About Us

History

When the original article about an intriguing new procedure known as the "coronary artery bypass graft" (CABG) was published in 1969, Dr. Jorge Garcia was a resident at Washington Hospital Center. At the time, he had every intention of becoming a pediatric surgeon. Yet, this new technique for treating heart disease held a strong fascination. On the advice of a mentor, Dr. Garcia applied for and was accepted into the highly competitive open-heart training program at the Cleveland Clinic, a pioneering center for CABG surgery.

Thirty years later, Dr. Garcia and his partners in Washington Regional Cardiac Surgery based at Washington Hospital Center manage one of the busiest and most successful cardiac surgery practices in the country

A Practice Timeline

Practice founded at Washington Hospital Center in 1974 by Dr. Garcia. He was joined by Dr. Luis Mispireta in 1976 and Dr. Paul Corso in 1978.

Garcia, Mispireta and Corso, together with Hospital Center cardiologists, helped to establish Washington Hospital Center's dynamic heart program, based on the Cleveland Clinic model.

Year One: performed 125 bypass procedures.

Year Two: performed 250 bypass procedures.

Year Five: performed over 600 bypass procedures, and as their reputation for quality and expertise grew, these physicians began to receive referrals of some of the area's most difficult cardiac surgery cases.

Today, WRCS includes 10 physicians who are nationally recognized practitioners, lecturers, authors and researchers.

WRCS surgeons perform over 2,600 cardiac surgery procedures each year at Washington Hospital Center, Washington Adventist Hospital and soon Georgetown University Hospital.

In 1990, fewer than 10% of patients were home by the fifth day after surgery. Today, 60% of those discharged home are able to return home by day 5, 40% by day 4, thanks to improved surgical techniques and post-operative management.

The practice now receives referrals of patients from around the country and the world.

Evidence-Based Medicine Yields Unique System of Care

Guiding all aspects of treatment at WRCS is a standardized system that covers every step of a patient's care, from a preoperative evaluation to discharge and follow-up appointments. This unique system is based on a best practices model, or evidence-based medicine. The system, which standardizes treatment and helps to ensure the best possible care for every patient, is dynamic, always under the vigilant review of WRCS physicians and nurses.

The high number of cases in the practice database – which exceeds 35,000 patients – makes it possible to effectively intertwine data with medical care. The evaluation process begins at weekly team meetings and is supported by the practice's full-time medical director, who tracks the system of care and ensures quality improvement. Patient outcomes are regularly measured against both internal and external benchmarks.

The system was developed at the Washington Hospital Center, the flagship hospital for WRCS surgeons, and it is also used as a model at the Washington Adventist Hospital. It will be the model at Georgetown University Hospital in the near future as well. Unique aspects of the WRCS system include:

The CVRR – cardiovascular recovery room – where heart patients are cared for postoper-atively. The CVRR serves as both recovery room and intensive care unit for most patients, who are transferred directly to a step-down unit rather than an ICU. With 12 beds dedicated to cardiac surgery patients, the CVRR is a highly specialized area of the hospital staffed by physician and nurse experts in heart care.

Intensivists – the physicians who staff the CVRR round the clock specialize in caring for postoperative heart patients. While the cardiac surgeon oversees the care of each patient and is the team leader, the intensivist is available to patients 24 hours a day with an unmatched level of expertise.

Cardiac nurse practitioners – have a highly specialized role in the care of WRCS patients. A nurse practitioner (NP) first meets the patient before surgery and conducts a thorough assessment for risk factors and special needs. Postoperatively, the NPs generally have a three-day goal to help the patient make the transition from the critical stage to discharge home. It is the NP's role to assess each patient's health needs and arrange for special services, including home care, physical therapy and cardiac rehabilitation.

Full-time medical director – manages the clinical practice, ensures that the system is monitored and reviewed regularly for quality improvement. He also coordinates the clinical aspects of a patient's flow through the cardiac surgery experience.

Post-discharge care – Once the patient is discharged home, WRCS remains the primary contact for that person for two weeks. Phone calls from patients during this crucial time period are usually triaged by nurses. In most cases, the nurses can answer patients' questions, but a practice physician is available for consultation at all times. At the end of the two-week period, patients return for an appointment with the surgeon, and they are then discharged back to the care of their cardiologist or primary care physician.

Surgical Expertise and Advances

Coronary Disease Minimally Invasive Techniques and Off-pump CABG

WRCS physicians are international leaders in minimally invasive, off-pump bypass surgery, one of the most recent advances during which surgeons perform CABG procedures without the use of the traditional heart-lung machine. One of the first in the country to perform "beating-heart surgery," or off-pump bypass, the WRCS group now performs >60% of its CABG surgery "off-pump," ranking among the highest rates nationally. WRCS physicians have trained surgeons from around the world in this important new technique.

Using the MIDCAB technique, off-pump surgery was combined with minimally invasive incisions in 1996 for patients with one blocked vessel. Today, with the use of advanced technology and surgical approach, WRCS physicians are performing beating-heart, multivessel bypass procedures for complete revascularization with significant success. Patients avoid the side effects and risks associated with the heart-lung machine, and they generally experience a faster, smoother recovery period. This approach has been found to especially benefit high-risk patients.

