jefferson Medical College, Philadelphia. He completed a residency in internal medicine at the University of Maryland Medical Center, served as Chief Resident at the Baltimore VA Medical Center, and completed fellowships in cardiovascular medicine and clinical cardiac electrophysiology at UPMC. Dr. Liu is board-certified in cardiology, cardiac electrophysiology and internal medicine by the American Board of Internal Medicine. He practices with South Hills Cardiology Associates, part of St. Clair Medical Services.
where most of the blood clots that come from the heart originate. The Watchman seals it off. “All of these measures mitigate the risk of stroke with AFib. We will have a comprehensive program at St. Clair and we’ll take care of people with AFib and reduce their risk of stroke. With treatment, you can return to a quality life without atrial fibrillation.” n
To contact Dr. Liu, please call 412.942.7900. Volume X Issue 3 I HouseCall I 9
NEW ERA IN CARDIAC SURGERY Continued from Page 9
Multidisciplinary approach improves outcomes James R. Edgerton, M.D., FACC, FACS, FHRS, is a leading cardio-
atrial fibrillation, but is also dedicated to the team approach. Dr. Kiser will develop cross-disciplinary approaches that will complement the great cardiac care that St. Clair Hospital is known for,” says Dr. Edgerton. Although he has lived in North Carolina for his entire life, Dr. Kiser
thoracic surgeon and the medical director of the Heart Arrhythmia Center
has an important connection to Pittsburgh, and especially to the South
at the Baylor Scott and White Heart Hospital near Dallas, Texas, and
Hills: his wife, Heather, is a native of Peters Township and her parents
a spokesperson for The Society of Thoracic Surgeons. A colleague of
and sisters still reside here. His brother-in-law, St. Clair Hospital cardi-
Dr. Kiser, he is familiar with his work. “The incidence of atrial fibrillation
ologist James W. Marcucci, M.D., initially told him of the opportunity at
is increasing tremendously as the U.S. population ages, and many more
St. Clair. “I never thought I would move to Pittsburgh, but this was a
people are seeking treatment,” Dr. Edgerton says. “Patients are becoming
great opportunity,” says Dr. Kiser. “We have a son, Austin, who is 24 and
increasingly savvy about the various treatment options for atrial fibrillation
works with me on my inventions and patents. He developed a simulator
and they are flocking to the places that have a multidisciplinary approach.
to help me train other surgeons. Our daughter Hannah, 22, recently
These places break down the ‘silo’ mentality, in which each specialty acts
graduated from the University of North Carolina and married Paul Ambrose,
independently of the others, and develop a collaborative approach. One
a U.S. Army Black Hawk helicopter pilot. They are serving our country
of those collaborative approaches is the convergent hybrid procedure
in Fort Rucker, Alabama. I’m very proud of them all.
developed by Dr. Kiser. “The addition of Dr. Kiser adds this important element to the treatment of patients at St. Clair. He is not only a leader in the treatment of
“My father was a tobacco farmer and my mother was a nurse who was in the first class of family nurse practitioners at the University of North Carolina. She opened a clinic in Carthage, North Carolina, and to
The Kiser family (left to right): Claytie (Dr. Kiser’s father); Hannah Ambrose (daughter); Heather (wife); Andy Kiser, M.D.; Austin (son); and Nancy (Dr. Kiser’s mother).
10 I HouseCall I Volume X Issue 3
the people there, she was viewed as a doctor. I decided to become a doctor after I had a football injury in high school. I had to see an orthopedic surgeon and I was impressed by him and what he did. I thought surgery looked very interesting. I eventually went to medical school at UNC and I was given a job in the cardiology research program; as a fourth year student, I met Dr. Benson Wilcox, the chief of cardiothoracic surgery at UNC, who became my mentor and role model. He mentored me all the way through; I was simply blessed all the way.”
“
I HOPE I CAN BE A SURGEON WHO REFLECTS WHAT THE COMMUNITY SEES IN ST. CLAIR HOSPITAL.
ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL
”
Dr. Kiser has a private pilot’s license and is a certified scuba diver, but his favorite way to relax is by spending time with his family or working on new inventions. “I’m very busy and I enjoy coming up with innovations. That has opened many doors for me and introduced me to many people. It’s a profession, but it’s also a hobby. For me, it isn’t work, but fun; it’s how I relax.” The clinical aspect of his work is always challenging and satisfying, says Dr. Kiser, and he enjoys contributing to advances in clinical care and inventing. But his greatest satisfaction comes, not from having a groundbreaking impact on heart surgery, but from impacting individual lives. “When the things I have done change a patient’s life for the better, it feels wonderfully satisfying. Maybe they stop smoking or develop a new healthy lifestyle; they have a new lease on life and they contribute more to the community. People see a new opportunity
Andy C. Kiser, M.D., FACS, FACC, FCCP
for their lives after they have been through cardiac surgery. They've been dealt a blow, but then they are able to overcome it and have a renewed life. To see the impact of my work in that way — that’s the best.” Developing a high quality cardiothoracic program, says Dr. Kiser, depends primarily on the team: “This is a team sport, and I am very impressed with the team at St. Clair. There are many specialties and disciplines, and they have a wonderful level of expertise. If you want to know the quality of a hospital, look to the nurses; many of the nurses at St. Clair have been there long term and that says a lot. “A high quality program is patient-centered and patient education is a priority. We’ll have a multidisciplinary approach to educating patients with atrial fibrillation and valve disease, with representatives from Nursing, Dietary, Pharmacy and Respiratory Therapy. With the clinical collaboration between St. Clair and Mayo Clinic, we’ll be able to share best practices. “I’m also looking forward to collaborating with the physicians at McGinnis Thoracic and Cardiovascular Associates, especially Dr. George Magovern, Dr. Stephen Bailey, and their colleagues. “At St. Clair, the community embraces the Hospital and the Hospital provides so much. It’s a great relationship — an ideal one. I hope I can be a surgeon who reflects what the community sees
in St. Clair Hospital.” n
Volume X Issue 3 I HouseCall I 11
DUNLAP FAMILY OUTPATIENT
Longtime benefactors name St. Clair’s new outpatient center with largest gift in Hospital’s history Construction of St. Clair Hospital’s new outpatient center is just getting underway in earnest, but it already has a name: DUNLAP FAMILY OUTPATIENT CENTER.
T
he multi-million dollar, 280,000-square-
tient center and a central utility building to
foot building has been named in honor of
support it. The investment represents the
Anna and Ed Dunlap and their family for
largest expansion at the Hospital’s main campus
their very generous donation to its construction,
in four decades and is in response to the 130
as well as their longtime commitment toward
percent growth in St. Clair’s outpatient volume
the Hospital. (St. Clair’s Fourth Floor Conference
since 2006.
Center, off its main lobby, is also named after the Dunlaps, and the Hospital’s nationally recognized
hensive diagnostic and therapeutic outpatient
Emergency Room also has benefitted from the
services, including: laboratory; medical imaging;
Dunlaps.)
cardio-diagnostics; physical and occupational
“What I find most impressive about St. Clair
EDWARD B. DUNLAP JR., FOUNDER, AND CHIEF EXECUTIVE OFFICER, CENTIMARK CORPORATION
“
is that the Hospital continues to function inde-
with 10 operating rooms, two procedure rooms, and 51 pre- and post-surgical rooms; a spacious
while still maintaining the caring and compassion
endoscopy (GI) suite with six exam rooms; other
of a neighborhood hospital,” says Ed, who serves
multidisciplinary clinical programs; conference
as Honorary Co-Chair of the Hospital’s Ground-
space; multiple seating options; a café serving
breaking Growth Campaign, which is designed
chef-prepared offerings; underground and valet
to raise funds for constructing the new outpa-
parking; and a commercial pharmacy.
important to us because it’s important to the health of the community.
