Chairman's Introduction

The Department of Cardiovascular and Thoracic Surgery at The University of Texas Southwestern Medical Center at Dallas provides clinical services in adult and pediatric cardiovascular and thoracic surgery, as well as heart and lung transplantation, to patients in Dallas/Fort Worth and North Texas. Members of the Department also participate in a variety of basic and clinical research endeavors in the fields of cardiothoracic surgery, physiology, and biochemistry. The department provides training in this field to future surgeons through the residency program in thoracic surgery.

The clinical heart transplantation program at The University of Texas Southwestern Medical Center at Dallas has now performed 526 heart transplants since its inception in April 1988. Through December 2004, this included 317 adult transplants at St. Paul University Hospital, 139 adult transplants at Baylor University Medical Center, and 70 pediatric transplants at Children's Medical Center Dallas. The UT Southwestern Heart Transplant Program remains the leading program in Texas in terms of survival, with one-, five-, and ten-year survival rates for adults at 92%, 81%, and 66% respectively for adult heart transplant recipients versus 82%, 68%, and 45% averages nationally.

Since 1990, UT Southwestern's Lung Transplant Program has performed a total of 257 lung transplants, including 123 lung transplants at St. Paul University Hospital and 124 lung transplants at Baylor University Medical Center. Since 1994, actuarial survival rates for the program has consistently exceeded the national average, with a one-year survival rate of 92% and a five-year survival rate of 60% at St. Paul University Hospital, versus national survival rates of 73% at one-year and 46% at five-years.  This includes more than 45 patients with cystic fibrosis with a 98% one-year survival.

The ventricular assist device program has witnessed increased activity over the past year with a total of 13 cases of ventricular assist performed. The majority of these cases represented LVAD placement with the TCI Heartmate as a bridge to cardiac transplantation. Members of the department also use temporary ventricular support with the Abiomed system. One case of adult ECMO was performed in 1998 for support after lung transplantation.

The adult open heart cardiac surgical volume has remained fairly constant through November 2004 (485 cases) compared to 2003 (487 cases), and the volume at St. Paul University Hospital in 2004 is 321 cases.  The pediatric open heart cardiac surgical volume in 2004 is 303 cases.

Clinical volume of general thoracic surgery has increased over the past year, with a total of over 1,100 lung, esophageal, mediastinal, and other chest cases performed. The volume of video-assisted thoracic surgery (VATS) procedures has seen a significant rise, comprising 72 cases last year. The department uses new technology for minimally invasive coronary bypass surgery as well. Dr. Wait and Dr. Meyer serve on the steering committee for the Southwestern Center for Minimally Invasive Surgery.

The Department of Cardiothoracic Surgery maintains an active basic science research laboratory that has been investigating cardiac metabolism under conditions relevant to open heart surgical procedures, such as after ischemia and during cardioplegic arrest. Investigators have identified changes in substrate utilization patterns in cardiac tissue that occur as a result of potassium cardioplegia and have investigated a variety of substrate modifying agents that lead to improved cardiac performance after ischemia. Studies of substrate metabolism in the lung have also been initiated with a goal of improving lung preservation strategies for transplantation. The laboratory receives funding from the National Institutes of Health, the American Heart Association and the American Lung Association.

The laboratory also participates actively in collaborative projects examining platelet and neutrophil kinetics during cardiopulmonary bypass as well as  the effects of nitric oxide on accumulation and release of these blood components. These studies are done in conjunction with the Division of Biomedical Engineering and receive funding from the Texas Advanced Technology Program (to Dr. Robert Eberhart and Dr. Michael Jessen.) Other collaborative ventures include studying the limitation of exercise in adult dogs after pneumonectomy with pulmonary medicine investigators.

Members of the department also serve as co-investigators in a number of national multi-center trials including:

• The National Pediatric Heart Transplant Study Group - a group of 21 pediatric heart transplant centers examining outcomes of heart transplantation in the pediatric population [Ring].
• Veterans Administration Cooperative Study 411 - The CARP trial (a randomized trial of revascularization in patients prior to major vascular surgery) [Jessen].
• Specialized Program of Research Excellence (SPORE) - Biomarkers for the early detection and chemoprevention of lung cancer [DiMaio].
• Surgical Treatments for Ischemic Heart Failures (STICH) - To help doctors determine what treatments will help patients with heart failure and coronary heart disease live longer. 
• Prevent IV-Duke University Research Institute Trial-compare CGT003 (an E2F decoy) with placebo in patients Coronary Artery Bypass Grafting (CABG)
• Utilization of an epidermal growth factor Receptor Antagonist, ZD 1839 (IRESSA), in completely resected primary stage IB, II, and IIIA Non-Small Cell Lung Cancer (NSCLC)
• The evaluation of nesiritide infusion, initiate post induction of anesthesia, in the management of Coronary Artery Bypass Graft (CABG) patients requiring cardiopulmonary bypass (CPB)
• The evaluation of PEN110-treated RBCs in surgical patients
• A study to determine the safety and effectiveness of REPEL-CV for reducing post-operative adhesions following pediatric cardiothoracic surgery
• The effects of Nitrous Oxide (NO) for inhalation during left ventricular assist device (LVAD) implantation
• Ex-Vivo Treatment with CGT003 of Coronary Vein Grafts in Patients Undergoing Coronary Artery Bypass Graft (CABG) procedures
• Catheter-based therapy of pleural effusions in cancer patients (optimal pleural effusion control, OPEC) CALGB #30102

Department members are contributors to a number of national registries. All cardiac surgical cases performed at UT Southwestern are entered in the Society of Thoracic Surgeons database, all transplant cases are recorded in the UT Southwestern Heart and Lung Transplant database, and all cardiac cases at the Dallas VA Medical Center are submitted to the VA Continuous Improvement in Cardiac Surgery Program.