HEART LUNG
VASCULAR INSTITUTE
2023 ANNUAL REPORT
Our Mission | To serve through healing, education and discovery
The Heart Lung Vascular Institute (HLVI) includes cardiology, cardiothoracic surgery, pulmonary and critical care, and vascular surgery. Each service line strives to ensure that HLVI provides excellence in: • Patient care
• Medical education • Biomedical research
The physicians at HLVI perform more cardiothoracic and vascular procedures than any other medical center in the region and participate in cutting-edge research to achieve excellence in patient care. The Heart Lung Vascular Institute devotes itself to the medical center’s mission of healing, education and discovery. This annual report shares HLVI’s services, volumes, outcomes and accomplishments. Our hope is that this report will give you a better understanding of the specialists who are devoted to the medical center’s mission of healing, education and discovery. Thank you for your trust and support of the Heart Lung Vascular Institute. For additional information regarding our programs and services, please contact us at 865-305-6970 or visit us at UTMedicalCenter.org.
Paul Branca, MD, FCCP, D-AABIP, Vice President, HLVI
Brent E. Hannah, MBA, RRT, FACHE, Executive Director, HLVI
02 Introduction 03 Dedication to David Hall 04 Cardiology 05 Structural Heart Program 14 Cardiothoracic Surgery
2 | HLVI Annual Report
Dedication to David Hall Almost 25 years ago, the medical center established its first Center of Excellence, The Heart Lung Vascular Institute (HLVI). Mr. David Hall was one of its key developers and served as the first Vice President of the Heart Lung Vascular Institute. Prior to his recent retirement, he served the medical center, either directly or through its partners, for over 30 years. During his service he did not stop with the Heart Lung Vascular Institute. He was key in the development of multiple Centers of Excellence. Mr. Hall was instrumental in incorporating the science of improvement methodologies into hospital operations and he was fundamental in the development of many community and national partnerships which facilitate the provisions of care throughout the care continuum. At the time of his retirement, Mr. Hall was serving as the medical center’s Executive Vice President.
The decades of work performed by Mr. Hall has positively impacted this community in innumerable ways. Many of these effects will live on indefinitely. One of the key developers of the Center of Excellence, Hall also served as the first Vice President of the Heart Lung Vascular Institute.
We are honored to dedicate this annual report to Mr. David Hall, thanking him for his outstanding service to the medical center, team members, patients and the people of this region.
29 Community Outreach 30 Nursing Excellence 32 Tell Us Your “Why” 34 Giving 36 Scholarly Activity
17 Pulmonary & Critical Care 20 Vascular Surgery 23 Center for Transplant Services 26 ECMO 28 Adult Cystic Fibrosis Program
UT Medical Center | 3
University Cardiology has long been dedicated to providing East Tennessee with dependable, top-quality cardiovascular care. Our team of 30 physicians includes sub- specialists in the areas of electrophysiology, advanced heart failure, cardiac imaging, interventional cardiology, structural heart, and adult congenital. Besides our primary location in Knoxville, we also serve patients at offices in these communities: • Halls • Morristown • Jefferson City • Northshore (West Knoxville) • LaFollette • Sevierville • Lenoir City • Sweetwater
Cardiac CT A Cardiac Computed Tomography (CT) scan creates detailed images of the heart, its blood vessels and surrounding structures. This helps clinicians pinpoint plaque
buildup in patients’ coronary arteries.
HeartFlow™ Analysis Patients now have
access to the noninvasive HeartFlow analysis. This personalized cardiac test helps clinicians diagnose coronary artery disease by using coronary scans to provide insights into arterial blockage and the impact it has on the heart. This helps clinicians determine the next best steps in a patient’s treatment plan.
This new analysis is supported by the ACC/AHA Chest Pain Guidelines and has been adopted by more than 725 hospitals worldwide, including 80 percent of the Top 50 Heart Hospitals in the US. New level 1 clinical evidence now shows that the HeartFlow strategy is a frontline diagnostic pathway for patients with suspected coronary artery disease (CAD).