12 I HouseCall I Volume X Issue 3
therapy; an infusion center; outpatient surgery
pendently by enhancing its services and facilities,
The Groundbreaking project is
EDWARD B. DUNLAP JR., FOUNDER AND CHIEF EXECUTIVE OFFICER, CENTIMARK CORPORATION
The new six-story building will offer compre-
”
CENTER Ed is the Founder and Chief Executive Officer of Washington
Help us build on our commitment to the community
County-based CentiMark Corporation, the leader in the commercial roofing and flooring industry in the U.S. and Canada. He and his wife are also the owners/operators of the iconic LeMont restaurant on Mt. Washington. They both agree that St. Clair offers the latest treatments and the newest technologies, but they reserve their biggest praise for the Hospital’s people. “From the moment you walk in the door, every person wants you to have a good experience,” says Ed. “You get exceptional care at St. Clair.” Ed and his family are so impressed with St. Clair that their
GROUNDBREAKING GROWTH – C A P I TA L C A M PA I G N –
The generosity of philanthropic individuals like Ed and Anna Dunlap makes possible St. Clair Hospital’s largest expansion in decades, thereby securing high quality health care in our community for generations to come.
philanthropic relationship with the Hospital spans more than
Funding for the $150 million expansion is being supported by
20 years. “The new outpatient center is going to be our most
government grants, tax-exempt bonds and Hospital funds, but it
important contribution,” he says. “It’s going to streamline
is private philanthropy that will ensure the project is completed.
the way the Hospital is providing care to patients.” Ed is hoping that others who have also experienced
Through decades of expansions, improvement and innovations,
St. Clair’s high-tech, high-touch patient care will join him and
the people of this region have stood by St. Clair Hospital,
his family in supporting St. Clair’s Groundbreaking Growth
continually lending their support and showing their faith in our
Campaign. “This fundraising effort will help lead St. Clair into
ability to deliver excellent health care. That unwavering commitment
the next generation of health care,” says Ed. “The Groundbreaking project is important to us because it’s important to the health of the community. This Hospital benefits the
has allowed us to remain an independent, nationally recognized leader in patient safety, quality, patient satisfaction and value.
community significantly. It makes getting excellent health care convenient. I think it’s the best hospital in the area.”n
EVERY GIFT MAKES A DIFFERENCE St. Clair Hospital Foundation asks that you please join in this transformative effort that will lead the Hospital into the next generation of health care. To donate to the Groundbreaking Growth campaign, please use the envelope included in this issue of HouseCall, donate online at stclair.org/giving, or call us at 412.942.2465.
{
Thank You!
Ed and his family are so impressed with St. Clair that their philanthropic relationship with the Hospital spans more than 20 years. “The new outpatient center is going to be our most important contribution,” he says. “It’s going to streamline the way the Hospital is providing care to patients.”
Volume X Issue 3 I HouseCall I 13
TREATING ADDICTIONS
ST. CLAIR HOSPITAL AND GATEWAY REHAB
Partner in the fight against substance abuse
“
We want
people to know that if they have a problem with opioid abuse or
S
t. Clair Hospital is funding a new program
resources were needed to
with Gateway Rehab to help individuals and
meet the demand for treat-
families who are struggling with opioid use
ment, and that people in
disorder (OUD) and other forms of addiction. For
seeking treatment needed
St. Clair patients, the service will provide immediate
immediate access to it.
and coordinated care, beginning in the Emergency
Accordingly, the Hospital,
substance abuse of any
Room (ER), through recovery and beyond, with the
through the Community
kind, they can come to
hope of not only saving lives but also improving the
Benefit Committee of its
quality of those lives. The program is the result of
Board of Directors, decided
a year-long effort that brought multidisciplinary
to make a substantial grant
experts from both facilities together, to brainstorm,
to fund this special program.
us. ...We’re right here, we care and we never close.
”
JULIA M. D’ALO, M.D., EMERGENCY MEDICINE PHYSICIAN, ST. CLAIR HOSPITAL
learn from each other and strategize. The new addiction treatment program provides behavioral
“We felt that in order to respond with the best approach possible, we needed to consult the best
health care, clinical medical care, and socioeco-
experts available. We were familiar with Gateway
nomic support with an approach that is holistic,
and we knew they had the expertise we needed.
pragmatic and deeply humane.
