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 over 600 heart transplants since its inception in April 1988. Through December 2004, this included 300 adult transplants at St. Paul University Hospital, 150 adult transplants at Baylor University Medical Center, and 100 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 a steady increase in the number of devices utilized. The majority of these cases represent 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.

Clinical volume of general thoracic surgery continues to steadily increase. with lung, esophageal, mediastinal, and other chest cases performed. The volume of video-assisted thoracic surgery (VATS) procedures has seen a significant rise, as well. 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 hypothermia 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 conducted with a goal of improving lung preservation strategies for transplantation. Recently the laboratory has focused on studies of a novel technique of long-term heart preservation for transplantation using a device that provides continuous perfusion to the stored organ. The laboratory has received funding from the National Institutes of Health, the American Heart Association, the American Lung Association, the Texas Advanced Technology Program and from industrial sponsors.

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

• MendCABG II Trial aimed at reducing cardiovascular death and non-fatal myocardial infarction up to post operative day 30; potentially having a significant benefit and lasting impact for CABG patients.
• On-X Prosthetic Heart Valve reduced anticoagulation clinical trial aimed at reducing the potential incidence of bleeding complications caused by taking higher dosages of Coumadine normally prescribed after receiving a mechanical heart valve.
• 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. 
• The effects of Nitrous Oxide (NO) for inhalation during left ventricular assist device (LVAD) implantation

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.