4 | HLVI Annual Report
Cardiac MRI Cardiac magnetic resonance imaging (CMR) is a noninvasive test that uses a magnetic field to produce a detailed image of the heart. Our Team Our dedicated advanced imaging cardiologists Anne Kassira, MD and Kashif Shaikh, MD. Conditions Treated 400 500 Cardiac MRI Volume
CMR continues to see increase utilization with a volume growth of 34% from the prior year, and 26% of the referrals are from outside the medical center. • Myocardial viability • Valvular heart disease • Cardiomyopathies (hypertrophic cardiomyopathy, • Aortopathies noncompaction cardiomyopathy and arrhythmogenic • Pericardial disease right ventricular cardiomyopathy)
300
200
100
0
2022
2023
Volume
303
406
• Cardiac masses and tumors • Congenital heart disease
• Infiltrative cardiac diseases
Electrophysiology A Cardiac Electrophysiologist is a cardiologist who specializes in heart rhythm disorders and the procedures used to treat them. At UT, we have four board-certified Cardiac Electrophysiologists. They treat a variety of heart rhythm problems and perform many different procedures. Conditions Treated • Atrial Fibrillation • Supraventricular tachycardia (SVT) • Bradycardia • Atrial Flutter • WPW • Ventricular tachycardia • Conduction abnormalities causing heart failure
EP Ablation Volume
600
500
400
300
200
100
0
2021
2022
2023
Volume
493
589
660
UT Medical Center | 5
Cardiac PET The medical center’s Cardiac PET uses Positron Emission Therapy (PET) to measure blood flow to the heart. This is a type of stress tests that allows clinicians to detect coronary artery disease. The Benefits of PET • Detects disease in blood vessles that are too small to be seen by the naked eye on an angiogram • Improved diagnostic accuracy compared to SPECT (another way to measure
myocardial blood flow) • Low radiation exposure • Test is completed in about 30 minutes
Cardiac PET Research HLVI helps the medical center meet its mission of discovery by conducting medical research through the Graduate School of Medicine and the Office of Clinical Trials. Here are some examples of recent research studies conducted by HLVI: •.Aurora trial enrollment (the medical center enrolled first patient in the world and was a top recruiter) • Flurpiridaz F-18 PET Myocardial Perfusion Imaging in Patients With Suspected Coronary Artery Disease | Journal of the American College of Cardiology (jacc.org) •.Upcoming involvement in additional flurpiridaz research to define the optimal protocol for flurpiridaz imaging (how to get best results with least radiation/time). What’s New with Cardiac PET •.Starting early in 2024 myocardial blood flow quantification will be available for every PET ordered • MBFQ (Myocardial Blood Flow Quantification) allows for measurement of absolute blood flow in each coronary territory - Improved diagnostic accuracy - Diagnosis of microvascular dysfunction - Evaluation of effectiveness of stress (was the test adequate to detect a problem)
6 | HLVI Annual Report
Hypertrophic Cardiomyopathy Center
The Hypertrophic Cardiomyopathy Center is dedicated to the evaluation and management of patients with hypertrophic cardiomyopathy (HCM). We are a comprehensive center compromised of a team with expertise in HCM. Our Team The HCM clinic is run by a group of dedicated clinicians proficient in managing patients with HCM, including cardiologists Anne Kassira, MD, Ben Shepple, MD, and clinical pharmacist, Jeff Lewis, PharmD. Services Offered
• Electrocardiograms • Holter monitoring • Echocardiography • Stress echocardiography • Cardiac MRI
This testing is performed by sonographers experienced in HCM as well as advanced imaging with cardiac magnetic resonance imaging. HCM Clinic
The HCM clinic is vital in the initiation and management of patients on mavacamten, a new medical therapy for HCM that is restricted under the REMS program (risk evaluation and mitigation strategy). These patients require intensive and frequent follow-up visits to ensure the safety of the drug administration. University Pharmacy has been certified as a specialty pharmacy that allows for dispensing of mavacamten. Alcohol Septal Ablation For patients requiring invasive septal reduction therapy, we offer alcohol septal ablation performed by experienced interventional cardiologists Raj Baljepally, MD, and Tjuan Overly, MD. Surgical Myectomy We also offer work with the department of Cardiothoracic Surgery to offer surgical myectomy. Electrophysiology Our Electrophysiology department also provides expertise in managing HCM patients with arrhythmias and placing implantable cardioverter defibrillators in those at high risk for sudden cardiac death. Genetic Testing We are able to offer our patients genetic testing, screening and counseling with our dedicated cardiovascular geneticist Ilse Anderson, MD.
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Inpatient Care Team At the medical center, University Cardiology has a dedicated team that takes care of patients who require hospital admission. Patients are matched with the cardiology specialists best able to manage their health issues. In addition to the inpatient team, the ICU team manages the most complex and critically ill cardiac patients. That includes those who require mechanical circulatory support devices.
Our Tea • Physicians
Conditions We Treat • Cardiogenic shock • Chest Pain/Heart Attack • Heart failure • Heart rhythm problems • Valve problems
• Nurse practitioners • Cardiac Cath Team • Cardiovascular ICU and Acute Care Nursing Teams • Echo, EKG, and Respiratory Teams • Physician assistants Mechanical Support Devices Available There are a variety of highly specialized resources available to patients, including: • Intraaortic balloon pump • Impella • ECMO
8 | HLVI Annual Report
Interventional Cardiology The Interventional Cardiology team uses advanced tools and techniques to evaluate and treat coronary artery disease. We are the only accredited chest pain center in Knoxville, providing round-the-clock heart-attack care to our community. Specialized Programs Microvascular Disease: Patients who experience chest discomfort or shortness of breath with exertion are often dismissed, particularly if nothing is discovered through stress test, CT scan, or cardiac catheterization.
At the medical center, we have a unique ability to diagnose and treat disorders of the small blood vessels in the heart. As the only center in the region capable of performing such testing, we can provide answers where others could not and tailor treatment to each individual patient.
Chronic Total Occlusion: Patients with totally blocked coronary arteries may continue to have symptoms that medications alone cannot control. The medical center offers patients specialized equipment, techniques and personnel who can open these blockages and improve quality of life. Specialized Equipment Intravascular Imaging: Our institution uses intravascular ultrasound and optical coherence tomography, which allow our physicians to see blood vessels from the inside out and ensure procedures achieve the highest possible quality. Atherectomy: Opening calcified lesions can be a challenge. At the medical center, we employ rotational atherectomy, orbital atherectomy, laser atherectomy and intravascular lithotripsy to achieve optimal results.
