2016 Annual Report

HEA

RT 2 0 1 6

Our electrophysiology (EP) team was one of the first in Virginia to offer the world’s smallest leadless (wire-free) pacemaker that is implanted directly into the heart with a catheter. Our team of electrophysiologists and cardiothoracic surgeons continue to provide a unique comprehensive program to address cardiac rhythm disorders, such as atrial fibrillation. Our EP program is among the busiest in the country.

Our structural heart program remains one of the nation’s most successful transcatheter aortic valve replacement (TAVR) centers.

The cardiothoracic surgery program reached an important milestone with 50,000 open heart cases.

Cardiac research also continues to be an important focus. Our heart experts are actively participating in numerous studies. This gives patients access to the latest emerging technologies while simultaneously improving cardiac care.

We are committed to the provision of safe, effective and quality cardiac care for the best value. As we move toward the alignment of cardiac and vascular services within Sentara Healthcare, we will continue to provide comprehensive and innovative care to this unique population of patients.

We encourage you to learn more about our nationally recognized innovative programs and services highlighted in this year’s annual report.

Sincerely,

It is with great pleasure that we share the 2016 Sentara Heart Annual Report with you. We are exceptionally proud to highlight some of the accomplishments of cardiac services across all Sentara Heart locations.

In 2016, we marked the 10-year anniversary of the opening of Sentara Heart Hospital, the region’s only dedicated heart hospital. For the 16th consecutive year, Sentara Heart was listed as a top 50 heart program by U.S. News & World Report. We are proud of this achievement as our cardiac program vies against more than 5,000 hospital programs nationwide for this recognition, including the most prestigious academic medical centers in the country.

The Sentara Heart network of hospitals and cardiac services impacts all of the communities that we serve. The care we provide wouldn’t be possible without the collaborative efforts of our 28,000-plus team members. Our world-class heart specialists strive for excellence in quality, customer care and safety every day. Each Sentara Heart service continues to uphold our long-standing reputation for clinical distinction with a proven record of exceptional patient outcomes. Ten of our hospitals have been recognized by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the American Heart Association for their outstanding treatment of patients with acute myocardial infarction.

Our two regional councils ensure exceptional quality at more than 100 care sites across our health system. The councils’ oversight and national benchmarking allow our care teams to identify areas of improvement, implement timely action plans and share standardized best practices across all Sentara Heart locations. This focus fosters the highest possible care processes and appropriate cardiac programs at our hospitals and cardiac service sites.

In 2016, we expanded the successes of some of our most respected and sought-after cardiac care programs and innovations. These successes include, but are not limited to, the following:

Sentara Heart’s non-invasive testing program partnered with IBM Watson to analyze structured and unstructured medical information. This involvement put Sentara Heart at the leading edge of a digital revolution to seek innovative ways to improve patient care.

Sentara Heart

2016 Annual Report

Thomas Klevan, MD Medical Director Sentara Heart

Audrey Douglas-CookeVice PresidentSentara Heart Hospital

Ken Armstrong Senior Divisional Vice President Sentara Cardiac Service Line

2 0 1 6

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3 5

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2 4

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2

1

5

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5 2

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6 3

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5 8

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3 8

2 1

Sentara Advanced Heart Failure Center

Sentara Heart Valve and Structural Disease Center

Sentara Aortic Center

Cardiac Nursing

Cardiac Education

Sentara Cardiovascular Research Institute

Glossary

Transferring a Patient to Sentara Heart

Sentara Heart Promise

Non-Invasive Cardiology

Cardiac and Cardiac Pulmonary Rehabilitation

Ornish Lifestyle Medicine Program

Interventional Cardiology

Electrophysiology Program

Cardiothoracic Surgery

Cardiac Anesthesiology

Vascular Program

Sentara Heart Arrhythmia Center

Welcome

Sentara Healthcare Overview

Sentara Heart Hospital

Sentara Heart Network

To view this report online, go to AnnualReport.SentaraHeart.com

Sentara RMH Medical CenterHarrisonburg, VA238 Beds

Sentara Virginia Beach General HospitalVirginia Beach, VA276 Beds

Sentara Williamsburg Regional Medical CenterWilliamsburg, VA145 Beds

28,000+ Members of the Team

More than 1,000 Quality Physicians and Advanced Practice Clinicians

12 Acute Care Hospitals

Advanced Imaging and Diagnostic Centers

Nursing and Assisted-Living Centers

Outpatient Care CentersPhysical Therapy Centers

Home Care and Hospice in Virginia and Northeastern North Carolina

Optima Health Plan Serving 450,000 Members

Sentara College of Health Sciences

Sentara Quality Care Network A Clinically Integrated Network

SENTARA HEALTHCARE

AT A GLANCE

VIRGINIA

Charlottesville

Harrisonburg Woodbridge

Williamsburg

Hampton

Norfolk

Suffolk

Elizabeth City, NC

South Boston Virginia Beach

Hampton Roads

Blue Ridge

Northern Virginia

North Carolina

South Boston

NORTH CAROLINA

One healthcare system with many doors, but a

shared commitment to quality care and creating

an extraordinary healthcare experience.

Sentara Princess Anne HospitalVirginia Beach, VA160 Beds

Sentara Healthcare

Sentara Norfolk General HospitalNorfolk, VA525 Beds

Sentara Northern Virginia Medical CenterWoodbridge, VA183 Beds

Sentara Obici HospitalSuffolk, VA 176 Beds

1 27 in Hampton Roads

1 in Northern Virginia

2 in the Blue Ridge Region

1 in South Boston

1 in Northeastern North Carolina

Acute Care Hospitals

Sentara Albemarle Medical Center Elizabeth City, NC182 Beds

Sentara CarePlex Hospital Hampton, VA224 Beds

Orthopaedic Hospital at Sentara CarePlex HospitalHampton, VA18 Beds (included in Sentara

CarePlex Hospital license)

Sentara Martha Jefferson HospitalCharlottesville, VA176 Beds

Sentara Heart Hospital Norfolk, VA 112 Beds (included in Sentara

Norfolk General Hospital license)

Sentara Leigh HospitalNorfolk, VA 250 Beds

Orthopedic Hospital at Sentara Leigh Hospital Norfolk, VA 48 beds

Sentara Halifax Regional HospitalSouth Boston, VA192 Beds

3SENTARA HEART

Staying Ahead

of the Curve

Our goal at Sentara is to be among the best healthcare providers in the country. We strive for top 10 percent rankings in all areas where care, quality and service are considered.

We’re proud that we have been recognized by many state and national organizations for our work, because it means that we are giving our patients the attention and help they deserve. From hybrid ORs to innovative physicians and advanced practice clinicians to new models of care, we’ve always been ahead of the curve.

Sentara provided $341,145,000 in Community Benefits in 2016

Sentara was FIRST in the nation to pioneer eICU®, a remote monitoring system for intensive care.

We performed Hampton Roads’ FIRST heart and kidney transplants, in addition to the FIRST open heartsurgery.

We were one of the FIRST health systems to join and provide data for the IBM Watson Health global initiative.

Sentara conducted the WORLD’S LARGEST clinical trial of copper- preventing health-care associated infections and we have copper-infused linens and hard surfaces in every hospital.

1 3 3,8 0 1Adult Hospital Admissions

7 9 0,2 2 3ER Visits

1 6,3 5 8 Deliveries

$ 310,123,000 $ 18,923,000 $ 12,099,000 $ 341,145,000

SENTARA HEART HOSPITAL

Recognized for more than 17 years as one of America’s best hospitals for Cardiology and Heart Surgery by U.S. News & World Report.

Sentara Heart includes more than 140 board-certified cardiologists,

cardiothoracic surgeons and anesthesiologists. From diagnostic testing

to emergency heart attack care, Sentara Hospitals provide quality heart

care to the residents of our service area and beyond. Because each

Sentara Hospital is part of the Sentara Heart network, each local heart

program shares innovative procedures, cutting-edge technologies and

best practices.

Our programs are accessible, located in convenient locations and

welcoming facilities throughout the community. This remarkable

delivery system is made possible through a sophisticated technology

infrastructure and a commitment to blending clinical teams with the

common goal of advancing patient care.

Our world-class heart specialists strive

for excellence in clinical quality, customer

centricity and medical innovation. Each

Sentara Heart service continues to

uphold our long-standing reputation for

clinical distinction with a proven record of

exceptional patient outcomes.”

— Ken Armstrong

Senior Divisional Vice President, Sentara Cardiac Service Line

5SENTARA HEART4

Sentara Heart Network

Sentara Heart boasts a strong network of cardiac care throughout its integrated

system. With the exception of heart surgery, all Sentara community hospitals provide

a range of heart services. Patients from throughout Virginia and North Carolina

can receive emergency heart care in the Sentara location closest to them and be

transferred by ground or air ambulance to Sentara Heart Hospital, Sentara Virginia

Beach General Hospital or Sentara RMH Medical Center for open heart surgery,

should they need this advanced care. The other Sentara hospitals offer a range of

heart services, from comprehensive diagnostic testing and diagnostic catheterization

to emergency interventional cardiology and rehabilitation, within the fully integrated

network of Sentara hospitals.

Cardiac Departments

Cardiac Medicine

Non-Invasive Cardiology

Diagnostic Cardiovascular Imaging: MR/CT

Preventive Cardiology & Rehabilitation

Clinical Cardiology

Invasive & Interventional Cardiology

Cardiac Electrophysiology and Pacing

Heart Arrhythmia

Team Members

Electrophysiologists

Diagnostic Cardiologists

General Cardiologists

Interventional Cardiologists

Cardiothoracic Surgeons

Vascular Surgeons

Cardiac Anesthesiologists

Advanced Practice Clinicians

Nurses

Infectious Disease Specialists

Intensivists

Pulmonologists

Endocrinologists

Nephrologists

Multispecialty Centers

Sentara Heart Valve and Structural

Disease Center

Sentara Heart Arrhythmia Center

Sentara Aortic Center

Sentara Cardiac Diabetes Center

Sentara CardiovascularResearch Institute

SCRI works collaboratively with local institutions,

government agencies and biomedical companies on nationally

and internationally recognized clinical research trials.

SA

MC

SCH

SHH SHRH SLH S

MJH

SN

VM

C SO

H SPAH SRMH

S

VBGH

SW

RM

C

Multispecialty Centers

Te

am Members

Ca

rdia

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ep

artm

en

ts

Sentara

Heart

Outpatient Campuses and Physician Offices

Sentara Cardiovascular Research Institute

Hospitals

12 acute care hospitals—seven

in Hampton Roads (Southeastern

Virginia), one in Northern Virginia,

two in the Blue Ridge region of

Virginia, one in Southern Virginia and

one in North Carolina.

Outpatient Campuses and Physician Offices

As an integrated healthcare system

throughout Virginia and North Carolina,

we operate more than 100 sites of care

and partner with local providers.

Neurologists

Hospitalists

Primary Care Physicians

RCES/RCIS Certified Clinicians

Quality Coordinators

Researchers

Navigators

Education Specialists

Transplant Coordinators

Perfusionists

CVT Technicians

Imaging Specialists

Cardiovascular Technologists

FULLY INTEGRATED

SYSTEM OF HEART CARE

SAMC–Sentara Albemarle Medical Center

SCH–Sentara CarePlex Hospital

SHH–Sentara Heart Hospital

SHRH–Sentara Halifax Regional Hospital

SLH–Sentara Leigh Hospital

SMJH–Sentara Martha Jefferson Hospital

SNVMC–Sentara Northern Virginia Medical Center

SOH–Sentara Obici Hospital

SPAH–Sentara Princess Anne Hospital

SRMH–Sentara RMH Medical Center

SVBGH–Sentara Virginia Beach General Hospital

SWRMC–Sentara Williamsburg Regional Medical Center

Hos

pita

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revi

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n ke

y

Aortic Disease

Heart Failure, MCS & Transplantation

Structural Heart Disease

Thoracic Surgery

Cardiothoracic Surgery

Pulmonary Hypertension

Cardiac Observation

Sentara Advanced Heart Failure

Center (includes specialization

in pulmonary arterial

hypertension)

7SENTARA HEART6

Sentara RMH Medical CenterHarrisonburg, VA | 238 Beds

Sentara Virginia Beach General HospitalVirginia Beach, VA | 276 Beds

Sentara Princess Anne HospitalVirginia Beach, VA | 160 Beds

Sentara Northern Virginia Medical CenterWoodbridge, VA | 183 Beds

Sentara Obici HospitalSuffolk, VA | 176 Beds

Sentara Albemarle Medical Center Elizabeth City, NC | 182 Beds

Sentara CarePlex Hospital Hampton, VA | 224 Beds

Sentara Martha Jefferson HospitalCharlottesville, VA | 176 Beds

Sentara Heart Hospital Norfolk, VA | 114 Beds

Sentara Leigh HospitalNorfolk, VA | 250 Beds

Sentara Halifax Regional HospitalSouth Boston, VA | 192 Beds

Ornish Lifestyle Medicine

AdvancedProcedures

AdvancedProcedures

AdvancedProcedures

AdvancedProcedures

Cardiac SurgeryHeart

Transplant/ VAD

STEMI Receiving

CenterPCI Center

Catheter-Based Diagnostic

Center

Pacemaker/ICD Implants

ArrhythmiaAblations

Non-Invasive Diagnostic

Testing

Advanced Cardiovascular

Imaging

Structural Heart Program

Cardiac Rehab

Sentara Williamsburg Regional Medical CenterWilliamsburg, VA | 145 Beds

Sentara Heart Services

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Cardiothoracic Surgeries

Interventional Cath Procedures

Electrophysiology Procedures(Ablation, AICDs and Pacers)

Diagnostic Cath Procedures

4,1 3 3

1 3,43 2

5,3 1 2

2,2 6 7

Non-Invasive Diagnostic Testing

(Echos, Stress Echos, Treadmill, Holter and Event Monitoring)1 0 2,47 3

Sentara Albemarle Medical Center (SAMC) in Elizabeth City, NC, joined

Sentara Healthcare in 2014. Sentara has provided care for North Carolina

residents at our hospitals in Virginia, but SAMC is the first Sentara hospital

actually located in the state.