Gateway is a Pennsylvania Opioid Use Disorder
“We recognized that substance abuse, and opioid abuse in particular, was a significant and growing concern for many that we serve,” says G. Alan
14 I HouseCall I Volume X Issue 3
Paul Bacharach, President and Chief Executive Officer, Gateway Rehab
Center of Excellence (COE); it was one of the first rehab facilities in the state to be so chosen. “St. Clair and Gateway complement each
Yeasted, M.D., FACP, Senior Vice President and
other,” Dr. Yeasted adds. “We each bring different
Chief Medical Officer Emeritus at St. Clair. “Our
strengths to this. Paul Bacharach, Gateway President
Emergency Room, inpatient units and primary care
and CEO, suggested that we model this new initia-
physician offices were increasingly confronting
tive on their Center of Excellence program. We are
OUD as the problem worsened and the number
truly thrilled to work with Gateway, which has long
of overdoses climbed. We realized that additional
been recognized as a leading light in the fight
but the abstinence-based models of treatment
want much more than that,” explains Julia
people at both institutions — the ER physicians,
don’t work well with OUD. The new model is
D’Alo, M.D., an emergency medicine physician
case managers, social workers, behavioral
Medication Assisted Treatment, or MAT. This
at St. Clair. “They need a bit of our humanity,
against addiction. All the credit goes to the
health staff, our chief nursing officer and
is evidence-based treatment that shows that
to feel personally cared for, as much as they
others — who planned it and will be a part of it.”
using certain medications decreases the over-
need our clinical expertise. They also need
Paul says that this program is timely. “Opioid
dose rate and keeps people in recovery programs
immediate help. We now give one of the
use disorder, and other forms of substance
longer. It is now widely accepted that MAT
approved medications right away in the ER,
abuse, is becoming a bigger problem across
and behavioral therapy, plus psychosocial
where the physicians have been certified to
the region. St. Clair was committed from the
interventions, are a safe, efficient and effective
give them. We call Gateway to summon a
start to meeting the increased demand for
model of care.”
Recovery Support Specialist (RSS), who will
Medication Assisted Treatment is primarily
treatment and rehabilitation with an approach that offers a rapid and effective response.”
A public health crisis
come to the ER as quickly as possible. This
for the treatment of addiction to opioids such
person is a peer who has been through
as heroin and prescription pain relievers that
recovery and becomes the patient’s mentor,
contain opioids. It blends behavioral therapy
advocate and helper for a year. Gateway will
and the administration of one of three FDA-
have a bed for the person for an immediate
health emergency in 2017 by the U.S. Depart-
approved medications: methadone, naltrexone
admission, or an outpatient appointment the
ment of Health and Human Services. Although
or buprenorphine, also known as Suboxone.
very next day.”
The opioid epidemic was declared a public
The program enables Gateway to hire care
few hospitals have had programs to treat opioid
These medications normalize brain chemistry,
use disorder, it has become more of an issue as
block the euphoria or “high” of opiates, and
coordinators who help manage other issues
the opioid epidemic has worsened and overdose
relieve physiologic cravings without the nega-
that often lead to relapse, such as unemploy-
deaths have increased, heavily impacting
tive effects of the abused substance. People
ment and homelessness, explains Paul. In
emergency services. “Addiction treatment
can take these medications and function
addition, the RSS assists the patient with basic
has long been considered a behavioral health
normally; others cannot tell that they have
lifestyle needs, such as transportation to
problem, but the onset of the opioid crisis
taken it.
appointments. The goal is for the RSS to engage
Traditionally, a person who comes to the
shifted it to the medical realm,” says Jason D.
the patient to want recovery: the RSS is living
Kirby, D.O., Medical Director at Gateway. “This
ER with a drug overdose receives emergency
proof that one can recover and life can get
occurred because of the medical complications
medical care to stabilize them, plus treatment
better. The services provide a nexus of support:
associated with opioid abuse, such as infections,
for related medical problems. They often
medication, social and medical care coordination,
endocarditis and organ failure,” he says. “Addic-
receive a referral to a facility that can provide
a caring personal relationship, and behavioral
tion has both behavioral and medical dimensions,
detoxification and rehab. “People need and
health care.
Continued on Page 16
WHAT DO WE KNOW ABOUT THE OPIOID CRISIS?