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Structural Heart Program The Structural Heart team is a multidisciplinary team that includes cardiac surgeons, interventional cardiologists, electrophysiologists, imaging cardiologists, pharmacists, nurse practitioners and more.
Procedures and Treatments • Transcatheter aortic valve replacement • Aortic and mitral balloon valvuloplasty • LAAO closure device • Percutaneous ASD/PFO closure • Percutaneous paravalvular leak closure
• Transcatheter mitral valve repair • Transcatheter edge to edge repair
10 | HLVI Annual Report
Patient Spotlight Sharon Hoover
TAVR and LAAO Closure Device Procedure The Heart Lung Vascular Institute now offers new options for atrial fibrillation patients. These minimally invasive procedures include Mini-Maze Surgical Therapy, Pulmonary Vein Isolation, and the LAAO closure device. Patients with aortic valve stenosis have the minimally invasive procedure option of a transcatheter aortic valve replacement (TAVR). For years, Sharon Hoover had experienced symptoms caused by atrial fibrillation. When one particular episode required a trip to the emergency department, she and her husband chose the medical center. Within a couple of weeks, Sharon was under the care of William J. Mahlow, MD, a cardiac electrophysiologist with University Cardiology. Mahlow diagnosed her with aortic valve stenosis. That’s a type of heart valve disease where the valve between the lower left heart chamber and the body’s main artery (the aorta) doesn’t open fully. It can cause the heart to beat irregularly. As a result, Sharon would need a valve replacement. Mahlow determined that Sharon was a candidate for the TAVR procedure. TAVR is much less invasive than traditional open-heart surgery, which means faster recovery time and less risk.
“One of my greatest joys is to care for a patient as they receive a treatment or procedure that dramatically reduces crippling symptoms or gets rid of a significant threat to their life. I am so glad to be able to offer these advanced, minimally invasive therapies to so many patients who need them,” said Mahlow. Sharon underwent the TAVR procedure and was discharged the following day. Her recovery was so minimal that, six days later, she went on vacation to Florida with her husband and her sister. “Other than not lifting anything over 10 pounds for a week, I had no restrictions, so there was very little disruption to my life,” Sharon said. To further reduce the risk of stroke, Sharon’s medical team also recommended a follow-up procedure to implant a LAAO closure device. The LAAO closure device is a one-time, minimally invasive procedure for people with atrial fibrillation not caused by a heart valve problem. Non-valvular atrial fibrillation, as it is known, can mean a lifetime of blood thinners, which can also lead to concerns about issues like bleeds and falls. Sharon had seen the LAAO closure device advertised on television and she had researched the device online. “I wanted to decrease the medications I was taking,” she said. “Blood thinners make you bruise easily, and I was concerned about the risk of a stroke. In addition, my insurance no longer covered the cost of one of the prescriptions.” Six weeks following the LAAO closure device implant, Sharon was able to stop taking the blood thinner.
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Brent Hannah, Executive Director of the Heart Lung Vascular Institute, said it’s an honor to be a part of stories like Sharon’s. “Offering advanced procedures like Watchman and TAVR helps us live up to our mission to serve our community. We know it is important to stay on the forefront so patients aren’t forced to travel outside our region for the latest advancements in care,” he said. Now, Sharon says that the impact of these state-of-the-art treatments has made a positive impact on her life. Although her symptoms weren’t severe, she’s comfortable, has more stamina and is confident that her heart is as good as it can be.
She said, “Without these treatments, I know my life would be restricted or over by now.”
Symptoms of atrial fibrillation include: chest pain, heart racing, shortness of breath, fatigue and light-headedness. If you or someone you love is experiencing these symptoms, please encourage them to call 911, make an appointment with their doctor today or call University Cardiology at 865-544-2800.
Mitral Regurgitation Procedures Mitral regurgitation (MR) is a condition where blood flows backward into the heart due to either a problem with the mitral valve itself, called primary MR, or due to a weak and enlarged heart, called functional MR. We offer minimally invasive treatment alternatives, Transcatheter Mitral Valve Repair (TMVR), or Transcatheter edge-to-edge repair (TEER), to open-heart surgery for patients with severe MR. This involves the placement of one or more clips on the mitral valve to improve its function. In carefully selected patients with functional MR, this therapy has been shown to lower the risk of hospitalization for heart failure and improve survival. MEET THE MITRACLIP ™
Does It Require Hospitalization? Typically, one night in the hospital is all that is required after the procedure.
A highlight of our program is the multidisciplinary evaluation of patients with functional MR in collaboration with our heart failure clinic staffed by heart failure specialists, nurse practitioners, pharmacists, and nurses. This collaboration ensures that we maximize the benefits of optimal medi- cal therapy prior to considering the clip procedure. After the procedure, patients have an immediate reduction of leaks and experience improvement in their shortness of breath and fatigue. The goal is to facilitate successful repair of the mitral valve, optimal recovery, and quick return to usual activity for the patient.