In 2016, the hospital’s cardiac rehabilitation (cardiac rehab) program saw

a 40 percent increase in patient usage. This increase is attributed to the

rehab team’s dedication to educating patients about the importance of

making healthy lifestyle changes to improve heart health. Cardiac rehab

patients recovering from heart events and heart procedures participate in

physical activity under the close supervision of medical experts. SAMC staff

also reworked scheduling to open up more early morning and weekday

appointments often requested by older heart patients.

The cardiac rehab program at SAMC is accredited by the American

Association of Cardiovascular and Pulmonary Rehabilitation. The 182-bed

hospital also has echocardiography accreditation from the Intersocietal

Accreditation Commission and nuclear cardiology accreditation from the

American College of Radiology.

In 2016, the hospital welcomed the services of its first electrophysiologist.

Since then, more than 50 heart patients have received automatic implantable

cardioverter defibrillators (AICDs). These devices are similar to pacemakers,

delivering electrical shocks to the heart when needed. Approximately 130

other patients received different types of implantable devices in 2016.

The hospital excels at providing timely emergency cardiac care with an

average door-to-needle time of 28 minutes. This time refers to how long

Sentara Albemarle Medical Center

Electrophysiology Procedures(AICDs and Pacers)

Nuclear Stress Testing

Diagnostic Cath Procedures

MUGA Scans

13 0

8 8 6

3,22 7

9 5 6

1 5

Non-Invasive Diagnostic Procedures(Echos 2,540; Stress echos 78; treadmill 56; Zio patches 140; Holter

monitoring 89; event monitoring 0; TEE 208; tilt table 116)

2016 VolumesSentara Albemarle Medical Center

2016 V

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SPOTLIGHT

SENTARA

HEART PROGRAM

continued on p. 12

Cardiothoracic Surgeries

Interventional Cath Procedures

Electrophysiology Procedures(Ablation, AICDs and Pacers)

Diagnostic Cath Procedures

1,7 82

1,6 9 0

1,9 6 5

4,4 0 0Non-Invasive Diagnostic Testing

(Echos, Stress Echos, Treadmill, Holter and Event Monitoring)21,725 SENTARA HEART10 11

Sentara Halifax Regional Hospital

For more than 60 years, Sentara Halifax Regional Hospital (SHRH) in

South Boston, VA, has provided exceptional care to residents of

Virginia’s south central region and residents of the bordering state of

North Carolina. The Halifax hospital joined Sentara Healthcare in 2013.

In 2016, SHRH received the Quality Innovation Award given by the

Virginia Health Quality Center, a nonprofit health quality consulting

company that conducts studies of exemplary infection control and

customer service. Only hospitals that score in the top 10 percent of a

Centers for Disease Control and Prevention (CDC) assessment for

infection prevention receive this award.

The skilled cardiac team at SHRH provides state-of-the-art diagnostic

testing, including heart catheterizations, electrocardiography (EKG),

transesophageal echocardiography (TEE), exercise and

pharmacologic stress tests, Doppler echo studies, nuclear imaging,

tilt table testing, and Holter and event monitoring. Additional cardiac

services include interventional cardiology, implantable devices and

cardiac rehabilitation.

The cardiac rehabilitation program at SHRH is accredited by the

American Association of Cardiovascular and Pulmonary

Rehabilitation. The 192-bed hospital also has echocardiography

accreditation and nuclear cardiology accreditation from the

Intersocietal Accreditation Commission (IAC).

SHRH is a leader in providing timely emergency cardiac care and

boasts an average door-to-balloon time of 54 minutes. This time

refers to how long it takes cardiac catheterization lab staff to perform

a coronary interventional procedure, such as angioplasty, on a heart

attack patient after they enter the ED. In 2016, the hospital performed

more than 700 cardiac procedures, including 539 diagnostic cath

procedures, 105 interventional cath procedures and 95 implantable

devices such as pacemakers.

Cardiac experts at SHRH are active in a variety of community

outreach programs. Members of the community can sign up for a free

Pocket EKG cardiac screening. Cardiac teams use EKGs, bloodwork

and vital signs assessments to screen participants for signs of cardiac

distress. Participants then receive pocket-size, laminated cards with

the EKG screening results. SHRH teams also offer community-wide

free screenings for peripheral artery disease (PAD), also known as

hardening of the arteries.

SPOTLIGHT

SENTARA

HEART PROGRAM

Echos

Nuclear Stress

Diagnostic Cath

Pacemakers/ICDs

3,5 9 7

1,47 8

1,7 8 8

5 3 9

9 5

Interventional Cath Procedures

Non-Invasive Diagnostic Procedures (Treadmill 451; Holter monitoring 1,337)

1 0 5

2016 VolumesSentara Halifax Regional Hospital

it takes emergency department (ED) personnel to

administer clot-busting thrombolytic drugs to a heart

attack patient after they enter the ED.

State-of-the-art diagnostic testing services at SAMC

include heart catheterizations, electrocardiography (EKG),

exercise and pharmacologic stress tests, Doppler echo

studies, nuclear imaging, tilt table testing, and Holter

and event monitoring. In 2016, the hospital performed

approximately 938 catheterizations, with approximately

70 percent of the procedures done transradially through

the wrist.

SAMC also provides the community with quarterly

Pocket EKG cardiac screenings. Cardiac teams use EKGs,

bloodwork and vital signs testing to screen members

of the community for heart disease. Participants receive

pocket-size, laminated cards with the screening results

that they can carry in their wallets. Should a participant

develop a heart problem in the future, doctors can

compare this baseline EKG with future EKGs to aid in a

timely diagnosis.

continued from p. 11

13SENTARA HEART12

Average LOS—

Elective CABG patientsSource: Sentara Heart

10

8

6

4

2

0Sentara Heart Hospital (SNGH)

Top 10% Hospitals–6.9 DAYS

National Average–9.4 DAYS

Sentara Heart Promise

6.77

2016

O ne morning at work, 48-year-old

Julie Williams’ heart rate soared

from a normal 60 beats per

minute to 170 beats. Her accelerated heart

beat continued for nearly four hours and the

longer it lasted the more intensely fatigued

she became.

Although Julie had suffered from SVT (what

many describe as “heart flutters”) for more

than 20 years, she had never experienced

anything that frightening. She called her

primary care physician, Dr. Renee Fischer,

who referred her to the Sentara Martha

Jefferson Hospital Device Clinic for a Holter

monitor. Results from two weeks of constantly

monitoring Julie’s heart led Dr. Fischer to refer

her to cardiologist Dr. William Freedman.

The first plan of treatment for Julie was

medication management. However, the

medication proved ineffective in regulating her

heart rate. In the meantime, Julie didn’t have

the energy or strength to do many of her

PATIENT

Sentara Heart

Julie Williams

normal activities and hadn’t gardened for

weeks. Dr. Freedman referred Julie to

Dr. John Zakaib. Having just moved his

practice from the Cleveland Clinic to

Charlottesville, Dr. Zakaib was Martha

Jefferson’s newest electrophysiology (EP)

cardiologist. He has advanced training in the

treatment of atrial fibrillation.

After additional testing, Dr. Zakaib offered

Julie the answer to her heart problem: She

could take various medications for the rest of

her life to try and control it—

or he could cure it with a

procedure called ablation.

“I was nervous but my family

offered me a lot of support,” said

Julie. “We decided that if this

procedure could cure me, I had

to have it done.”

On October 10, 2008, Julie

underwent treatment in the

Sentara Martha Jefferson EP

procedural lab. With Julie

relaxed under the mild sedation

of Versed and Fentanyl, Dr.

Zakaib conducted diagnostic

tests to determine the cause of

her irregular heart rhythms.

He pinpointed a focal location in

the electrical system of Julie’s

heart that caused her arrhythmia.

He performed ablation, effectively stopping

the harmful impulses and terminating the

arrhythmia.

“I don’t have enough kind words to say about

Dr. Zakaib and the staff,” said Julie. “I was

emotional going into the surgery, but they

kept me as comfortable as possible. One

nurse even held my hand throughout the

entire procedure. I’d refer anyone having

problems like mine to Dr. Zakaib. I’m so glad

he’s at Martha Jefferson.”

From treatment to cure: Overcoming Afib

7.42

2015

Program Leads

Melissa Connolly, MSN, RN, ACNP-C

Amy Shannon, MSN, RN, FNP-C

Sentara Heart Promise offers a one-of-a-kind

support system that provides coordinated care

for better health before, during and after heart

surgery. Developed at Sentara Heart for coronary

artery bypass and valve replacement surgery

patients, Sentara Heart Promise provides:

• Pre-surgical screening, evaluation and

education

• Heart team approach to care

• Patient and family individualized plans of care

• Post-surgery follow-up care

• Preventive services and counseling

The program’s centerpiece is a unique, pre-

surgery assessment tool administered by nurse

practitioners to evaluate a patient’s health prior

to surgery. This clinical checklist is designed to

identify underlying conditions that could disrupt

scheduled surgery or complicate recovery.

Since the pilot was created in 2012, the program

has eliminated day of surgery cancellations

for cardiothoracic surgery patients and has

significantly reduced readmission rates.

Other major successes include:

• Streamlined, same-day appointments with

the Promise team and cardiac surgeons

• Identification of underlying conditions

prior to surgery, preventing complications

or surgery delays

• Collaboration with Endocrinology to

provide both pre- and postoperative

diabetes care

• Decreases in postoperative atrial

fibrillation, prolonged vent and

postoperative renal failure rates

• Decreased patient length of stay

• Decreased surgical cancellation rates

• Heart team approach, individualized risk

assessment shared with each patient

• Deliver medical approaches or other

alternative therapies to patients too high-

risk for surgery

• Streamlined pre- and post-surgical education

to ensure patients are well-informed about

their procedure without overwhelming them

with excessive materials

• Improved outcomes with a postoperative

recovery checklist that patients can easily

follow during their admission and at home

Sentara Heart Promise is led by advanced

practice clinicians who work with our elective,

outpatient population and our inpatient

preoperative population. Through this

program, every surgical patient has a point

of contact for the entire surgical timeline:

preoperatively, postoperatively and up to 30

to 90 days post discharge. 15SENTARA HEART14

Advanced Cardiovascular Imaging

• One of the fastest and most accurate cardiac CT

scanners in the region. It takes only five seconds—

or five heartbeats—for this 256-slice cardiac CT

scanner to create complete images of the heart and

surrounding arteries.

• An accredited Echo Lab that performs more than

1,000 echo studies every month. Extensively trained

registered sonographers perform echocardiograms,

which are then read the same day by a cardiologist.

The availability of 3D echocardiography aids surgical

decision making by enabling doctors to crop images

and providing more detailed views of structures. The

lab also performs 2D stress echocardiography and

transesophageal echocardiography.

• A comprehensive oncology clinic with the latest

technology for echocardiographic strain, a test of

myocardial function in patients undergoing

chemotherapy. This procedure, which is necessary for

early detection and quantification of myocardial

dysfunction, can help inform therapeutic decision

making. It is also useful for follow-up evaluations of

therapeutic results.

skilled, subspecialized doctors are using world-class technology to

usher in a new era in imaging characterized by incredibly fast and

accurate diagnosis of cardiovascular disease, chest pain, stroke, and

other life-threatening illnesses.

As enthusiastic supporters of a wide array of cardiac clinical research

studies, our echo team is perennially at the technological forefront

of cardiac imaging. Throughout the Sentara Heart Network, all echo

labs are fully accredited by ICAEL. Our accomplishments in

echocardiography—together with rapidly growing areas such as

percutaneous transcatheter aortic valve replacement and atrial

fibrillation ablation—are essential to the Sentara mission of improving

health every day.

To contact the Advanced Cardiovascular Imaging Program,

call (757) 388-8870.

Non-Invasive

Cardiology

Advanced Cardiovascular Imaging

Heart diagnosis has traditionally required catheterization, a

procedure that increases both cost and patient risk. Over the

last decade, pressure has mounted for faster and cheaper

diagnoses, with less aggravation to patients. The healthcare

community responded with dramatic improvements. Most

notable is advanced coronary computed tomography (CT)

scanning, an innovative tool doctors now use to non-

invasively detect or rule out heart problems in patients.