Bypass Conduits

Complete arterial grafting, the preferred approach, is performed whenever possible.

The internal mammary artery (IMA) remains the conduit(s) of choice, but WRCS uses two new approaches to bypass conduits. First, radial artery conduits are used in many cases in place of venous grafts from the leg. These grafts have been shown to have improved longevity. Second, when leg grafts are used, surgeons are now accessing them endoscopically, a less traumatic approach for the patient that results in a faster, more comfortable recovery.

Transmyocardial Revascularization

WRCS surgeons are among the most experienced in the country in the use of transmyocardial revascularization (TMR). With lasers, surgeons create channels through the myocardium to enhance blood flow to viable heart muscle in patients suffering from medically refractory angina and nonreconstructable coronary artery disease. This procedure is often used in combination with a CABG or angioplasty to treat an area of the heart muscle that cannot be reached using the traditional bypass or catheter procedures.

Heart Failure/Transplantation

A WRCS surgeon performed the first heart transplant in Washington, DC, in 1987, and our program is now one of the largest in the metropolitan region. Heart transplantation for patients with end-stage heart failure is a team effort that begins with a comprehensive assessment of each patient's potential as a transplant candidate. Unique to WRCS is a team of two cardiologists who specialize in this type of evaluation. Of the 150 patients referred to the WRCS heart failure team annually, approximately 10% are placed on the transplant waiting list. The team is available for consultation on the management of those patients not placed on the list. In addition to transplantation, treatment options for these patients include IV medications to improve heart function, mechanical assist devices and a myriad of new investigational modalities, such as biventricular pacing and passive heart restraints.

Devices

WRCS physicians use several types of assist devices to support patients in the process of being evaluated for heart transplantation, patients who are awaiting a transplant, chronic heart failure patients who are not transplant candidates, and patients who experienced post-cardiotomy shock. These devices include:

Abiomed BVS 5000 – a temporary, external pump that can be used for post-cardiotomy shock, as a bridge to a more permanent left ventricular assist device (LVAD), or as a temporary right heart support in patients already on an LVAD.

TCI HeartMate Vented Electric VA Systems – a portable, implantable left-side assist device that can be used as a long-term support or as a bridge to transplant. Patients can also go home on this system.

Thoratec Device – a more permanent assist device that is external, but allows the patient some flexibility. It can be used to support the right side, left side or both while awaiting transplantation.

Valve Repair and Replacement

WRCS surgeons offer extensive expertise in both mitral and aortic valve repair. Whenever feasible, valve repair is the approach of choice for disorders that require surgery. In patients with mitral valve regurgitation, the WRCS success rate for valve repair procedures exceeds 90%. Intraoperative trans-esophageal echocardiography is used extensively to assess the success of repair procedures and for direct evaluation of cardiac function before and after the repair.

Aortas

WRCS also specializes in aorta repairs for patients with aortic dissections and aortic aneurysms. Last year they performed 33 such procedures, most in emergency situations for patients who were critically ill and unstable.

Research

WRCS surgeons have always taken the lead in developing and perfecting new techniques and processes to improve patient outcomes. Current research projects include those that are studying: For more information about Cardiac Surgery Research within MedStar, please go to http://www.medstarresearch.org/cardiac_surgery.htm

Minimally Invasive Cardiac Surgery in High-Risk Patients (the elderly, women and patients who have undergone bypass surgery before)

Atrial Arrhythmias After Cardiac Surgery

Transmyocardial Revascularization and Its Effect on Quality of Life in High-Risk, End-Stage Coronary Disease Patients

Autoimmunity and Infection in Atherosclerosis

Angiogenesis (the use of angiogenic growth factors to encourage collateral capillaries to grow or improve the function of existing vessels to enhance blood flow)

New Devices and New Pharmaceuticals

In the future, WRCS research and practice will increasingly rely on robotics – the use of robots that will allow surgery to be performed through tiny scopes inserted into very small incisions. WRCS physicians will be involved in the early clinical trials of robotic surgery.

Publications

The results of hundreds of research studies conducted by WRCS in the past 25 years have been published in highly regarded professional journals. Some of the most recent articles authored or co-authored by WRCS physicians have been published by The New England Journal of Medicine, The Journal of Cardiac Surgery, The Annals of Thoracic Surgery and The American Journal of Cardiology. In addition, WRCS physicians annually present abstracts at the American College of Cardiology convention and at meetings and conferences throughout the United States, Europe and Asia.

Heart Attack I Diet I Excercise I Risk Factors I Valve Symptoms

Heart Disease Symptoms I Bypass Surgery I Questions & Answers

Washington Regional Cardiac Surgery, P.C.
Washington Hospital 110 Irving Street NW, Suite 1E3, Washington, DC 800-234-9498
Washington Adventist Hospital 7610 Carroll Ave Suite 440 Takoma Park, MD 800-401-2640

www.heartsurgery-dc.com