12 | HLVI Annual Report
Patient Spotlight Michael Simpson, Open Heart Surgery Michael Simpson, a lifelong resident of Knoxville, lives with his wife and daughter and serves as a magistrate in the Knox County judicial system. He described himself as dedicated to a healthy lifestyle: eating right, exercising frequently and keeping his weight down, along with check-ups with his primary care physician every six months. But during a work-out at the gym in September 2022, he felt something wasn’t right. “My breathing wasn’t normal. I felt like I was going to throw up, and then I thought maybe it was just heartburn,” he said. As the discomfort eased a bit, he drove home, took an antacid and called his wife. After talking to him for a few minutes, she said, “You don’t sound like yourself, I’m calling an ambulance.” The EMTs told Michael that he was actively having a heart attack. They rushed him to the Emergency Department, where the medical team quickly performed a heart catheter procedure. There, he received the unthinkable news. The blockage in his heart was in an area where a stent was not possible, and they would have to perform open heart surgery the next morning.
“That night, I was just in shock. Total shock. I couldn’t believe that it happened to me,” Michael said.
The medical team performed a single bypass open heart surgery the next day. After a short stay in the hospital, Michael was released to go home with new restrictions and medications, as well as a comprehensive recovery plan. As Michael’s cardiac rehab program began, he said, “It was comforting to be back in the gym again, this time, with a heart monitor and nurses guiding me along the way.”
Still tentative and weak from the surgery, the rehab team worked to rebuild his strength so he could resume his normal, day-to-day activities. “It built my confidence,” Michael said. “I did 36 sessions, and it was a great experience. The staff was really good and worked with me personally. I credit them with getting me back to the point I was before.” Michael’s heart attack caused a considerable amount of personal reflection. “It can happen to anybody,” he said. “Now, I want to live my life. Of course, I want to be careful, do the right things, and eat right. But I want to go back to racing, camping and traveling abroad. I want to do all the stuff I dreamed of.”
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With four cardiac surgeons, three thoracic surgeons, a team of physician assistants and nurse practitioners, the Cardiothoracic Surgery team has a busy daily clinic, inpatient service and operating room schedule.
Our cardiac surgeons provide a broad range of services, with a strong focus on: • Coronary disease
• Valve repair or replacement • Disease or injury of the aorta
Our thoracic surgeons provide expertise in all areas of chest surgery, including: • Lung • Chest wall • Esophageal procedures Both teams are skilled with minimally invasive approaches to surgery, including the use of our daVinci surgical robot. Our surgeons collaborate with our structural cardiologists to offer a catheter-based heart valve replacement for those patients who qualify. This approach allows a dramatically reduced hospital stay, recovery
time and no major incisions. Inpatient Services
Our inpatient services are on the seventh floor of the Heart Hospital. Nurse Manager, Shannon Cusick oversees a staff focused on providing outstanding pre-and-postoperative care and recovery.
The nurses are trained in managing drains, pacemakers and specialty devices unique to our cardiac population. This floor also includes exercise physiologists whose key role is ensuring all appropriate patients are safely getting out of bed and working on their recovery. Outpatient Clinics Patients are seen every day in one of the outpatient clinics within the HLVI building or the Cancer Institute, with onsite testing as needed.
14 | HLVI Annual Report
Meet Our New Cardiothoracic Surgeons
John Murray, MD Residencies
• Cardiac Surgery, Emory University School of Medicine, Atlanta, Ga. • Integrated Cardiothoracic Surgery Resident, Emory University School of Medicine, Atlanta, Ga. Medical School • MD, Medical University of South Carolina, Charleston, S.C. Board Certification • American Board of Thoracic Surgery – Thoracic and Cardiac Surgery Kimberley Linden, MD Fellowship • Research Fellow, Cooper University Hospital, Camden, N.J. Residencies • Cardiothoracic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C. • General Surgery, Cooper University Hospital, Camden, N.J. Medical School • MD, Drexel University College of Medicine, Philadelphia, Penn. Board Certifications • American Board of Surgery - Surgery • American Board of Thoracic Surgery - Thoracic Surgery
Cardiac Surgery Volume
500
400
300
200
100
0
2021 406
2022
2023 408
Volume
378
UT Medical Center | 15
Patient Spotlight Scott LaVoie, Thoracic Surgery, Barret’s Esophagus
Teachers encourage their students to be curious. So, when Scott Lavoie’s students asked the high school math teacher and Army veteran about the telltale scar on his neck, he told them. Because Scott has a story others can learn from. “Food was getting stuck in my chest and esophagus, causing pressure and pain,” he said. Scott asked his primary care provider about his trouble swallowing during a routine physical. A whirlwind of GI-related tests revealed extensive damage to his esophagus caused by escaping stomach acid. The diagnosis: Barrett’s Esophagus with high-grade dysplasia — and it was precancerous. Faced with an escalating condition, Scott met with cardiothoracic surgeon, Sean Jordan, MD.
“He said it would progress to esophageal cancer. If not in six or nine months, certainly in one or two years,” Scott said.
So, Jordan and James M. McLoughlin, MD, a surgical oncologist, reconstructed Scott’s esophagus and upper stomach, a surgery that lasted about eight hours.
“From the surgeons to the residents, the nurses and my physical therapist, I had very competent people taking care of me,” Scott said. Five days after his surgery, a swallow test showed Scott’s healing was on target. Just two months later, he was released from care and now eats whatever he wants in small meals throughout the day. Now back at school full time, Scott’s been answering questions from students and raising awareness of Barrett’s esophagus and silent reflux with colleagues who may have similar symptoms. “One of them is a close friend, also a veteran and fellow teacher. He told me he had Barrett’s esophagus, and he was going to get it checked out. Now he’s changing his diet,” Scott said.