Advanced cardiovascular imaging at Sentara Heart Hospital,

Sentara Virginia Beach General Hospital and Sentara

Williamsburg Regional Medical Center perform the most

complex cardiovascular imaging within 150 miles. Our highly

16 SENTARA HEART 17

At present, IBM Watson Health allows for retrospective analysis only,

confirming and recording cases of aortic stenosis already diagnosed

by a cardiologist and ensuring the diagnosis is captured in appropriate

records. In the future, the goal is to improve the accuracy of heart

disease diagnosis by using artificial intelligence as a first set of eyes

on diagnostic imaging tests to identify what is normal and what is not.

For instance, IBM Watson Health will read an echocardiogram and

document any signs of aortic stenosis. A technician reviews the

echocardiogram and the computer system’s findings, noting any

additional problems. A cardiologist now has more information to

ensure an accurate reading of the study. The addition of IBM Watson

Health as a first step in imaging reading should improve accuracies

and efficiencies while allowing doctors to spend less time on clerical

paperwork and more time treating patients.

As IBM Watson becomes more proficient in reading echocardiograms,

it could be used to promote best practices in following early stage aortic

stenosis patients by identifying those patients who were overdue for

clinical follow-up or imaging studies and alerting the clinician, patient or

both. The system will be able to pull from a vast array of data, including

medical imaging, electronic medical records, radiology and pathology

reports, lab results, medical journals, research studies and clinical care

guidelines to identify potential problems and predict outcomes.

Sentara Heart will continue to collaborate with IBM Watson Health to

provide data that can teach the system how to identify signs of other

cardiovascular conditions, such as heart attacks, valve disorders,

cardiomyopathy (disease of the heart muscle) and deep vein

thrombosis. IBM Health also has plans to teach the system to read

breast and lung imaging for cancer detection.

IBM Watson Health

Sentara Heart continues to be a forerunner in the use of innovative

technologies to improve the health of cardiovascular patients. In 2016,

our non-invasive cardiology program contributed data from more than

3,000 heart echocardiograms to IBM Watson Imaging Clinical Review, a

$4 billion health technology initiative spearheaded by IBM Health.

IBM Watson made a splash in 2011 when the computing system bested

some well-known Jeopardy champions on television, taking home the

$1 million first-place prize. The system understands natural language

and reasoning and is able to learn over time.

Sentara Heart is a founding member and lead contributor to a

worldwide group of 24 health institutions collaborating with IBM Health

on this project. For our first endeavor, IBM Health used the information

we provided to teach a computing system, known as IBM Watson

Health, how to read echocardiograms and identify signs of a common

heart condition called aortic stenosis.

Up to 1.5 million Americans have aortic stenosis, a condition that

occurs when calcium deposits build up on the heart’s aortic valve. The

valve becomes stiff and doesn’t open properly, restricting blood flow to

the body and causing fatigue, shortness of breath, chest pain, dizziness

or fainting. The number of people with aortic stenosis continues to rise

as people live longer.

Currently, one of IBM Watson Health’s main contributions is ensuring

that diagnostic test information makes its way into a patient’s medical

records. IBM Watson Health minimizes the risk of this oversight by

reading every single file in a heart patient’s medical record to identify

new information that represents a change between a cardiologist’s

report and data that should carry through to other records, such as

electronic medical records, billing and insurance reports.

NON-INVASIVE CARDIOLOGY

19SENTARA HEART18

physical fitness programs and provides

counseling and education on a range of

topics, such as a heart-healthy diet, tobacco

cessation and stress management. Specialists

work one-on-one to help patients build

endurance and stamina so they can return

to the activities they love and improve their

heart health.

The cardiac rehab programs at 10 Sentara

hospitals are certified by the American

Association of Cardiovascular and Pulmonary

Rehabilitation. Two locations currently are

seeking certification. In 2016, Sentara cardiac

and pulmonary rehab programs expanded

their service offerings to include:

Tobacco cessation program: In 2016, the

registered nurses and exercise physiologists

Ornish Lifestyle Medicine™ Program

for Reversing Heart Disease

A whole foods, plant-based diet that’s naturally low in fat and refined carbohydrates

Moderate aerobic activity

Stress management

Psychosocial encouragement

via support groups

In 2016, on the campus of Sentara Princess Anne in Virginia Beach,

Sentara became the first and only provider in the state to offer patients

a clinically proven way to reverse heart disease. Nearly four decades

of research show that people who complete and stick with the Ornish

Lifestyle Medicine™ program can reverse the progression of coronary

artery disease and other chronic conditions. Program participants may

reduce their risk of heart attack, lower their need for medication and

avoid the need for serious cardiac interventions like bypass surgery.

Program Overview—Over nine weeks, the Ornish Lifestyle Medicine™ program focuses on four core

lifestyle components:

Cardiac rehabilitation (rehab) at Sentara

Heart is instrumental in a patient’s recovery

following a cardiac event, such as a heart

attack, valve surgery or heart transplant. All

12 Sentara hospitals offer cardiac rehab, while

nine locations also offer pulmonary rehab

for patients with chronic lung problems,

such as emphysema, interstitial lung disease

and chronic obstructive pulmonary disease

(COPD). These programs help thousands of

patients every year.

The Sentara cardiac rehab team, comprised

of a medical director, cardiac nurses, exercise

physiologists, registered dietitians and

other heart experts, guides patients through

on the cardiac rehab team at Sentara Heart

Hospital completed training to become

certified tobacco cessation counselors. These

experts are taking part in a pilot program

aimed at reducing hospital readmissions

for patients with congestive heart failure

and heart disease by helping them to quit

smoking. Tobacco cessation training and

certification will expand to cardiac rehab team

members at other hospital locations.

Yoga for a stronger heart: The cardiac rehab

programs at Sentara Heart Hospital, Sentara

Leigh Hospital and Sentara CarePlex Hospital

added cardiac yoga to their service offerings.

The classes are taught by a yoga instructor

who has special training and is certified to

work with cardiac patients. Research suggests

that yoga-based programs help those with

heart disease by lowering blood pressure,

reducing stress and improving respiratory

function and heart rate.

Music for better breathing: Music therapy

is now part of the pulmonary rehab service

offerings at Sentara Heart. Patients use

deep breathing techniques while singing

and humming to improve respiratory

function. Studies show that music therapy, in

conjunction with traditional therapies, reduces

disease symptoms and improves quality of

life and mental well-being in patients with

chronic lung diseases.

Cardiac and Pulmonary

Rehabilitation

1

2

3

4

SENTARA HEART20 21

Participants experienced a 300% improvement in blood

flow to the heart

After three years, 77% of people who had undergone

coronary intervention procedures avoided

revascularization with no increased frequency of

cardiac events

After one year, participants experienced a significant

decrease in the frequency of angina, or chest pain,

with almost 3/4 of participants having no chest pain, a

result comparable to what is typically achieved through

revascularization procedures like coronary artery bypass

Low-density lipoprotein (LDL, or bad) cholesterol

numbers dropped by almost 40%

Participants lost an average of 24 pounds

After one year, nearly 90% of people still use the

healthy habits they learned in the program

ORNISH LIFESTYLE MEDICINE PROGRAM

Groups of up to 15 people participate in twice-

weekly, four-hour sessions for a total of 72

hours. Sentara experts in stress management,

behavioral health, fitness and nutrition direct

and lead the sessions. A nurse case manager

coordinates care and monitors each participant

as they progress through the program.

Sentara began offering the program as a way

to help patients be more proactive about

their health. Other locations in the Sentara

network will introduce the program in the

near future. Medicare and many commercial

insurers cover program costs for qualified and

eligible members.

2 5% 3 6%

8%

decrease of

low-density

lipoprotein (LDL)

cholesterol

increase

of exercise

capacity

reduction of A1C levelssignificant decreases in both systolic

and diastolic blood pressure

Study findings about the program’s effects

are compelling:

Ornish Results at Sentara in 2016

In 2016, 56 Sentara patients enrolled in the Ornish Lifestyle Medicine™ program.

At program completion, participants experienced a:

Ornish Lifestyle Medicine at Sentara Princess Anne

For more information, call (757) 507-8820 or go to Ornish.SentaraHeart.com.22 23SENTARA HEART

NATIONAL GUIDELINES

9 0 minutes

or less

2014-2016 Interventional In-Hospital

Risk-Adjusted O/E Mortality RatioSource: Sentara Heart (Includes all Sentara hospitals except Sentara Albemarle Medical Center)

A ratio of less than 1.0 means that fewer patients died than expected based on the

performance of other hospitals as adjusted for patients with the same types and severity

of medical problems.

Total Number of Cath Labs in the SystemSTEMI Program

Sentara Heart is a recognized leader for expedited treatment of ST-

elevation myocardial infarction (STEMI) patients. American College of

Cardiology and American Heart Association national guidelines state

that hospitals treating STEMI patients with emergency PCI should

reliably achieve a door-to-balloon time of 90 minutes or less. As a

participating hospital in D2B: An Alliance for Quality™, Sentara Heart’s

median time of 60 minutes for door-to-balloon was well below average

in 2015.

1.0

0.8

0.6

0.4

0.2

0.0

1.2

Expected mortality for this patient population

53 MINUTES

Sentara Martha

Jefferson Hospital

55 MINUTES

Sentara Williamsburg

Regional Medical Center

61 MINUTES

Sentara Leigh Hospital

62 MINUTES

Sentara Northern Virginia

Medical Center

64.5 MINUTES

Sentara Norfolk General Hospital

67.5 MINUTES

Sentara CarePlex Hospital

Median Door-to-Balloon Time

Sentara STEMI Receiving

Centers

Interventional

Cardiology Sentara Heart Hospital provides a wide range of cardiac

interventional procedures to treat coronary artery disease. The

sooner a patient suffering from heart defects and disease gets

interventional care, the better their chances of survival and

complete recovery.

Each year, Sentara Heart performs more than 4,000 interventional

procedures across 22 catheterization laboratories (cath labs)

throughout the state of Virginia. These state-of-the-art cath labs

significantly reduce radiation exposure.

Our cardiac teams provide specialized interventional catheterization

for defects that have historically required open surgery, such as:

• Atrial septal defects

• Ventricular septal defects (VSD)—including implantation

of a muscular VSD device

• Patent foramen ovale

• Intracoronary stents

• Drug-eluting stents

• Atrial, valvuloplasty, and

percutaneous coronary

interventions

• Chronic total occlusion

60 MINUTES

Sentara RMH Medical Center

Sentara Virginia Beach

General Hospital

What does the O/E mortality ratio mean?

The observed-to-expected mortality outcome (O/E mortality ratio)

is a risk-adjusted measure of a hospital’s mortality (death) rate. Risk

adjustment takes into account how sick patients are upon entering the

hospital. The mortality observed-to-expected measure tells us how we

are performing on mortality relative to what is expected for our patients,

given a variety of complicating characteristics, including their age,

chronic conditions like diabetes or heart failure, or whether the patient

was transferred from another hospital or admitted as an emergency. An

O/E ratio less than 1.0 indicates better than expected outcomes and an

O/E ratio greater than 1.0 indicates poorer than expected outcomes. (For

example, an O/E ratio of 0.50 for mortality would mean that mortality

was only 50% of the expected value; conversely a mortality ratio of 1.50

means that mortality was 150% of expected or 50% higher than expected.)

Sentara Albemarle Medical Center

Sentara CarePlex Hospital

Sentara Heart Hospital

Sentara Halifax Regional Hospital

Sentara Leigh Hospital

Sentara Martha Jefferson Hospital

Sentara Northern Virginia Medical Center

Sentara Obici Hospital

Sentara Princess Anne Hospital

Sentara RMH Medical Center

Sentara Virginia Beach General Hospital

Sentara Williamsburg Regional Medical Center

Sentara Heart Median Time—60 MINUTES

.7 8

2 2 TOTAL CATH LABS

24 SENTARA HEART 25

ElectrophysiologySentara Heart Hospital has one of the country’s leading

electrophysiology (EP) programs, featuring four EP labs with

advanced 3D mapping systems and a separate Hybrid Cardiac

Operating Suite. Our board-certified electrophysiologists

treat heart rhythm disturbances using the latest devices and

advanced procedures that take place inside the heart without

the need for open surgery.

In 2016, Sentara Heart electrophysiologists performed more

than 900 catheter ablations to treat cardiac arrhythmias,

including atrial fibrillation, ventricular tachycardia and

supraventricular tachycardia. This minimally invasive

procedure targets areas of the heart causing the arrhythmia.

We also have a number of clinical research opportunities that

give patients access to the latest cardiac care technologies.

Leadless Device Therapy

As one of the busiest electrophysiology programs in Virginia, the

sophisticated device therapy program at Sentara Heart performs more

than 1,600 device procedures each year.

In 2016, Sentara Heart Hospital became one of the first hospitals in

Virginia to offer the world’s smallest leadless

(wire-free) pacemaker, the Micra®

Transcatheter Pacing System. This device

regulates heart rhythm for patients with

bradycardia, a slow or irregular heartbeat of

fewer than 60 beats per minute.