NEARLY
200
AMERICANS DIE
every day from
OPIOID
%
21
OF
2.1
MILLION
4OF 5 OUT
PATIENTS prescribed
a b u s e d
HEROIN USERS
OPIOIDS
OPIOIDS
LAST YEAR
prescription
MISUSE THEM
OVERDOSES
first misused
OPIOIDS
Source: www.cdc.gov/nchs/products/databriefs/db329.htm
Volume X Issue 3 I HouseCall I 15
TREATING ADDICTIONS Continued from Page 15
Dr. Kirby is well qualified to treat substance abuse disorders, with experience in both emergency medicine and addiction medicine. He is
standards; by teaming up with Gateway, St. Clair is offering the very highest level of care to an underserved population. The fact that St. Clair
a former ER physician who witnessed firsthand the devastating impact
tapped Dr. Yeasted, the CMO Emeritus, to lead this effort is a strong
of substance abuse. “St. Clair is strategically located for this. The ER
statement about the importance of this to the Hospital, the medical
there gets 64,000 visits annually — making it the busiest in western
staff, the administration and the community.”
Pennsylvania. They are a high volume, high quality ER and they see a high number of drug overdose patients.”
Dr. D’Alo shares her colleagues’ commitment to caring for persons with OUD and extends a compassionate invitation to the community from the St. Clair ER staff: “We want people to know that if they have
An innovative approach “It’s a novel idea to pair St. Clair and Gateway,” Dr. Kirby continues.
a problem with opioid abuse or substance abuse of any kind, they can come to us. We want to help and we know how to help. We have treat-
This program gets people from the acute setting of the ER to Gateway
ment that works, that can get them to recovery. If your life is not what
right away, which is critically important because there is a small window
you want it to be, it can get better. We’re right here, we care and we
of opportunity to get the person into treatment. Before, we had no clear
never close.” n
path to treatment; people were stopped by many barriers. If they had to sit in the ER and wait for a bed to open in a treatment program, they would get tired of waiting and leave, putting them at risk to resume using and at a higher risk to overdose. Now, patients can be transferred immediately from St. Clair’s ER to our facility, to begin addiction treatment
Alarming Increase in Overdose Death Rates
directly after treatment for an overdose. With MAT, you don’t feel the withdrawal symptoms, so you are less likely to use. The goal is that nobody leaves the ER, goes home and gets into trouble. This saves lives.” Mallory S. Ciuksza, M.D., an internal medicine physician with
In 2015, more than 33,000 Americans died of an opioid overdose
St. Clair Medical Services, regularly treats people with addiction and asked to serve on the planning committee. “As a primary care physician,
Over 64,000 in 2016
I take care of the person with addiction and often other members of the family who are impacted by the addiction: the father whose blood pressure
Overdose deaths in 2017
is high despite medication, because of his anxiety, or the mother who
70,237
neglects her diabetes because she is so focused on her son with opioid use disorder. I see the impact on the whole family. It touches every part of a community, and so it requires a community solution. “This program with Gateway is a huge step in the right direction,
2015
putting systems in place to help more people who want to be helped. The COE designation means that this program meets the highest possible
Source: www.cdc.gov/nchs/products/databriefs/db329.htm
“
We want to help and we know how to help.
”
JULIA M. D’ALO, M.D., EMERGENCY MEDICINE PHYSICIAN, ST. CLAIR HOSPITAL
16 I HouseCall I Volume X Issue 3
2016
2017
SECOND ANNIVERSARY
ST.CLAIR HOSPITAL & MAYO CLINIC CELEBRATING
Clinical collaboration with Mayo Clinic benefits St. Clair patients
I
n September, St. Clair Hospital marked its second
anniversary as a member of the Mayo Clinic Care Network with several days of special events and lectures.
Timothy B. Curry, M.D., PhD, Director, Education Program,
Center for Individualized Medicine, Mayo Clinic, delivered
grand rounds presentations on pharmacogenomics to physicians and other clinicians at the Hospital and later before a group of community leaders at the Duquesne Club in Downtown Pittsburgh. Pharmacogenomics looks at the role of the genome (genetic makeup) in prescription drug response and analyzes how a person’s genetic makeup affects that person’s response to a drug or drugs. The intent, said Dr. Curry,
Timothy B. Curry, M.D., PhD, Director, Education Program, Center for Individualized Medicine, Mayo Clinic
an internationally recognized expert, is to optimize drug therapy so a patient receives the maximum benefit of
experts to assist with challenging medical cases, at no
a drug, with minimal side effects.
additional cost. Moreover, St. Clair works with Mayo Clinic
Discussions on pharmacogenomics are just one of many
specialists to enhance patient care through the exchange of
ways in which St. Clair physicians are collaborating with
best practice information, collaboration on the advancement
the world-renowned Mayo Clinic. Through this clinical
of clinical programs, and direct consultation.
collaboration — unique in western Pennsylvania — St. Clair physicians have direct access to the expertise of Mayo Clinic
To learn more about the benefits of the clinical collaboration,
please visit stclair.org/mayo. n
WHAT IS PHARMACOGENOMICS?