Scott has a lot of lessons yet to share and is thankful to UT Medical Center for helping him. “This gave me a new lease on life.”
16 | HLVI Annual Report
University Pulmonary and Critical Care (UPCC) physicians and nurse practitioners specialize in the diagnosis and treatment of inpatient critical care patients who are typically hospitalized as well as diagnosed and treated for pulmonary (lung) conditions in an outpatient setting. We have been providing exceptional and compassionate care to the region for more than 40 years. Our board-certified physicians and team of practitioners will work with you, your family and your primary care physician to ensure you receive the best treatment possible.
UPCC uses state-of-the- art diagnostic tools and treatments to address our patients’ pulmonary
concerns. Our physicians and nurse practitioners provide compassionate, expert care. Our Locations In addition to our office at the main campus, we see outpatients at our Regional Health Centers in Halls, Morristown and Lenoir City,
as well as a satellite office in Northshore Center and Sevierville. Each location has respiratory therapists present to provide advanced on-site pulmonary function testing.
Our Team The medical center provides a
comprehensive slate of lung-related services. The Pulmonary and Critical Care Division has grown tremendously in the past few years, now having 15 physicians and five outpatient Nurse Practitioners.
Respiratory Care provides care for patients in need of treatments, therapies, education, and many different services throughout the medical center. Respiratory Therapist work to provide 24/7 care for all patients from Pulmonary Function Testing, Bronchoscopy, Neonatal ICU, Adult ICUs, and Acute care. UT RTs are well trained and diverse in the care they provide, delivering state-of-the-art care for patients ranging from the tiniest premature neonate to geriatric. Using protocols that have been subject to multiple publications and educational presentations throughout the US.
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Our pulmonary medicine inpatient Nurse Manager, Taylor Rouch, oversees a large staff of specialty nurses providing high-quality care focused on advanced lung disease. These nurses and respiratory therapists continue to serve a heroic role on the frontline of care for Knoxville’s patients with COVID-19.
Our Services Our Pulmonary and Critical Care services include cutting edge-care for all lungdiseases, including special focus on: • COPD • Pulmonary Fibrosis • Asthma • Adult Cystic Fibrosis • Lung Cancer • {ulmonary Hypertension Our Specialties
COPD Program: Katie Gardner, DO, leads our COPD program, incorporating the latest medical treatments and pulmonary rehabilitation to optimize lung function. Advanced procedures such as bronchoscopic lung volume reduction are offered when appropriate. Interstitial Lung Disease: Jared Kravitz, MD, leads the Interstitial Lung Disease program, a multidisciplinary focus on the causes and treatment of diseases which cause scars diminishing lung capacity. A twice monthly case-conference gathers specialists from Pulmonary, Rheumatology, Radiology and Pathology. The team discusses and creates treatment plans for patients. Pulmonary Vascular Disease: Our Pulmonary Vascular Disease section is growing greatly. Francisco Soto, MD, leads the research program, with a special emphasis on Pulmonary Hypertension. We provide complex and comprehensive treatments for these debilitating disorders. Specialty Thoracic Oncology: Our pulmonologists work closely with our thoracic surgeons and Cancer Institute to provide a multidisciplinary approach to lung cancer. Specialty Thoracic Oncology clinics are staffed three times per week, and bronchoscopic biopsies, including those with the latest ION Robotic Bronchoscope, are done daily. Interventional Pulmonologists: Our three interventional pulmonologists deal with a spectrum of lung and pleural diseases caused by anatomic defects. They specialize in difficult procedures such as rigid bronchoscopy, bronchoscopic electrosurgery, stent placement, tracheostomy placement and management of pleural disease. Some of our research efforts have included the use of bronchial valves to improve emphysema. Critical Care: All of our pulmonologists are dual-trained as Critical Care specialists. They manage the sickest ICU patients, partnering with Emergency and Trauma to run the hospital’s life support systems.
18 | HLVI Annual Report
Patient Spotlight Reagan Bollig, MD, Lung Cancer When medical center surgeon, Reagan Bollig, MD, learned that he had lung cancer, he experienced surgery and cancer treatment from the patient’s perspective for the first time. While making his rounds one day last year, Bollig experienced what he thought to be kidney stones. He checked himself into the Emergency Department between patients, and his doctor called him the next day and suggested that they do a CT scan. The scan revealed a mass on Bollig’s lung, and Ben Bevill, MD from Pulmonary and Critical Care was called in to perform a Robotic Guided Transbronchial biopsy. The procedure determined that the mass was cancerous. Just three days after receiving his diagnosis, Bollig, his wife, son and family friends embarked on a two-week vacation out West, a trip that had been planned for months. “I knew that a week after I got back, my chest was going to be cut open,” Bollig said. However, at that time, he did not know how aggressive the cancer might be. On the trip, he, his family, and their friends hit all the spots they’d planned, including Sedona, the Grand Canyon, Zion, Moab and Breckenridge. They indulged in road snacks, played games and listened
to music. “But when I’d walk the dog at night alone,” he said, “that’s the time that I would reflect and really appreciate the time we had together as a family. You can’t help but think, ‘I hope I have more.’” Upon returning home, Bollig reported to the hospital for surgery. Thoracic surgeon Sean Jordan, MD, hoped that he could remove the cancer by taking one small segment of the lung, but it was possible that he’d have to take the entire lobe. Fortunately, Jordan discovered that the mass was more mobile than he originally thought, and very little of his lung had to be removed. The biopsy yielded the best possible results – the cancer was low-grade, not aggressive and not growing. An avid runner and cyclist, Dr. Bollig found the recovery process to be slower than expected. “I couldn’t run for a long time,” he said. “I used to tell patients, ‘You’ll be tired for a couple of weeks,’ but now, I really know what to say to them. I lived it,” he said.