Traditional pacemakers rely on leads, or wires, to provide

an electrical connection between the device and heart. If these leads

malfunction or an infection develops in surrounding tissue, patients must

undergo another surgery to replace the device and leads.

Micra is about the size of a large vitamin and weighs the same as a

penny. Sentara electrophysiologists use a transcatheter procedure to

implant the wire-free device directly into the heart’s right ventricle

chamber where it delivers electrical stimulation to the heart.

• Automatic pacing: Micra automatically adjusts the heart’s pacing

based on a patient’s activity level.

• MRI compatibility: Traditional pacemakers contain metals that can’t

undergo magnetic resonance imaging (MRI). Micra doesn’t contain

these metals, which means patients can get advanced imaging

diagnostic procedures.

• Permanent placement: Should a patient need more than one heart

device, doctors can turn off Micra and implant a new device—while

Micra stays in the heart—without risk of electrical interaction.

Permanent His Bundle Pacing

Sentara electrophysiologists also are among a select

few in the region with the expertise to perform a

pacemaker technique known as permanent His bundle

pacing (PHBP). The bundle of His is a group of heart

muscle cells that transmits electrical impulses from

the atrioventricular node to the left and right ventricles.

Patients with congestive heart failure and bundle

branch disease traditionally require cardiac

resynchronization therapy (CRT) to treat heart rhythm

problems. CRT involves placing leads, or wires, into

the right and left ventricles to generate simultaneous

pacing of the two ventricles.

With PHBP, our electrophysiologists position the

pacemaker leads to directly engage the bundle of His.

This alternative therapy enables patients to maintain a

regular heart rhythm with less risk of heart muscle

damage than traditional right ventricular pacing.

In July 2016, Sentara Heart Hospital became one of the first hospitals

in the area to implant the world’s smallest pacemaker in patients

with bradycardia. The Micra® Transcatheter Pacing System (TPS) is

a new device that provides patients with the most advanced pacing

technology at one-tenth the size of a traditional pacemaker. Micra is

the only leadless pacemaker approved for use in the U.S. The device

is small enough to be delivered through a catheter and implanted

directly into the heart with small tines, providing a safe alternative to

conventional pacemakers without the complications associated with

leads – all while being cosmetically invisible.

The Micra TPS is also designed to automatically adjust pacing

therapy based on a patient’s activity levels. The Micra TPS is the

first and only transcatheter pacing system to be approved for both

1.5 and 3 Tesla (T) full-body magnetic resonance imaging (MRI)

scans, providing patients with access to the most advanced imaging

diagnostic procedures available, if and when they need one.

Sentara Implants World’s Smallest Pacemaker

27SENTARA HEART26

Charles Southall’s Sentara Heart Care Team at Sentara CarePlex Hospital

PATIENT

Sentara Heart

Emergency staff goes the extra mile—literally

D ale Hoak, a 74-year-old retired

William and Mary history professor,

remembers only a few parts of the

late spring evening that started with him in his

kitchen and ended with emergency surgery.

“I felt some constricting in my throat

muscles,” Dale says. “I went to put water on

my face, and it didn’t help. I had to crawl

about 20 feet to my sofa.”

Dale’s wife called for an ambulance, and the

couple soon arrived at Sentara Williamsburg

Regional Medical Center. Dale believes he

went in and out of consciousness as nurses

monitored him and doctors ordered tests.

“I heard Dr. (Paul) Cash say, ‘It’s what I hoped

it wasn’t,’” Dale recalls. He had experienced

an aortic rupture, with the interior lining of his

aorta coming loose, and needed surgery

immediately to repair it.

Sentara Nightingale Regional Air Ambulance

often transports patients such as Dale to

Dale Hoak

another facility under these circumstances.

However, on that June evening, fog grounded

Nightingale. Dr. Cash and Janet McCoig, an

emergency department nurse whose shift was

ending, arranged for an ambulance to

transport Dale to Sentara Heart Hospital,

about an hour away in Norfolk.

“They actually got in the ambulance with me,”

says Dale. “That’s not what usually happens.

They kept me alive. They wanted to watch my

blood pressure and try to keep it as low as

possible.”

A few hours later, Dr. John Sirak at Sentara

Heart Hospital repaired Dale’s aortic tear and

inserted a valve to keep the aorta functioning.

“I learned that what happened to me is

caused by an aortic aneurysm. Dr. Philpott,

who helped me after the surgery, said that on

a scale of one to 10, with 10 being lethal,

I was a 9.5,” Dale shares. “They didn’t know

if I would survive; after nine hours of surgery,

I woke up OK.”

Dale stayed in the hospital for 15 days and

then headed home, with a promise to monitor

his health. The aorta aneurysm he had faced

is a condition that can be detected with

screenings conducted at Sentara Aortic Center

and then treated.

Dale also attended cardiac rehabilitation at

Sentara Williamsburg Regional Medical

Center. About a month later, Dale saw

Dr. Cash and Janet in the lobby of Sentara

Williamsburg, where he was attending his

rehab classes every Monday, Wednesday and

Friday for 10 weeks.

“Dr. Cash told me he’s never seen anyone so

dire as me,” Dale says. “I thanked them both

profusely and asked that they give my thanks

to several other Sentara Williamsburg nurses

who helped me.”

“They actually

got in the

ambulance with

me,” says Dale.

“That’s not what

usually happens.”

29SENTARA HEART28

SENTARA HEART HOSPITAL SENTARA RMH MEDICAL CENTERSENTARA VIRGINIA BEACH GENERAL HOSPITAL

2014-16 Primary Coronary Artery Bypass Graft

(CABG) In-Hospital O/E Mortality RatioSource: Sentara Heart

Source: Sentara Heart

Atrial Fibrillation Reduction

in the Post-Surgical CABG Patient

Presence of Afib is known to contribute to an extended length

of stay and stroke complications for the hospitalized patient. A

clinical workgroup sought to address this issue by developing and

standardizing a process to implement Afib prophylaxis utilizing an

antiarrhythmic medication, Amiodarone, for all CABG patients,

perioperatively. The implementation of this clinical initiative

resulted in a decreased hospital stay by 3.8 days and an overall

decrease in Afib occurrence.

A ratio of less than 1.0 means that fewer patients died

than expected based on the performance of other

hospitals as adjusted for patients with the same types

and severity of medical problems.

.92

0.52

What does the O/E mortality ratio mean?The observed-to-expected mortality outcome (O/E mortality

ratio) is a risk-adjusted measure of a hospital’s mortality (death)

rate. Risk adjustment takes into account how sick patients are

upon entering the hospital. The mortality observed-to-expected

measure tells us how we are performing on mortality relative to

what is expected for our patients, given a variety of complicating

characteristics, including their age, chronic conditions like

diabetes or heart failure, or whether the patient was transferred

from another hospital or admitted as an emergency. An O/E ratio

less than 1.0 indicates better than expected outcomes and an O/E

ratio greater than 1.0 indicates poorer than expected outcomes.

(For example, an O/E ratio of 0.50 for mortality would mean

that mortality was only 50% of the expected value; conversely a

mortality ratio of 1.50 means that mortality was 150% of expected

or 50% higher than expected.)

• Coronary Artery Bypass

• Ablation Procedures

• Aortic Root Replacement

• Aortic Valve Replacement

• Heart Transplant

• Minimally Invasive Mitral Valve Surgery

• Mitral Valve Repair/Replacement

• Open Pericardiectomy

• Open Repair Aortic Aneurysm/Dissection (Ascending & Descending)

• Minimally invasive lung or mediastinal mass resection for diagnostic and therapeutic purposes

• Metastatectomy for advanced cancers

Procedures performed at Sentara Heart include:

Most common thoracic procedures include:

23.2

29.6

20.62

22.9

6.06

16.6

11.5

13.8

18.4 18.9

12.5

14.6

Occurrence of Atrial Fibrillation

Post-Cardiac Surgery

• Resection of Cardiac Tumor

• Repair Atrial Septal Defect

• Repair Patent Foramen Ovale

• Repair Ventricular Septal Defect

• Repair Ventricular Aneurysm

• Transmyocardial Revascularization

• Tricuspid Valve Repair/Replacement

• Ventricular Assist Device Placement

• Endovascular Repair of Thoracic Aneurysm (TEVAR)

• Decortication, manual and chemical pleurodesis and lung volume reduction surgery

Cardiothoracic SurgeryCardiothoracic surgery at Sentara Heart is a highly regarded

program with nationally recognized surgeons, superior quality

and complex cases. Much like that of an academic center, this is

a deep and diverse program that continues to treat increasingly

acute cases. It is also a program that can serve the many

needs of patients in one place, sometimes in a single visit with

multidisciplinary approaches offered in many programs for

structural heart, thoracic oncology and aortic patients.

In 2016, the cardiothoracic surgery program reached an important

milestone with 50,000 open heart cases being performed by the

MACTS surgeons and Sentara Heart surgery team. Last year

alone, the surgeons from Mid-Atlantic Cardiothoracic Surgeons

(MACTS) and Sentara RMH Cardiothoracic Surgery managed

more than 2,200 cases at Sentara Heart Hospital, Sentara Virginia

Beach General Hospital and Sentara RMH Medical Center. The

cardiothoracic program brought innovative procedures new to

Sentara Heart such as open Cox-Maze IV, WATCHMAN device for

atrial fibrillation, intuity aortic valve and mitra-clip.

Mid-Atlantic Cardiothoracic Surgeons work closely with pulmonary

medicine, oncology and radiology to provide a multidisciplinary

approach to thoracic surgery. Our surgeons lead the regional effort

to launch lung cancer screenings, participate in national Society

of Thoracic Surgeons (STS) quality metrics, and perform sleeve

thoracic surgeries (a highly complex procedure involving the lung).

This surgical group is highly regarded for its efforts to advance

cardiovascular and thoracic practices. Individually, its members

serve on a multitude of national committees.

31SENTARA HEART30

Cardiac AnesthesiologyWith 10 board-certified cardiothoracic anesthesiologists, Sentara

Heart provides 100 percent physician-staffed anesthesiology services.

The physicians of Anesthesia Specialists work exclusively with the

cardiothoracic surgeons and cardiologists, allowing patients to

benefit from a dedicated and collaborative team of physician experts

who perform high volumes of innovative procedures. Each one has

completed a full residency in general anesthesia as well as advanced

fellowship training in cardiothoracic anesthesiology and critical care.

Cardiothoracic anesthesiologists are exclusively dedicated to the care of patients undergoing surgery of the heart and lungs. They assist in the following cases:

• Coronary artery bypass surgeries

• Valve repairs and replacements

• Open aortic procedures

• Thoracic and lung surgery

• Heart transplant

• Ventricular assist devices

• High-risk interventions in the

cath lab

• Transcatheter aortic valve

replacement (TAVR)

• MitraClip

• WATCHMAN left atrial appendage

closure device

• EP Lab procedures, ablations,

pacemakers, and implantable

cardioverter defibrillators (ICD)

• Extracorporeal life support (ECLS),

including extracorporeal membrane

oxygenation (ECMO)

Cardiothoracic anesthesiologists at Sentara Heart immerse themselves in advanced

training and technologies. They collaborate on innovative procedures such as

MitraClip, WATCHMAN, and TAVR. Many of the cardiothoracic anesthesiologists are

actively involved in hospital leadership committees focusing on patient safety, clinical

quality, root cause analysis, best practices, ethics, and more.

The dedicated, skilled and experienced cardiothoracic anesthesiology team

contributes to the ability of Sentara Heart to provide services that would otherwise

not be available in the community. They play a crucial role in producing excellent

morbidity and mortality rates, especially given the acuity level of the population

we serve.

This team of subspecialists excels in the management of critically ill

patients undergoing complex operations, which encompasses the use

of invasive monitoring techniques, single-lung ventilation, management

of cardiopulmonary bypass, advanced hemodynamic management,

and the control of postoperative pain. They are skilled at reading and

interpreting intraoperative transesophageal echocardiograms. This

allows the team to diagnose unexpected coronary and valve problems,

confirm already suspected disease processes, and determine the

success of a procedure, all within the surgical suite.

32 SENTARA HEART 3332

In 2016, Sentara Heart and Sentara Vascular

Specialists initiated efforts to more closely

align our nationally recognized cardiac and

vascular programs. It’s estimated that two-

thirds of Americans with vascular disorders

also have heart problems.

Sentara Vascular Specialists is comprised

of 17 vascular surgeons and two transplant

surgeons. This group of experts performs

more than 9,000 vascular procedures every

year and has deep expertise in treating

patients with simple to extremely complex

circulatory disorders.

Vascular Interventional Center

The Vascular Interventional Center at Sentara

Norfolk General Hospital (SNGH) is one of the

country’s most technologically advanced and

comprehensive centers of its kind. The center

features a dedicated preoperative area and

intensive care unit specifically for patients

undergoing vascular procedures.

Sentara Vascular Specialists work closely with

cardiology, radiology and oncology experts

to provide a multidisciplinary approach to

vascular and endovascular surgery. The

center’s hybrid operating room has top-of-the-

line imaging technology found only at a select

few hospitals nationwide. Here, our vascular

surgeons use advanced endovascular

techniques to perform complex procedures,

such as abdominal and thoracic aortic

aneurysm repair. We began work on a second

hybrid operating room in 2016, to be open in

the fall of 2017.

