Chairman's Introduction
The Department of Cardiovascular and Thoracic Surgery at The University of Texas Southwestern Medical Center at Dallas provides clinical services in adult and pediatric cardiovascular and thoracic surgery, as well as heart and lung transplantation, to patients in Dallas/Fort Worth and throughout North and Central Texas. Members of the Department also participate in a variety of basic and clinical research endeavors in the fields of cardiothoracic surgery, physiology, and biochemistry. The department provides training in this field to future surgeons through the residency program in thoracic surgery.
The clinical heart transplantation program at The University of Texas Southwestern Medical Center at Dallas has now performed 722 heart transplants since its inception in April 1988. Through December 2009, this included 377 adult transplants at University Hospital-St. Paul, 217 adult transplants at Baylor University Medical Center, and 128 pediatric transplants at Children's Medical Center Dallas. The UT Southwestern Heart Transplant Program remains the leading program in Texas in terms of survival, with one-, five-, and ten-year survival rates for adults at 92%, 81%, and 68% respectively for adult heart transplant recipients versus 88%, 74%, and 55% averages nationally.
Since 1990, UT Southwestern's Lung Transplant Program has performed a total of 391 lung transplants, including 207 lung transplants at University Hospital-St. Paul and 184 lung transplants at Baylor University Medical Center. Over the past ten years, actuarial survival rates for the program have consistently exceeded the national average, with a one-year survival rate of 91% and a five-year survival rate of 64% at St. Paul University Hospital, versus national survival rates of 86% at one-year and 56% at five-years. This includes more than 65 patients with cystic fibrosis with a 95% one-year survival. University Hospital-St. Paul remains one of the leading lung transplant centers in the nation for survival outcomes int he most recently published UNOS Center data (July, 2009).
The use of ventricular assist devices has increased in our department over the last few years, following the national trend in this exciting area. Our department offers a broad range of both short- and long-term devices to support patients with end-stage heart failure. The short-term devices include the TandemHeart, Abiomed BVS and ventricular systems, and Impella devices. Long-term options include the Thoratec Heartmate II, and more recently the Heartware LVAD for which UT Southwestern is a designated site for the Heartware Bridge to Transplant Trial. The department will also participate in the Heartware Destination Trial, another area of anticipated increase in patient and physician interest for end-stage heart failure.
The adult open heart cardiac surgical volume experience a slight increase in 2009 performing over 600 open heart cases, despite a 15-20% decline nationally, The pediatric open heart cardiac surgical volume in 2004 is 303 cases.
Clinical volume of general thoracic surgery has increased over the past year, with a total of over 1,100 lung, esophageal, mediastinal, and other chest cases performed. The volume of video-assisted thoracic surgery (VATS) procedures has seen a significant rise, comprising 72 cases last year. The department uses new technology for minimally invasive coronary bypass surgery as well. Dr. Wait and Dr. Meyer serve on the steering committee for the Southwestern Center for Minimally Invasive Surgery.
The Department of Cardiothoracic Surgery maintains an active basic science research laboratory that has been investigating cardiac metabolism under conditions relevant to open heart surgical procedures, such as after ischemia and during cardioplegic arrest. Investigators have identified changes in substrate utilization patterns in cardiac tissue that occur as a result of potassium cardioplegia and have investigated a variety of substrate modifying agents that lead to improved cardiac performance after ischemia. Studies of substrate metabolism in the lung have also been initiated with a goal of improving lung preservation strategies for transplantation. The laboratory receives funding from the National Institutes of Health, the American Heart Association and the American Lung Association.
The laboratory also participates actively in collaborative projects examining platelet and neutrophil kinetics during cardiopulmonary bypass as well as the effects of nitric oxide on accumulation and release of these blood components. These studies are done in conjunction with the Division of Biomedical Engineering and receive funding from the Texas Advanced Technology Program (to Dr. Robert Eberhart and Dr. Michael Jessen.) Other collaborative ventures include studying the limitation of exercise in adult dogs after pneumonectomy with pulmonary medicine investigators.
Members of the department also serve as co-investigators in a number of national multi-center trials as well as participating in a number of national registries. All cardiac surgical cases performed at UT Southwestern are entered in the Society of Thoracic Surgeons database, all transplant cases are recorded in the UT Southwestern Heart and Lung Transplant database, and all cardiac cases at the Dallas VA Medical Center are submitted to the VA Continuous Improvement in Cardiac Surgery Program.