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University Vascular Surgeons are experts in the diagnosis and treatment of diseases of the arteries and veins. These doctors helped develop stent grafts that are now being used throughout the United States for repair of aneurysms and clogged peripheral arteries. Endovascular stents often can be placed in the artery through a small incision, reducing post-operative pain and shortening recovery time. Staff vascular surgeons lead East Tennessee’s only training program for vascular surgery fellows. In addition to advanced surgical procedures, complete noninvasive vascular system testing using state-of-the-art technology and expertise is offered. Research The Vascular Surgery team is at the forefront of research and innovation for aortic aneurysm repair.
The TAMBE™ device is the only off-shelf aortic stent for thoracoabdominal aortic aneurysm repair. The team was one out of 42 centers in the nation to participate in the GORE TAMBE clinical trial, and the first in Tennessee to implant a TAMBE device for complex endovascular aortic aneurysm repair.
The team prepared the day before with didactics and simulation for the procedure. The surgery was successful with a great patient outcome. The Vascular Surgery team participates in multiple research projects and clinical trials throughout the year. They currently have four active clinical trials and numerous ongoing clinical research projects.
20 | HLVI Annual Report
New Vascular Surgeon: Lauren B. Grimsley, MD The Vascular Surgery division at the medical center welcomed Lauren Grimsley, MD, as its newest faculty member in September 2023. Grimsley earned her undergraduate degree at Clemson University and medical degree at the Medical University of South Carolina. She completed her General Surgery residency training at The University of Tennessee Medical Center. During her residency training she earned an MBA degree, completing the Physicians Executive Master’s in Business program at The University of Tennessee Haslem College of Business. Grimsley then went to the University of Kentucky for a two-year vascular surgery fellowship. She has a strong record of teaching accomplishments and clinical research leading to her recruitment back to Knoxville to join Vascular Surgery. Grimsley practices all aspects of vascular surgery and leads the Vascular Division Clinical Research team.
University of Tennessee Vascular Surgery Fellowship Program
The University of Tennessee Vascular Surgery Fellowship program is a fully accredited ACGME two-year program leading to board certification in Vascular Surgery by the American Board of Surgery. Established over 30 years ago and the oldest fellowship at the medical center, the program has a strong tradition of graduating highly sought-after vascular
surgeons in both academics and private practice. Approximately 40 percent of fellowship graduates join academic surgical training programs with notable alumni now serving as Chief of Vascular Surgery at numerous universities such as UCLA (Vincent Rowe, MD) and University of Kentucky (Eleftherios Xenos, MD).
Currently this highly competitive vascular fellowship program graduates two fellows per year with Michael McNally, MD, as the fellowship program director.
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Vascular Surgery All Volume
Endovascular Procedure Volume
5250
4500
3750
3750
3000
3000
2250
2250
1500
1500
750
750
0
0
2021 3044
2022 3174
2023 3298
2021 4546
2022 4575
2023 4637
Volume
Volume
Carotid Artery Procedure Outcome Data 30-Day Mortality or Stroke Jan 2022-Dec 2023
TJC National Benchmark
Case Volume
UT Medical Center
Procedure
Carotid Artery Stent-Asymptomatic Carotid Artery Stent-Symptomatic
50 50
<3.0% <6.0%
2.0% 0.0%
Carotid Endarterectomy-Asymptomatic Carotid Endarterectomy-Symptomatic
110
<3.0% <6.0%
0.0%
94 0.9% Green = Exceeds Expectation of National Benchmark
Data Source: UTMC and TJC
Carotid Artery Procedure Data and Awards In collaboration with the Brain and Spine Institute, continued achievement of the TJC Comprehensive Stroke Accreditation Award and Excellent Carotid Artery Procedure Outcome Data.
22 | HLVI Annual Report
Our Team The Kidney Transplant Center at the University of Tennessee Medical Center is a UNOS (United Network for Organ Sharing) accredited program that began in 1984. Over the past four decades, our center has proudly conducted over 1500 kidney transplants. Our experienced team of surgeons, dedicated medical professionals, and compassionate support staff work collaboratively to provide patient-centered care, throughout their transplant journey. This has resulted in consistently high success rates and improved post-transplant outcomes.