Vascular Services

Endovascular suites at each Sentara hospital

allow our physicians to use the newest

technology to treat a range of vein and artery

disorders, including deep vein thrombosis

(DVT), blockages, tears, aneurysms and

abnormal narrowing of arteries. Sentara

Vascular Specialists treat all disorders

involving the circulatory system, peripheral

arteries and veins. Vascular services include:

• Balloon angioplasty and stenting

• Treatment of peripheral artery disease

(PAD), carotid artery disease, kidney

disease, diabetic vascular disease and

venous disease

• Vein access for dialysis and chemotherapy

• Limb amputation prevention and

rehabilitation

Vascular

ProgramSentara Norfolk General Hospital

35SENTARA HEART34

Amputation

Aortic Surgery

Carotid Surgery

41 7

47 5

3 0 0Dialysis Access

Peripheral Vascular

Vein Procedures

Non-invasive Vascular

1,3 9 7

5,7 9 2

9 6 7

6 7,6 3 8

2016 VolumesVascular Program

VASCULAR PROGRAM

Vascular Center Achievements

Our vascular specialists are internationally recognized for superior

quality and innovation in treating increasingly complex cases. The

team’s achievements include:

• One of the first participants in the Vascular Quality Initiative. This

Society of Vascular Surgery program allows us to benchmark and

compare outcomes against other vascular centers nationwide.

• Nationally respected vascular surgery fellowship. Our vascular

surgery fellowship program, run through Eastern Virginia Medical

School (EVMS), is one of the largest in the country. We accept three

new fellows every year for a two-year program.

• Global leaders in vascular research. Our vascular team ranks

among the top 5 percent in enrollment for clinical trials in which

we participate. At any given time, at least 20 clinical trials are

underway at Sentara. The breadth of our research is vast, focusing

on potentially life-saving advancements such as lower extremity

revascularization, innovative stent and balloon technology, and

carotid, aortic and venous interventions.

• Stewards of best practices. Our vascular experts share expertise

and best practices with other medical professionals every year at

the Current Concepts in Vascular Therapies Mid-Atlantic Conference

hosted by Sentara and EVMS.

• Transplant experts. Sentara Vascular Specialists is the only group in

Hampton Roads and eastern North Carolina that performs kidney

and pancreas transplantations.

• Vein specialists. Our vascular experts treat varicose veins, spider

veins and other vein diseases at four Vein Center of Virginia

locations statewide.

Advanced Aortic Program

The aortic experts at Sentara Vascular

Specialists are internationally recognized for

their skill at treating the most complicated

aortic disease problems. Our surgeons

provide a complete range of diagnostic and

treatment services for abdominal aortic

aneurysms, thoracic aortic aneurysms, aortic

dissection and other types of aortic disease.

Since 2009, the Advanced Aortic Program has

seen a 40 percent increase in patient cases.

This growth is largely attributed to our

experts’ ability to use the most innovative

procedures and devices in order to manage a

range of conditions from simple to complex.

Some of the advanced procedures available at

Sentara include:

Thoracic Endovascular Aortic Repair (TEVAR):

Sentara has one of the country’s largest

thoracic aortic programs. When possible, we

use a minimally invasive procedure called

thoracic endovascular aortic repair (TEVAR) to

repair the aorta, the body’s major blood

vessel. Thanks to our success at performing

hundreds of TEVAR procedures, Sentara

is among a select handful of centers

nationwide asked to participate in two

landmark device studies. Our involvement in

aortic clinical trials has increased nearly 90

percent since 2000, a true reflection of our

program’s excellence.

Central Venous Program According to the American Heart

Association, venous thromboembolisms

(VTE), blood clots that originate in a vein,

are the third leading cause of cardiovascular

death after heart attack and stroke. VTEs

affect between 600,000 and 1 million

Americans every year. Types of VTEs

include deep vein thrombosis (DVT), a

blood clot in a deep vein in the leg or arm,

and pulmonary embolism (PE), a blood clot

that breaks free from a vein and travels to

the lungs.

Sentara Vascular Specialists are national

leaders in the use of an innovative surgical

technology called the AngioVac Cannula

and Circuit System to remove difficult-to-

access clots. Previously, removal of certain

clots in the heart or abdomen required

open surgery, which often resulted in

significant blood loss. With the AngioVac

System, our surgeons often perform the

procedure percutaneously through the skin.

The circuit part of the AngioVac System

creates an extracorporeal bypass that

filters blood outside of the body during the

removal of the clot, which is done by

suctioning with the AngioVac cannula.

During surgery, a reinfusion cannula sends

filtered blood back into the body, minimizing

blood loss.

Using this technology, Sentara vascular

surgeons have successfully removed clots

from the heart’s right atrium, inferior vena

cava and superior vena cava. In 2016,

Sentara surgeons were among the first in the

country to use AngioVac to remove a blood

clot in a pediatric patient’s right atrium.

As a high-volume center for AngioVac

procedures, Sentara surgeons perform

about two procedures per month and are

sought after to share their expertise at

conferences worldwide.

In Situ Fenestration: We are a world leader in

an innovative TEVAR procedure called in situ

fenestration to revascularize aortic branches

during aortic emergencies. During urgent

situations, our vascular surgeons use lasers

to make holes (fenestrations) in stent grafts to

accommodate brachiocephalic or visceral

arteries. The stent grafts are used to

reconstruct the aorta and its major branches.

Fenestrated Endovascular Aortic Repair

(FEVAR): Our doctors are among the most

experienced in the region at performing FEVAR

procedures to treat complex abdominal aortic

aneurysms once considered inoperable. Our

vascular surgeons use computed tomography

(CT) imaging scans to custom design a graft

that has pre-made holes, or fenestrations. The

fenestrated graft is positioned using fusion

imaging technology to reconstruct the aorta

and the arteries that branch off from the aorta

to the kidneys, liver and small bowel.

Thoracic EndoAnchors®: Sentara vascular

surgeons were the first in the country to use

thoracic endograft anchoring technology, or

EndoAnchors, to stop blood leaks (endoleaks)

which can occur following a thoracic

endovascular aortic repair. These devices

strengthen the seal between a stent graft and

the aorta, effectively stopping leaks. We

perform more of these procedures at Sentara

than any other medical center in the world.

36 SENTARA HEART 37

Sentara Heart Arrhythmia Center Offers:

• A hybrid team approach toward patient care—both a

cardiothoracic surgeon and cardiac electrophysiologist review

every option with patients to determine the best treatment plan

• Comprehensive Afib treatment program that includes an advanced

heart mapping system, advanced diagnostic testing and leading-

edge procedures not available anywhere else in the region

• The only advanced hybrid EP cardiovascular operating room in

Southeastern Virginia

• Services tailored to referring doctors, ranging from one-

time recommendations for medical management to invasive

interventions

The Sentara Heart Arrhythmia Center (SHAC) is one of the few centers

in the country with the expertise and technology to perform all of the

most revolutionary ablation procedures available for the treatment of

heart arrhythmias.

The center is also a national leader in performing the Open Cox

Maze IV and minimally invasive Cox Maze procedures, as well as

hybrid surgical ablation.

Doctors at the SHAC are committed to employing the latest methods

and tools to treat Afib, which is a growing national health concern.

Sentara Heart is experiencing an increase in the number of patients

seeking treatment for Afib. The risk of developing this heart rhythm

disorder, which affects nearly 5.1 million Americans, increases with

age. As the Baby Boomer generation gets older, the number of people

with Afib could triple to 15.9 million by 2050.

Individuals seeking arrhythmia care comprise a very diverse group,

some of whom require complex therapies. The SHAC provides a

resource for managing unique patients across the region with seamless

access to advanced diagnosis and medical and interventional

treatments—all within one setting. We are the only center in

Southeastern Virginia to bring together highly talented cardiothoracic

surgeons and cardiac electrophysiologists in a highly collaborative

approach to cardiac care. We consider this centralized treatment process

to be an important step forward for patient care and satisfaction.

cardiologists at Sentara Heart Hospital to

develop an arrhythmia program that

allowed expansion of an arrhythmia clinic

and service offerings throughout the

Hampton Roads region. This will allow

the SHAC to better meet the growing demand

for arrhythmia care and electrophysiology

procedures.

Cardiac lead removal continues

to be an area of growth for the

SHAC. There is a growing need

for doctors at the SHAC to

perform cardiac lead removal

procedures as part of the

normal course of management

of implantable devices such as

cardiac resynchronization therapy

defibrillators (CRT-Ds), implantable

cardioverter defibrillators (ICDs), and

pacemakers.

To contact the Sentara Heart Arrhythmia

Center, call (757) 388-8020 or go online to

sentara.com/Afib.

• A dedicated program navigator who

provides a single point of contact to

referring doctors and patients through

the entire care cycle process

• Access to advanced Afib research studies

that are among the top enrollers in the

nation, including:

o ARCA Biopharma Genetic-AF trial

o AtriCure Hybrid DEEP Pivotal AF trial

o AtriCure ABLATE study for open maze

procedures

Areas of Growth

The SHAC is continuing its development of

integrated services and use of the Hybrid

Cardiac Operating Suite. Cardiothoracic

surgeons, cardiac electrophysiologists and

cardiothoracic anesthesiologists work closely

together to handle complex treatments and

surgeries for patients requiring more in-depth

procedures. The increasing efficacy and

success of these complex procedures is a

testament to the benefits of a highly

collaborative and hybrid approach to care.

The SHAC also dramatically increased its

community outreach efforts and coverage for

patients who require arrhythmia management,

providing ablation procedures and standard of

care therapy for flutter and fibrillation to

under-served and under-resourced areas of the

Hampton Roads community. In 2015, the

SHAC worked with Sentara Heart

Sentara Heart

Arrhythmia CenterProgram Leads

Jonathan Philpott, MD, Cardiothoracic Surgeon

Philip Gentlesk, MD, Cardiac Electrophysiologist

39SENTARA HEART38

Sentara Advanced

Heart Failure Center

Medical Director, John Herre, MD,

Advanced Heart Failure Cardiologist

Surgical Director, Christopher Barreiro, MD,

Cardiothoracic Surgeon

The number of people being diagnosed with heart failure

continues to increase with nearly 6 million Americans

currently affected. To serve the needs of this burgeoning

population, Sentara Heart expanded the Sentara Advanced

Heart Failure Center in 2014—doubling its capacity.

The center has four subspecialized programs, each with

their own distinct specialists and clinics.

Normal Body Function

Heart Failure

CardioMEMs™

On October 30, 2015, center physicians implanted CardioMEMS™, a new,

miniaturized, wireless heart failure monitor, into the pulmonary arteries

of eight patients. Sentara Heart was the first in Southeastern Virginia to

perform this procedure.

The CardioMEMS™ system has no wires or batteries, allowing for

greater ease of mobility. Daily pulmonary pressure readings taken at

a patient’s home and transmitted to the center enable specialists to

detect warning signs of heart failure up to 45 days before the onset

of symptoms. Clinicians can immediately alter a patient’s treatment

to prevent problems from worsening. This proactive step decreases

the chances of hospitalization, improves quality of life and reduces

healthcare costs.

In clinical trials, CardioMEMS™ reduced hospital

admissions by 37 percent.

Ventricular Assist Devices (VADs)

Sentara Heart is among select U.S. hospitals chosen by

manufacturer Thoratec to participate in a clinical trial to evaluate

the effectiveness and safety of a new ventricular assist device, or

VAD, called HeartMate III. The center’s surgical director, Michael

McGrath, MD, is leading the Momentum 3 trial at Sentara Heart.

The HeartMate III incorporates advanced technology that makes surgical placement easier.

Single-sided cables enable patients to discreetly slip the external portions of the device into

a front pocket and enjoy a more active lifestyle. In 2015, Sentara Heart surgeons implanted

the HeartMate III into three patients.

LVADs help the heart’s left ventricle (the main pumping chamber of the heart) deliver blood

to the rest of the body. Long-term VADs may serve as bridges to transplantation, stabilizing

heart failure patients until a heart transplant is possible, or as destination therapy for those

with more advanced heart failure who are not transplant candidates.

1,100 patient treatments

More than 1,100 patients receive treatments—ranging

from medication management to the latest innovative

technologies—through this cutting-edge program.

“Newer indications and devices allow us to care for the full

spectrum of patients with heart failure”

— John Herre, MD, Medical Director, Advanced Heart Failure Center

Sentara Heart Hospital LVAD program’s patient survival (red line)

far exceeds that of the national patient survival experience (blue line).

In 2016, Sentara Heart

provided:

12

35

Heart Transplants

Long-Term VADs

30 Short-Term VADs

A ventricular assist device (VAD) is a mechanical pump that is used to support heart function and blood flow in people who have weakened hearts. It is used to stabilize a patient for up to a few days (short-term VAD) or as a bridge to heart transplant to a long-term solution (long-term VAD) to help a heart work better.