Pharmocogenomics is the study of how an individual’s genetic inheritance affects the body’s response to certain drugs.
Volume X Issue 3 I HouseCall I 17
IN THE NEWS
azette Post-G h g r u tsb ned The Pit d a byli ublishe p ly al’s t it n rece Hosp . Clair t S n lans, o story nsion p a p x e s s and it with succes owed it ll o f g then plaudin orial ap it d e n a spital. the Ho
18 I HouseCall I Volume X Issue 3
Reprinted with permission of Pittsburgh Post-GazetteÂŽ.
ASK THE DOCTOR
Ask the Doctor KARIN OLTYAN, M.D.
Q A
Do you have any suggestions on how better to achieve my health goals?
How often have you been seen by a doctor and told to “lose weight” or “get more exercise”?
Thursdays and Saturdays, at 8 a.m. for 30 minutes, by walking on a treadmill at the gym.” In this case, the more
These lifestyle recommendations are important to
specific the goal, the better. Schedule the goal on your
your health, yet often they are too vague, and it is
smartphone or calendar so it becomes part of your routine.
difficult to follow through with the suggestions. Generic
Engage a friend, family member or colleague to work on
recommendations can feel overwhelming, and we often
lifestyle changes with you, to help you remember and stay
find excuses not to do them.
on track with your plan, or even to take on some of the
As a primary care physician, I have seen how lifestyle
responsibilities at home. It is easier to be
changes improve health. They help manage conditions
motivated when someone else is expecting
such as diabetes or high blood pressure, reduce pain from
you, or if you know you have extra help.
osteoarthritis, or even cope with stress. They can help
So before your next office visit,
reduce the number of medications patients are required
think about those lifestyle changes to
to take on a regular basis. So I frequently counsel patients
improve health in a more detailed
about how to more effectively make these changes.
way — set a goal that is reachable,
One way to get started making lifestyle changes is to
be specific about the details, make
develop a short-term goal that you can work on before
it enjoyable, engage with others,
the next office visit. The goal should be realistic and
and think about rewarding yourself
detailed. An example of a goal for weight loss may be
in a healthful way when you do
“lose 5 pounds in one month.” It is good to have a longterm goal, too, such as “I want to lose 30 pounds by next summer,” but the short-term goal is easier to accomplish,
reach the goal. n
Karin Oltyan, M.D.
helps to build your confidence when you reach the goal, and then you can set a new goal for the next visit. After developing a goal, think about how you want to achieve it. Be specific about what you are going to do — where, with whom, when, how long — and try to make it enjoyable. An example for getting more exercise is: “I will exercise four days a week on Mondays, Tuesdays,
KARIN OLTYAN, M.D. Dr. Oltyan specializes in family medicine. She earned a medical degree at The Pennsylvania State University College of Medicine, Hershey, Pa., and completed a residency in family medicine at Brown University Memorial Hospital of Rhode Island, Pawtucket, R.I. Prior to joining St. Clair, Dr. Oltyan served as an attending physician with Franciscan Medical Group, Burien, Wash. For five years there, Dr. Oltyan also served as Medical Director and Clinical Supervisor of the Youth Health Clinic. She is board-certified by the American Board of Family Medicine. Along with Ruth Christoforetti, M.D., Dr. Oltyan practices with St. Clair Family Practice Associates, part of St. Clair Medical Services. To contact Dr. Oltyan, please call 412.942.8570.
Volume X Issue 3 I HouseCall I 19
1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org
General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400
IT’S OFFICIAL:
Dunlap Family Outpatient Center
The covered main entrance to the new addition.
(Please see Page 12 for story.)
HouseCall
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
@StClairHospital