Transplant Surgeons Daniel A. Galvez Lima, MD Oscar H. Grandas, MD
Transplant Nurse Practitioner Karen Hensley
Transplant Nephrologist Wala Abusalah, MD
Hep C+ The Kidney Transplant Center has begun offering hepatitis C-positive (HCV+) kidney transplants. This can offer several benefits, and this practice has become more common with new antiviral medications for hepatitis C. Here are some potential benefits: • Increased Organ Availability • Shorter Wait Times • Survival Benefit • Effective Treatment Options • Quality of Life Improvements Paired Donation The Kidney Transplant Center has partnered with the Alliance for Paired Kidney Donation to offer Kidney Paired Donation (KPD). Paired donation is a transplant option that can offer several benefits to patients in need of a kidney transplant. In KPD programs, incompatible donor-recipient pairs are matched with other pairs to facilitate compatible transplants. Here are some benefits of kidney-paired donation:
• Increased Donor Pool • Reduced Wait Times
• Overcoming Blood Type or Immunological Barriers
• Improved Outcomes • Non-Direct Donor Involvement • Increased Efficiency in Organ Utilization • Promotion of Living Donation
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Robotic Nephrectomy We now offer robotic nephrectomies for our live kidney donors. This approach offers several potential benefits compared to traditional open surgery or laparoscopic techniques. Some of the advantages of roboticnephrectomy for live kidney donation include: • Minimally Invasive Surgery • Improved Precision and Visualization • Shorter Hospital Stay • Reduced Scarring • Quicker Return to Normal Activities • Potential for a Broader Donor Pool Volumes/Listings/Public Outcomes • 64 Transplants
Renal Transplant Volume
70
60
50
40
30
2021
2022
2023
Volume
57
53
64
Outcomes (Reported July 2023)
National Patient (recipient) 1 year survival
1 Year Graft Survival
National 1 Year Graft Survival
Patient (recipient) 1 year survival
Organ Group
Adult Kidney Transpant
96.71%
94.09%
97.40%
96.27%
Adult Kidney-Deceased Donor Graft Recipients Adult Kidney-Living Donor Graft Recipients
96.35%
92.92%
97.10%
95.50%
100%
97.65%
100%
98.54%
24 | HLVI Annual Report
Patient Spotlight Joe Bailey MD, Kidney Transplant At the Center for Transplant Services, we get to experience the gift of life on a regular basis. Recently, Dr. Joe Bailey of Johnson City came in for his annual check-up. It’s been five years since Mary Bell, a then-stranger, donated one of her kidneys to him and saved his life. “I saw a story on the news about a schoolteacher who needed a kidney,” Mary said, “and I thought ‘I’m retired, I’m a widow, my kids are grown. I have two perfectly functioning kidneys. I could do this.’” As she continued to think more about it, Mary concluded that it wasn’t just something she could do, it was something she needed to do. For 57-year-old Dr. Bailey, waiting had become agonizing. With Stage V kidney failure, he was on dialysis, which often lasted 12 hours at a time. Vascular Surgeon Oscar Grandas, MD said, “‘We’ll get you a kidney.’ We were overjoyed,” said Bailey.
Dr. Bailey and his wife, Cyndi, waited a long time. They kept a suitcase packed by the door for four years in case a kidney suddenly became available from an organ donor. “When I finally got the call, and they said, ‘We have a kidney,’ I said, ‘Okay, we’ll get on the road.’” However, they told him that the transplant was scheduled for a date in three weeks’ time. It was then that he realized that the kidney was coming from a living donor. Throughout the process, Mary said she felt a sense of protection and gratitude. “The staff at the medical center made me feel very treasured. Everyone thanked me,” she said. “I was told I could back out at any time, but I never wavered.” They met for the first time one month after the surgery. In October, they celebrated five years of friendship – and five years of life. “She totally changed my life,” Dr. Bailey said. “I was a dead man walking. I got time with my family. With my daughters. With my dog. Time I never would have had. There’s no way I could’ve lived five years more.”
“I was a critical care nurse for 40 years, and I helped a lot of people, but I don’t think I had ever saved anyone’s life,” Mary said. “It’s a gift that I got to do it.”
UT Medical Center | 25
Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving treatment. The mechanical support system is used for patients with a serious illness to provide rest to the patient’s heart and lungs. The medical center is the only hospital in East Tennessee that can provide the experience and expertise in advanced mechanical circulatory support with ECMO.
ECMO is used to provide support for heart and lung recovery or as a bridge to additional treatment options.
The Heart Lung Vascular Institute’s ECMO program has earned the Silver Level ELSO Award from the Extracorporeal Life Support Organization. This prestigious award is presented to centers that demonstrate an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction and ongoing clinical care.
ECMO Volume
30
25
20
15
10
5
0
2021
2022
2023
Volume
11
15
26
26 | HLVI Annual Report
Patient Spotlight Brittnee, ECMO Patient
Soon after Brittnee gave birth to her third child, Brayden, she learned that the flu she’d been fighting for weeks had developed into bacterial and viral pneumonia, and she was put on a ventilator. After nearly two weeks, she became septic, and her lungs collapsed. Brittnee was emergency airlifted to the medical center where she was immediately treated with ECMO, a potentially lifesaving treatment for seriously ill patients with lung and heart conditions. The technology, which became widely known during the COVID-19 pandemic, had first come to the medical center in late 2020. The machine essentially does the work for the patient’s lungs and heart, giving them time to heal. Ultimately, Brittnee was on ECMO for 70 days. “I really don’t remember anything from after I gave birth to waking up two months later,” she said. Born and raised in Knoxville, Brittnee and her husband, Jeremy, were married in 2020 and have seven children in their large, blended family. People from their church, including the pastor and his wife, stepped in and helped Jeremy take care of the kids, especially newborn Brayden, while Brittnee fought for her life.