40 41SENTARA HEART

Milton Hugate

M ilton Hugate has always been an

active person. At age 83, he still

likes to mow his yard and his

neighbor’s. Living in a rural area of Virginia with

large lawns, the mowing is no easy task. Yet, he

has always taken on the challenge with no

problems – except when he started to have

trouble breathing.

“For about eight months starting in late 2015,

Milton struggled even walking from the living

room to the bathroom,” shares his wife,

Margaret. “He couldn’t do it without losing

his breath.”

But Milton wouldn’t stop his usual activities.

In May 2016, he spent a day working with a

chain saw and walking up and down stairs.

When he came inside and finally sat in the

kitchen, he collapsed into his daughter’s arm.

He was rushed to a non-Sentara Healthcare

PATIENT

Sentara Heart

A fast recovery after a quick fix

hospital, diagnosed with severe aortic

stenosis (a narrowing of the heart’s aortic

valve opening), and asked to undergo a valve

replacement at another non-Sentara facility.

Milton’s daughter, Donna, had another idea.

As a nurse practitioner, she wanted to

investigate all of the treatment possibilities.

A call to a friend led her to the Sentara

structural heart team and evaluations for her

father at Sentara Heart Hospital.

“The staff worked it so we could have a lot of

the pre-testing done at one time, so we didn’t

need to do much driving back and forth. The

testing and the operation were scheduled

quickly, and it all went fast. Milton had his

procedure on a Wednesday and left the

hospital that Friday,” Margaret said. “He had

great care.”

Milton had a TAVR, a transcatheter aortic valve

replacement, a minimally invasive procedure

that can sometimes be used as an alternative

to open heart surgery. It is also known as TAVI,

a transcatheter aortic valve implantation.

Sentara Heart Hospital is one of a select group

of heart centers across the country that

pioneered the method.

TAVR allows doctors to replace a damaged

valve without removing it. Working with a

catheter, they deliver a collapsible

replacement valve to the site. When they

expand the new valve, the old valve leaflets

are pushed out of the way.

Within a few days of returning home, Milton

met with an in-home physical therapist. She

set up a walker for him and said they would

go at his pace. Little did she know that the

pace would be fast: When she turned around

to check on something, Milton was up and

walking down the hall.

“He felt great almost right away,” says

Margaret. “He’s doing anything he wants—

working in his shop and cutting the grass.

Anything that needs fixing, he tries to take

care of it.”

42 43SENTARA HEART

Medical Director, Michael Eggert, MD, Pulmonologist

Advanced Practice Clinician, Vanessa Knowles, MSN, RN, FNP-C

Pulmonary Arterial Hypertension (PAH)

For more than a decade, Sentara Heart has been a pioneer in the

specialized diagnosis and treatment of a rare, often-fatal heart and lung

disease called pulmonary arterial hypertension, or PAH. PAH is a type of

high blood pressure in the lungs that causes the arteries in the lungs to

tighten and stiffen. This forces the right side of the heart to work harder

to push blood out of the heart, through the lungs and into the rest of

the body. Over time, this extra stress causes the right side of the heart

to enlarge and eventually to fail.

Michael Eggert, MD, medical director of the PAH program at the

Advanced Heart Failure Center, refers to PAH-induced right-sided heart

failure as “the other heart failure.” The disease often goes undiagnosed

or is misdiagnosed until it has progressed to a more advanced stage.

“In the 1990s, before specific therapies were developed, half of PAH

patients died within three years of diagnosis,” says Dr. Eggert. “Today,

our survival time from diagnosis has more than doubled, with some

patients living more than 15 years, when the disease is caught and

treated early. In time, we may be able to add even more time to

patients’ lives with better disease detection and management and the

possibility of transplantation.”

In 2016, Sentara Heart’s Pulmonary Hypertension Clinic was accredited

as a Pulmonary Hypertension Association Regional Clinical Program

(RCP). This designation of clinical excellence recognizes Sentara Heart’s

status as a leader in PAH diagnosis and treatment and will further

increase the program’s visibility while enhancing regional clinical

research and collaboration.

Sentara Heart PAH program highlights include:

• Disease management of more than 300 patients, which is

comparable to patient populations seen at large state academic

medical centers

• Annual diagnostic evaluation of several hundred patients

Normal Pulmonary Artery

Pulmonary Artery with Hypertension

• Multidisciplinary PAH care team comprised of a transplant-trained

pulmonary hypertension cardiologist, pulmonologists, cardiologists,

cardiopulmonary rehab specialists, nurses, cardiac respiratory

therapists, clinical coordinators and research coordinators

• Specifically designated inpatient units within Sentara Heart for

disease management of PAH patients

• Specialized training of staff at Sentara hospitals, as well as within

the cardiac ICU and advanced heart failure units at Sentara Heart,

in the identification and treatment of PAH

• Participation in national and international clinical trials focused on

identifying new PAH therapies

• Quarterly educational support group meetings in the Hampton

Roads region for patients with PAH and their loved ones

• Annual PAH symposium to raise disease awareness among

clinicians in the medical specialties of pulmonary medicine, critical

care, infectious disease, internal medicine, family medicine and

respiratory care and to discuss the future direction of the diagnosis,

treatment and management of the disease

To contact the Sentara Advanced Heart Failure Center, call (757) 388-2831 or go online to sentara.com/HeartFailure.

The Sentara Norfolk General Hospital Pulmonary Hypertension

Clinic was one of only three centers nationwide to earn

Regional Clinical Program (RCP) designation by the Pulmonary

Hypertension Association (PHA). This accreditation is based on

the program’s ability to deliver quality care to patients living

with a complex, often misdiagnosed, life-threatening disease.

It is the result of participation in a pilot program with the PHA

and a rigorous review process. Conclusion of the RCP pilot has

laid solid groundwork toward meeting the PHCC program goals

of providing increased access for PH patients to high-quality

care and fostering collaboration between regional treatment

sites and those receiving PHA’s Center of Comprehensive Care

(CCC) accreditation.

300

250

200

150

100

50

0

Q42014

Q42015

Q12016

Q22016

Q32016

Q42016

Pulmonary Hypertension Clinic

Episode Count

SENTARA ADVANCED HEART FAILURE CENTER

45SENTARA HEART44

Medical Director, Paul Mahoney, MD, Cardiologist

The Sentara Heart Valve and Structural Disease Center is the only

program in Southeastern Virginia and Northeastern North Carolina

focused on diagnosing and treating heart valve and structural

heart disease.

The center offers the most innovative heart valve repair options

available including the newest generation of valves that doctors

implant through minimally invasive catheterization. The center

was the first in the region to offer these advanced transcatheter

cardiac treatments:

• MitraClip device for mitral valve repair

• Transcatheter aortic valve replacement (TAVR) for severe

aortic stenosis

• WATCHMAN left atrial appendage closure device for

atrial fibrillation

• Parachute investigational device for ischemic cardiomyopathy

In addition, the center continues to perform a high volume of other types

of heart valve repair and replacement surgeries including percutaneous

aortic and mitral balloon valvuloplasty, atrial septal and ventricular

septal defect repairs, closures of paravalvular leaks, and as a result of

the multidisciplinary approach, traditional aortic valve surgeries.

Program Team

Neville Mistry, MD, Cardiologist

Lauren Morris, PA-C, Advanced

Practice Clinician

Marianna Garcia , PA-C,

Advanced Practice Clinician

Kelley Meredith, PA-C,

Advanced Practice Clinician

Elizabeth Willette, NP

Sentara Heart Valve and Structural Disease Center

6 9 6Dec 2011 2012 2013 2014 2015 Dec 2016

TAVRHeart Team

ReviewFollow-Up

Visits

Total TAVR Procedures Performed from

December 2011 - December 2016

At the center, a program navigator guides first-time patients through

the referral and screening process. Upon completion, a team of

interventional cardiologists, cardiothoracic surgeons and advanced

practice clinicians work collaboratively to assess the patient’s condition

and determine the most appropriate course of therapy or treatment.

The result is an individualized disease management plan tailored

specifically to a patient’s cardiac needs.

The program navigator and coordinators provide a single point of

contact for referring physicians, providing updates on a patient’s

progress and communicating follow-up care management upon the

patient’s discharge from the center.

Rapidly growing advancements in minimally invasive heart surgery

are yielding faster recoveries and improving patient satisfaction and

comfort – all with less visible scarring. Because of these benefits,

doctors at the center perform catheter-based heart procedures for most

single-valve repairs and replacements whenever possible.

4746 SENTARA HEART

Sentara Heart Valve and Structural Disease Center

WATCHMAN

For the past decade, Sentara Heart has been an active participant

in clinical trials for the WATCHMAN left atrial appendage (LAA)

closure device. Doctors at Sentara Heart have implanted over 100 of

the devices since FDA approved the WATCHMAN in March of 2015.

The WATCHMAN is a self-expanding device that seals off the LAA,

a small pouch off the left

side of the heart where

blood clots can form in

patients who have

atrial fibrillation (Afib).

At first, a mesh

membrane on the

device acts as a filter,

allowing blood to flow

through while stopping

clots from entering the

bloodstream where

they can cause strokes.

Eventually, heart tissue grows over the device, permanently sealing

off the LAA.

LAA occlusion eliminates the risk of stroke without the need for

blood thinners, which is great news for the many patients who are

unable to take them due to side effects or bleeding risks. Most

patients who receive the WATCHMAN go home within 24 hours and

can stop taking blood thinners within two months.

Transcatheter Aortic Valve Replacement (TAVR)

Sentara Heart is proud to be one of a select group of distinguished

heart centers across the country that helped pioneer transcatheter

aortic valve replacement (TAVR), a minimally invasive treatment to

replace diseased aortic valves. Since the program began in December

of 2011, the center has completed 696 TAVR procedures—nearly 243 of

them in 2016 alone.

TAVR is a highly innovative treatment for patients who suffer from

severe aortic stenosis, a condition caused by a narrowing of the aortic

valve due to calcium buildup. This restricted opening reduces blood

flow leading to extreme fatigue, severe shortness of breath, and

possible heart failure. Many patients who have severe aortic stenosis

also have other health issues, like diabetes or lung disease, that make

them high-risk candidates for open-heart valve replacement surgery.

SENTARA HEART VALVE AND STRUCTURAL DISEASE CENTER

The Center’s Latest Advancements Include:

MitraClip

In June 2014, Sentara Heart was the first in the region to offer a first-of-

its-kind device called the MitraClip to treat heart failure patients who

have mitral regurgitation. Mitral regurgitation is the most common

heart valve problem in the U.S., affecting approximately 4 million

people. An estimated 50,000 Americans undergo mitral valve

repair surgery every year. Because MitraClip is a minimally

invasive catheter-based implant procedure, it is a welcome

option for heart failure patients whose conditions are so

severe that they cannot undergo open chest surgery.

MitraClip attaches to the mitral valve leaflets creating

a double opening of the mitral valve. This allows for

greater closure and reduces the leakiness of the valve.

Sentara Heart doctors have performed 92 MitraClip

procedures. Studies show that patients who receive MitraClip

have fewer hospitalizations and enjoy an improved quality of life.

Sentara Heart also is participating in the Cardiovascular Outcomes

Assessment of the MitraClip Percutaneous Therapy (COAPT) clinical

trial, a national study comparing the effectiveness of MitraClip to

medical therapy for heart failure patients who are not candidates for

traditional mitral valve surgery. Cardiologist Paul Mahoney, MD, is the

study’s principal investigator.

To contact the Sentara Heart Valve and Structural Disease

Center, call (757) 388-6144 or go online to sentara.com/

HeartValveCenter.

2014

144

2015

193

2016

243

Because TAVR is a catheter-based procedure, it can be a good

alternative for high-risk and elderly patients once considered

inoperable.

With this minimally invasive procedure, doctors at Sentara Heart

can repair the aortic valve without removing the old, damaged

one. Instead, they use a catheter to place a balloon-expandable

replacement valve into the heart. Most patients are often out of the

ICU in a day and home within 72 hours.

Sentara Heart is participating in the PARTNER-II and SURTAVI

clinical trials studying TAVR. Dr. Mahoney and cardiothoracic

surgeon Joseph Newton, MD, are leading both studies.

TAVR Program Growth(Does not include clinical trial volume)

4948 SENTARA HEART

The team provides fast, accurate diagnoses and treatments in our Advanced Imaging Center

and Hybrid Cardiac Operating Suites. Treatment options for aortic conditions at Sentara include

medication management, minimally invasive endovascular surgery, ascending aorta and aortic

arch open surgery, and valve-sparing surgery.

The Sentara Aortic Center serves as a medical home for patients needing long-term disease

management, providing medical management of hypertension, genetic counseling, patient and

family education, and ongoing monitoring via diagnostic and imaging tests.

Aortic Alert Program

The Sentara aortic emergency call system is helping to save lives. If an aortic emergency occurs

at a Sentara hospital, staff need only dial 1-2 within the hospital

to put the Aortic Alert Program into immediate effect.

This system connects the caller with a highly trained operator who assesses the situation and

deploys the aortic disease team. Together, they use their expertise to create a personalized plan

for a patient’s aortic care.

Since the Aortic Alert Program went into effect in 2014, Sentara hospitals have

seen dramatic improvements in the following areas:

Outside Sentara, someone experiencing an aortic emergency can call

(844) 601-2255 or (757) 252-9001.

Sentara Aortic Center

1 hourtime reduction between emergency room arrival and imaging scans 1.5 day

decrease in hospital stays

2 6 min.faster transportation times with the Nightingale Regional Air Ambulance as the primary mode of transportation

Sentara Aortic

Center TeamOur multidisciplinary team of

specialists include:

• Cardiothoracic Surgeons

• Vascular Surgeons

• Cardiologists

• Emergency Department Physicians

• Radiologist/Imaging Specialists

• Geneticist

• Advanced Practice Clinicians

(Nurse Practitioners and

Physician Assistants)

Co-Directors

Jean Panneton, MD, Vascular Surgeon

Jonathan Philpott, MD, Cardiothoracic

Surgeon

Lauren Gillis, MSN, RN, ANP-BC,

Advanced Practice Clinician

The Sentara Aortic Center opened in 2015 and

is one of only a handful of programs in the

U.S. with physicians who specialize in aortic

diseases. The center merges its expertise

with sophisticated technology to ensure fast

and effective diagnoses and treatment of

aortic conditions. The center’s high quality

emergency care and long-term management

of aortic disease is unmatched in the mid-

Atlantic region.

Our multidisciplinary team of specialists

includes experts in aortic disease, emergency

medicine, surgery and imaging—all

working together to deliver exceptional and

compassionate care. The team manages a full

range of aortic conditions including:

• Thoracic aortic aneurysms

• Abdominal aortic aneurysms

• Thoraco-abdominal aneurysms

• Aortic dissection

• Traumatic aortic injury

• Penetrating aortic ulcers

• Intramural hematoma

• Aortic occlusive disease

51SENTARA HEART50

Cardiac NursingHeart patients at all Sentara hospitals receive exceptional care from

our team of highly specialized cardiac nurses. Many of our nurses hold

advanced certifications or degrees, including doctoral degrees,

in various subspecialties. At Sentara, we encourage our nurses to

perform at the highest level of their clinical expertise while providing

support to patients who are undergoing or recovering from advanced

cardiac procedures.

Patients and their loved ones agree that the care provided by Sentara

nurses is extraordinary. Our customer service scores show that patients

consistently rate their overall care at Sentara at the highest level

possible, a 9 or 10 on a scale of 10 (best hospital) to 0 (worst hospital).

Advanced Care for Patients with Chronic Illness

The role of cardiac nurses continues to expand and become more vital

as the care delivery model for each patient increases in complexity.

Many patients have multiple comorbidities or chronic illnesses, such

as heart disease and diabetes. This combination of health problems

can complicate cardiac treatment and recovery. Nurses must manage

the primary reason for hospitalization, such as heart surgery, while

also monitoring other conditions that can interfere with recovery. For

instance, heart patients who also have diabetes often need special

wound treatment to ensure proper healing. Our nurses tap into their

high-level education and training to ensure a patient’s recovery goes as

smoothly as possible with few risks or complications.

Advanced Practice Clinicians Perform Top-of-License Work:

• Coordination of care through ambulatory clinic and physician

practice sites

• Assistance with advanced structural heart procedures

• Cardiothoracic surgery program support

• Assistance with complex catheter ablations in electrophysiology

and catheterization labs

• Management of advanced heart failure patients

• Support for a range of bedside procedures

Nurse-Directed Stress Testing

Over the past decade, the responsibility for performing heart stress

tests has shifted from physicians to cardiac nurses. Under the guidance

of a cardiologist, Sentara cardiac nurses who have completed special

training conduct exercise stress tests for patients to check for heart

disease, irregular heartbeats and other cardiac-related problems.

Surgical Partners

An increasing number of cardiac nurses are assisting with complex

cardiac procedures in the hybrid operating room, electrophysiology

(EP) lab and catheterization lab. Sentara nurses provide support for

catheter ablations, cardiothoracic surgeries and advanced structural

heart procedures, such as aortic valve repair and replacement.

This surgical collaboration allows for a seamless transition to post-

surgical care during a patient’s recovery. Our nurses also work closely

with patients who have received ventricular assist devices (VADs),

implantable cardioverter defibrillators (ICDs) and pacemakers, as well

as those recovering from heart transplants.

Post-Surgical Intensive Care

In the cardiac surgery intensive care unit (CSICU), cardiac nurses

are part of a multidisciplinary team comprised of cardiologists,

cardiovascular surgeons, nurse practitioners and cardiovascular

perfusionists. The nurses collaborate with heart experts to ensure a

continuum of care for patients who require extracorporeal life support

(ELS), also known as extracorporeal membrane oxygenation (ECMO).

ELS is an emergency stabilizer for patients suffering from acute heart

failure or respiratory failure. This ventricular support system pumps

and oxygenates a patient’s blood in order to give the heart and lungs a

temporary rest. Caring for patients on ELS requires advanced nursing skills. 5352 SENTARA HEART

Cardiac Education Medical education is integral to fulfilling the Sentara mission of improving

health every day. For cardiology specialists at Sentara Heart, this means

extending expertise and knowledge to internal medicine residents and students

at Eastern Virginia Medical School (EVMS) in Norfolk, VA. EVMS shares a

campus with Sentara Norfolk General Hospital (SNGH), which serves as the

medical school’s primary teaching institution.

Medicine, as an instruction guide. The rotation

focuses on both cardiology and medical

reasoning, equipping residents with the

logic and probability tools needed to make a

diagnosis, order appropriate tests, develop

a treatment plan and make a long-term

prognosis.

Each month, a different cardiology expert

from a Sentara hospital prepares and

presents a lecture for EVMS internal medicine

residents and students. Core topics for these

monthly lectures range from congestive heart

failure to atrial fibrillation and hypertension.

SNGH also hosts weekly grand rounds

featuring cardiology experts from world-

renowned medical institutions, such as the

Every year, cardiology experts from Sentara

Heart hospitals volunteer hundreds of hours

of time to educate EVMS internal medicine

residents and students about heart disease

and treatments. Many serve as preceptors to

residents and students, providing one-on-one

guidance and instruction.

Sentara cardiologist John E. Brush Jr., M.D.,

serves as division chief of cardiology for

internal medicine at EVMS and coordinates all

Sentara volunteer cardiac education efforts.

All internal medicine residents at EVMS

complete a mandatory cardiology rotation at

Sentara Leigh Hospital in Norfolk, VA.

Dr. Brush leads this rotation using his well-

respected book, The Science of the Art of

Johns Hopkins University School of Medicine

in Baltimore, MD, and McMaster University

Michael G. DeGroote School of Medicine

in Ontario, Canada. These livestreamed

presentations can be viewed by other

clinicians worldwide.

Sentara Heart also provides postgraduate

training for EVMS advanced practice

clinicians, such as physician assistants and

nurse practitioners. When appropriate,

Sentara Heart physicians collaborate with

EVMS on research projects to improve the

delivery of healthcare to cardiac patients.

55SENTARA HEART54

Recent Areas of Focus and Change Include:

High Reliability Organization:

In 2013, Sentara Heart made a commitment

to change the organization’s culture to be

more reflective of a High Reliability Organization

(HRO). Sentara Heart’s cardiac nurses piloted

this initiative. They recognized that Sentara

already had all of the tools needed to initiate

and sustain this change, most notably

behavior-based safety habits, medical response

teams, daily safety huddles, and patient-

centric care.

The clinical staff worked diligently to promote

the four pillars of an HRO culture: accountability,

leadership, safety and patient-centric care.

Staff then applied the HRO principles to three

targeted safety components that greatly impact

clinical care: out-of-unit codes, catheter-

associated urinary tract infections, and

inpatient falls with injuries.

By 2015, the staff noted remarkable results at

Sentara Heart, and is looking to expand the

HRO program to other Sentara hospital

locations. HRO program results at Sentara

Heart as of October 2015 reflect decreases in:

• Out-of-unit codes: 6 in 2015 vs. 20 in 2014

• Catheter-associated urinary tract

infections: 6 in 2015 vs. 12 in 2014

• Inpatient falls with injury: 11 in 2015 vs.

16 in 2014

Continuing Education:

Many cardiac nurses are taking the

next step into furthering their education

with advanced certifications or degrees,

including doctoral degrees, in various

subspecialties. Sentara Heart continues to

promote continuing education among all

nurses in an effort to transform the care

delivery model. Highly specialized cardiac

nurses bring a significant amount of

intellectual capital to the evidence-based

care they provide every day.

Partners in Research:

Since 2011, Sentara Heart has encouraged

front-line nurses to participate in

research and quality improvement

initiatives by creating a culture of inquiry

and providing logistic support. Every

Friday, researchers from the Sentara

Cardiovascular Research Institute host

a Cardiac Journal Club where nurses

brainstorm possible research or quality

improvement projects with experienced

researchers. The number of nurse-driven

quality improvement projects at Sentara

Heart has increased steadily each year.

In 2015, there were 32 Sentara Heart

presentations, 22 involving cardiac nurses.

Exceptional Patient Care:

The formalized cardiac committees at

Sentara Heart serve as a great platform

for the cardiac nurses. While there are

various types of cardiac nurses working

in multiple settings, there are several

standardized approaches to cardiac care

that are constant among all sites.

Consistency is key and remains a strong

theme among the cardiac nurses. Each

nurse understands the importance of

providing the best care as cost efficiently

as possible. It is for this reason that the

cardiac team is always looking for

collaboration for group purchasing.

The outcome of applying these principles

to the care delivery model, and adhering

to the Sentara Commitments to Cardiac

Nursing Care, is reflected in our customer

service scores. These scores reflect a

rolling 12 months’ percentile ranking

of 96 percent. On a scale of 10 (best

hospital) to 0 (worst hospital), 86 percent

of patients rate their overall care at

Sentara at a 9 or 10.

The Sentara Heart cardiac nurse

embodies the Sentara Philosophy of

Nursing as evidenced by the treatment

provided to patients suffering from heart

conditions. Each patient requires a unique

and individualized treatment approach.

The Sentara Heart nurse delivers a

hallmark standard of care that serves

as a role model for other heart centers

nationwide to emulate.

CARDIAC EDUCATION

Echocardiogram Sonographer Training

Before a Sentara cardiologist can make

a diagnosis, our exceptionally skilled

echocardiogram sonographers use their

expertise in non-invasive technology to

produce clear, readable images of a

patient’s heart.

Approximately 85 sonographers (also

known as echo technicians) work at the 12

Sentara hospital locations. All of the Sentara

echocardiogram labs, including a few that are

located within doctors’ offices, are accredited

by the Intersocietal Accreditation

Commission. Throughout the year,

Sentara sonographers receive training

on best practices to reduce variations

in lab reporting and ensure consistent

standards systemwide.

A new focus for our sonographers

in 2016 was on cardio-oncology and

cardiac strain imaging. Technicians

participated in a hands-on workshop

to learn more about the strain

imaging function available on some

ultrasound machines at various Sentara

hospitals. This ultrasound test captures

information that helps doctors identify early

signs that a heart is under stress or starting to

incur damage. Heart strain is a precursor to

heart failure and congestive heart disease.

Checking for early signs of cardiac disease

is especially important for patients with

cancer undergoing chemotherapy and

radiation because these treatments

can weaken heart muscle. As part

of a newly formed cardio-

oncology program, Sentara

cardiologists work closely

with oncologists to ensure

cancer treatments aren’t

damaging a patient’s

heart. Information from

echocardiograms with

strain imaging enables

cardiologists to more clearly see and identify

subtle changes in heart function. If needed, a

patient’s oncologist can alter treatment before

too much damage occurs.

An education specialist conducts annual

workshops. In 2017, Sentara sonographers will

dissect cow and pig hearts to get an in-depth

look at the heart’s structure and to gain a better

understanding of how the chambers, valves and

arteries interact.

Sonographers also participate in a monthly

guest lecture series presented by various

Sentara heart experts. The annual workshops

and monthly lectures allow sonographers to

earn required continuing medical education

(CME) credits at the same hospital system

where they work.

57SENTARA HEART56

AmuletPrincipal Investigator: Dr. Paul

Mahoney

The AMPLATZER™ Amulet™ Left Atrial

Appendage Occluder (Amulet) is intended

to reduce the risk of thromboembolism

from the left atrial appendage (LAA) in

patients with non-valvular atrial fibrillation.

SurtaviPrincipal Investigators: Drs. Paul

Mahoney and Joseph Newton

To compare the effects of bucindolol

hydrochloride to metoprolol succinate

(Toprol-XL) on the recurrence of

symptomatic atrial fibrillation/atrial

flutter in patients with heart failure who

have a specific genotype for the beta-1

adrenergic receptor.

Enable MRIPrincipal Investigator: Dr. Robert

Bernstein

To confirm the safety and effectiveness

of the ImageReady™ MR Conditional

Defibrillation System when used in the

1.5T MRI environment under the labeled

Conditions of Use.

AXAFAPrincipal Investigator: Dr. Philip

Gentlesk

To demonstrate that anticoagulation with

the direct factor Xa inhibitor apixaban is

not less safe than Vitamin-K-antagonists

(VKA) therapy in patients undergoing

catheter ablation of non-valvular AF

in the prevention of peri-procedural

complications.