While on ECMO, one of Brittnee’s lungs became detached from its side wall, and she began bleeding internally. She underwent surgery to try to stop the profuse bleeding. The doctors told Jeremy that, even though her chances of survival were slim, it was important to maintain their positivity and help motivate Brittnee to keep fighting. And that’s exactly what she did. Brittnee was finally taken off ECMO and what followed was months of physical therapy and significant ups and downs. Brittnee was finally able to go home for good four months later, but she could not fully take care of herself without additional care for several more month. “I learned that I’m a pretty strong person, stronger than I thought I was,” she said. “My faith definitely guided me through my healing process. I wouldn’t have been able to do any of this without Jeremy’s support. And if it wasn’t for the staff, nurses and doctors at the medical center, I wouldn’t be here today.”
Learn more about ECMO and watch to hear Brittnee’s story here.
UT Medical Center | 27
The medical center is proud to be the only Adult Cystic Fibrosis Specialty Center in East Tennessee. Clay Callison, MD, directs this treatment and research program. Most of our patients make their transition from pediatric care at East Tennessee Children’s Hospital (ETCH) in their late teens. The medical center partners with ETCH to provide a smooth transition. Program Growth
The last year saw continued growth in our Adult Cystic Fibrosis Program as we have continued to graduate patients from our pediatric center as well as capture new patients who have moved to our region. With this growth, we have evaluated our current clinic processes for patient monitoring, especially as many of these patients live farther and farther from our center.
We have continued to embrace home spirometry as a cornerstone to our remote patient evaluations and have continued to expand the use of telehealth for our patients, both on a routine basis as well as for acute evaluations. We recently began a focused effort on abdominal ultrasound screening for liver disease, which has seen significant success. We continue optimizing this process through close interaction with radiology and by including the APRI calculation in our annual lab process. This indentifies those patients who need to travel to a hepatology center, since we do not have a board-certified hepatologist in East Tennessee. In 2023, Lindsay A. Samarin joined our team in preparation for the retirement of our longest tenured nurse practitioners in 2024. We plan to continue our work on social determinants of health to identify patients who need additional assistance, as we look to expand our screening process across our organization in 2024 beyond food insecurity. Awards National CFF Conference Poster Presentation November 2023 “Area Deprivation Index and Cystic Fibrosis Care Delivery: Data from the Tennessee and Mississippi Cystic Fibrosis Consortium.”
Program Patient Growth
140
120
100
125
80
121
107
96
82
87
60
99
74
58
40
66
20
24
20
20
19
19
18
15
16
11
12
0
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Existing Patients
New Patients
28 | HLVI Annual Report
2023 Community Events Our team is dedicated to improving the health of our community and to increasing the knowledge within the community about hands-only CPR and the early signs and symptoms of a heart attack. We have partnered with the Knoxville Area Urban League, American Heart Association, and various other community organizations to expand our reach into the community to provide screenings and education to our community members. HeartWise is an annual community event that educates the public about early detection and treatment of coronary artery disease. This event, held in Knoxville and Halls in 2023, offers a wide range of
11 events
education and screenings. These include: • Comprehensive cardiac risk assessment • COPD pulmonary screening • Cardiac calcium scoring • “Ask a Pharmacist” medication counseling • HLVI Healthy Nutrition
1,360 Community Members Reached
Other events included: • HLVI teamed up with our Stroke and Trauma partners to provide education on early heart attack and stroke signs and symptoms and Stop the Bleed information. • Smoking cessation information was also provided at several of the events. • Several screenings were offered at different events including lung cancer, COPD, carotid, and abdominal aortic aneurysm. • Hands-only CPR and early heart attack care education have been a major focus for the Heart Lung Vascular team for the past few years.
UT Medical Center | 29
Our nurses strive for excellence in the practice of professional nursing in our region while supporting the medical center’s mission, vision and values. The Region’s Only Magnet Hospital The American Nurse Credentialing Center’s Magnet Recognition Program is the most prestigious distinction a health care organization can receive for nursing excellence and quality patient outcomes. Organizations that
achieve Magnet recognition are part of an esteemed group that demonstrates superior nursing practice and outcomes.
While the benefits of Magnet speak for themselves, the journey to and redesignation of Magnet requires real dedication. The University of Tennessee Medical Center is one of four hospitals/systems in Tennessee with Magnet designation. There are almost 6,000 hospitals in the U.S., but only around 8% of them have earned this special recognition.
The organization achieved Magnet recognition for the third time in 2021 after achieving recognition in 2016 and 2011.
Our nurses have shown immense dedication to their patients — at times standing in for loved ones — and their profession by delivering safe, high-quality and compassionate care. We are incredibly proud of all our nurses, who have resolutely served the East Tennessee community, honored their profession with excellence and supported one another with courage. Nurse Excellence Awards Nurse Excellence Awards are awarded annually during Nurses Week. Nominations are submitted by nurse managers or peers and winners are chosen based on dedication, exceptional clinical practice, and distinguished contributions to the nursing profession.
In 2023, two HLVI nurses received this award, Megan Fisher, BSN, RN, ECMO Program, and Kristal King, BSN, RN, 9 Heart.
The Silver Lamp Award originated in 2006 at the Baptist Health System Foundation. With hospitals facing financial challenges, funding for continuing education became increasingly scarce. These awards, funded through many generous donors, were established with input from physicians and administrators to maintain excellence in healthcare.
30 | HLVI Annual Report
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