Victoria

Principal Investigator: Dr. Wayne Old

This is a randomized, placebo-controlled,

parallel-group, multi-center, double-blind,

event driven trial of MK-1242 (vericiguat)

in subjects with heart failure with reduced

ejection fraction (HFrEF).

Linq HFPrincipal Investigator: Dr. John Herre

The purpose of the LINQ™ HF study is

to characterize Reveal LINQ™ derived

data from patients with heart failure

by assessing the relationship between

changes in LINQ™ derived data and other

physiologic parameters with subsequent

acute decompensated heart failure

(ADHF) events.

As the pre-eminent cardiac research institute

in the mid-Atlantic region, Sentara Heart

works collaboratively with local institutions,

government agencies and biomedical

companies on nationally and internationally

recognized clinical research trials. We focus

our efforts on discovering more effective

cardiovascular treatments and protocols while

eliminating those that are potentially harmful

or not as beneficial. Our ultimate goal is to

provide enhanced clinical care that advances

patient outcomes and improves the overall

health of our community.

Our research touches on every aspect

of heart care, including medical devices,

heart failure, electrophysiology, cardiac

surgery, pulmonary hypertension, cardiac

interventional procedures, structural heart

disease, and the medical management of

coronary artery disease risk factors such as

diabetes and high cholesterol.

Collectively, our research nurses coordinate

more than 80 clinical trials at any given time,

shepherding participants through the entire

trial process, providing care during periods of

need, and tirelessly advocating for their

patients’ well-being.

Sentara Cardiovascular

Research InstituteOver the last decade, the SCRI specialty physician team and uniquely trained

registered nurse research coordinators have made significant strides in

advancing the understanding and treatment of the No. 1 killer in America:

Cardiovascular disease. For more information about current

research trials or questions about SCRI,

please call (757) 388-5480.

Investigational Research Studies at Sentara HeartHere is a sampling of some of the clinical trials active at SCRI in 2016.

59SENTARA HEART58

echocardiography A diagnostic test in which

ultrasonic waves are used to produce images

of the position and motion of the heart and its

internal structures.

ejection fraction The percentage of blood

pumped out of the right and left ventricles

with each heartbeat.

electrophysiology (EP) A branch of cardiology

that deals with the diagnosis and treatment

of heart rhythm disorders. EP doctors

(electrophysiologists) ablate tissue, implant

and manage cardiac devices, and otherwise

care for patients with heart rhythm disorders.

endocarditis Inflammation of the lining of the

heart and valve leaflets.

extracorporeal membrane oxygenation (ECMO)

The technique of providing both cardiac

and respiratory support (oxygen) to patients

whose heart and lungs are so severely

diseased or damaged that they can no longer

function. Other variations of its capabilities

have been tested and used over the last few

years, making it an important tool in life and

organ support (extracorporeal circuitry). With

all of these uses, a new term, extracorporeal

life support (ECLS), is now commonly used to

describe this technology.

femoral artery A large artery in the thigh that

connects to the aorta.

implantable cardioverter defibrillators A small

device that’s placed in the chest or abdomen

to help treat irregular heartbeats called

arrhythmias. An ICD uses electrical pulses

or shocks to help control life-threatening

arrhythmias, especially those that can cause

sudden cardiac arrest.

inoperable Unsuitable for a surgical procedure.

lipid A group of naturally occurring molecules

that include fats, waxes, sterols, and fat-soluble

vitamins.

mitral valve The only bi-leaflet valve in the

heart, it regulates the flow of blood from the left

ventricle to the left atrium.

mitral valve repair A surgical procedure to

treat the narrowing (stenosis) or leakage

(regurgitation) of the mitral valve – the “inflow

valve” for the left side of the heart.

myocardial biopsies The removal of a small

piece of heart muscle for examination.

myocardial infarction Otherwise known as a

heart attack, this occurs when blood vessels

that supply blood to the heart are blocked,

preventing enough oxygen from getting to

the heart. The heart muscle dies or becomes

permanently damaged.

myocardium The fibrous muscle tissue of

the heart.

palpitations A rapid or irregular heartbeat.

patent foramen ovale (PFO) A “hole” in the

heart that is often harmless. About 1 in 5

Americans have PFO. Many don’t know it until

a medical condition like a stroke or mini stroke

occurs. PFOs often have no symptoms but they

increase your risk for stroke.

pericardial tissue The tough, protective sac

surrounding the heart.

GLOSSARY

We have provided this glossary for those readers

who may not be as familiar with some of the

medical terms used in this annual report.

atrial septal defect (ASD) A form of congenital

heart defect that enables blood flow between

two compartments of the heart and can lead to

lower-than-normal oxygen levels in the arterial

blood that supplies the brain, organs and

tissues. However, an ASD may not produce

noticeable signs or symptoms, especially if the

defect is small.

balloon valvuloplasty A procedure performed

to open a narrowed heart valve using a thin

tube called a catheter with a small balloon at

its tip. The catheter is inserted through a small

incision in the groin and then threaded up to

the opening of the narrowed heart valve. The

balloon is then inflated to stretch the valve

open and relieve valve obstruction.

bi-leaflet A valve that has two leaflets that

regulate the flow of blood. A normal aortic

valve has three leaflets.

calcification A disease state in which calcium

from the blood collects in the body tissues.

When this occurs on the leaflets of the heart’s

valves, it may cause them to harden and

reduce their ability to open and close properly.

cardiac ablations A procedure that can correct

heart rhythm problems, typically using long,

flexible tubes inserted through a vein in the

groin (or wrist) and threaded to the heart to

correct structural problems. Cardiac ablation

works by scarring or destroying tissue in the

heart that triggers an abnormal heart rhythm.

cardiac catheterization Cardiac catheterization

is a minimally invasive procedure commonly

used to diagnose and treat heart conditions.

During catheterization, small tubes (catheters)

are inserted into the circulatory system to

determine if there are obstructions within

the blood vessels that feed the heart.

cardiopulmonary bypass (CPB) Bypass of

the heart and lungs. During this technique,

which is often used during heart surgery, a

heart-lung machine temporarily takes over

the function of the heart and lungs.

catheterization A procedure in which a

thin tube called a catheter is inserted

into the body.

comorbidity The presence of one or more

additional disorders or diseases that occur

at the same time as a primary disease or

disorder.

congestive heart failure A condition in

which the heart cannot pump enough blood

to the body’s other organs.

coronary artery disease A narrowing of the

small blood vessels that supply blood and

oxygen to the heart.

echocardiogram (ECHO) A test that uses

sound waves to produce live images of your

heart, allowing your doctor to monitor how

your heart and its valves are functioning.

An echo can help spot blood clots in the

heart, fluid in the sac around the heart, and

problems with the aorta.

echocardiogram (EKG) A test that checks for

problems with the electrical activity of your

heart and translates the heart’s electrical

activity into line tracings – spikes and dips,

called waves – on paper.

OF TERMS

angina Chest pain that occurs when an area

of the heart muscle does not receive enough

oxygen-rich blood.

aorta The largest artery in the body, it receives

blood from the heart that has been oxygenated

in the lungs, and delivers this blood to the body

and brain.

aortic stenosis A progressive disease that

affects the aortic valve of the heart.

aortic valve The heart valve that regulates the

one-way flow of blood from the left ventricle to

the aorta.

arteries Blood vessels that carry blood away

from your heart to other parts of your body.

atria The two upper chambers of the heart that

receive blood returning from the body.

atrial fibrillation Atrial fibrillation, or AF, is the

most common type of heart rhythm disorder

(arrhythmia). During an arrhythmia, the heart

can beat too fast, too slow, or with an irregular

rhythm. AF occurs if rapid, disorganized

electrical signals cause the heart’s two upper

chambers (the atria) to contract very quickly

and irregularly (fibrillate).

61SENTARA HEART60

2016 Sentara Heart Annual Report

The CARE Unit (cardiac assessment, recovery and evaluation) at Sentara Heart Hospital “always says yes!”

to referring providers wanting to transfer or admit cardiac patients to our care. Over the last few years,

Sentara Heart Hospital has experienced a 36 percent increase in patient transfers and referrals. The hospital

will not turn away a cardiac patient in need.

In 2016, Sentara Heart collaborated with Sentara’s Regional Transfer Center to coordinate efforts to transfer

cardiac patients. All patients are transferred with the underlying principle of “Right place, right time and the

right level of care.” Our one-call-does-it-all system allows a referring or accepting physician to focus on the

patient instead of arranging and coordinating transfers.

The process is quite seamless as the CARE Unit uses the Regional Transfer Center’s teletracking system to

view all patients awaiting transfer:

• Once Sentara Heart Hospital receives a transfer request, an expert CARE Unit team member gathers

information about the patient’s clinical needs and relays the details to a Sentara Heart doctor.

• Sentara’s doctors and the CARE Unit evaluate the patient’s clinical needs and determine the best

mode of transportation, either via ambulance or Nightingale Regional Air Ambulance.

• Depending on the patient’s status, the CARE Unit prepares the required procedure room—

ICU, cath lab, operating room, CARE unit, stepdown or other.

• A member of the CARE Unit team notifies the referring physician of the action plan

and serves as the central point of contact throughout the patient transfer and for all

status updates.

The CARE Unit at Sentara Heart Hospital on the campus of Sentara Norfolk General

Hospital serves as the portal for entry, preparation and recovery for catheterizations,

electrophysiology (EP) and cardiac operating room procedures. This system provides

seamless coordination of cardiac care and ensures that Sentara Heart is prepared to meet

a patient’s level of care before arrival.

Transferring a Patient to Sentara Heart Hospitalpercutaneous coronary intervention (PCI) A

procedure more commonly known as coronary

angioplasty that is used to treat the narrowed

(stenotic) coronary arteries of the heart found

in coronary heart disease. These narrowed

segments are due to plaque buildup.

perioperative The time period describing the

duration of a patient’s surgical procedures

from check-in through recovery—

preoperative, intraoperative, and

postoperative.

peripheral vascular disease (PVD) A slow and

progressive circulation disorder. It may involve

disease in any of the blood vessels outside of

the heart or in the arteries, veins, or lymphatic

vessels. Organs supplied by these vessels, such

as the brain, heart, and legs, may not receive

adequate blood flow. The legs and feet are

most commonly affected.

pressure ulcers Also known as bedsores,

pressure ulcers are localized injuries to the skin

and/or underlying tissue that usually occur over

a prominence as a result of pressure or friction.

pulmonary arterial hypertension (PAH) An

increase of blood pressure in the pulmonary

arteries. These arteries carry blood from your

heart to your lungs to pick up oxygen. PAH

causes symptoms such as shortness of breath,

dizziness, fainting, chest pain, and leg swelling.

As the condition worsens, its symptoms may

limit all physical activity.

pulmonary valve The valve that regulates the

flow of blood from the pulmonary artery to the

right ventricle.

regurgitation The backward flow of blood

(in the opposite direction than it would

normally flow).

stenosis The narrowing of an opening.

stents A small mesh tube that’s used to treat

narrow or weak arteries.

syncopy A loss of consciousness, or

fainting, caused by a temporary lack of

oxygen to the brain.

ST-segment elevation myocardial infarction

(STEMI) A type of heart attack that occurs

when a coronary artery suddenly becomes

at least partially blocked by a blood clot,

causing at least some of the heart muscle

being supplied by that artery to die.

telemanagement Advanced technology

that enables doctors and nurses to monitor

patients remotely.

transcatheter aortic valve replacement (TAVR)

(also referred to as TAVI or transcatheter

aortic valve implantation): A treatment

option for inoperable patients that allows

doctors to replace a heart valve using a

catheter put into a small cut – avoiding the

need for open-heart surgery.

transesophageal echocardiogram (TEE) A

type of echo test that provides a close look

at the heart’s valves and chambers, without

interference from the ribs or lungs. During

a TEE, an ultrasound transducer, positioned

on an endoscope, is guided down a

patient’s throat into the esophagus.

tricuspid valve The heart valve that regulates

the flow of blood from the right ventricle to

the right atrium.

tricuspid valve repair The tricuspid valve

is located between the heart’s right upper

chamber (atrium) and lower chamber

(ventricle). Its role is to make sure blood flows

the correct way through the heart. In some

people, this valve does not function correctly

(tricuspid valve disease). The valve can be

repaired (preferred) or replaced.

tri-leaflet A valve with three leaflets. A

normal aortic valve is a tri-leaflet valve.

valve leaflets Flaps of tissue that open and

close to help regulate the flow of blood in one

direction through the valve.

valvuloplasty A procedure in which a catheter

is advanced from a blood vessel in the groin

through the aorta into the heart. A large

balloon at the tip of the catheter is inflated

until the flaps of the valve are opened. Once

the valve has opened, the balloon is deflated

and the catheter is removed. Valvuloplasty

is performed in certain situations in order to

open a heart valve that has become stiff.

veins The blood vessels that return

de-oxygenated blood to the heart and lungs.

ventricles The large, lower blood-pumping

chambers of the heart.

GLOSSARY OF TERMS

62 63SENTARA HEART

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SentaraHeart@sentara.com