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.

Clinical Program

The clinical heart transplantation program at The University of Texas Southwestern Medical Center at Dallas has now performed over 700 heart transplants since its inception in April 1988.  This includes nearly 400 adult transplants at University Hospital-St. Paul,  just over 200 adult transplants at Baylor University Medical Center, and over 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 68% respectively for adult heart transplant recipients versus 88%, 74%, and 55% averages nationally.

Since 1990, UT Southwestern's Lung Transplant Program has performed a total of 391 lung transplants, including 207 lung transplants at University Hospital-St. Paul and 184 lung transplants at Baylor University Medical Center. Over the past ten years, actuarial survival rates for the program have consistently exceeded the national average, with a one-year survival rate of 91% and a five-year survival rate of 64% at University Hospital-St. Paul, versus national survival rates of 86% at one-year and 56% at five-years.  This includes more than 65 patients with cystic fibrosis with a 95% one-year survival.

The use of ventricular assist devices has increased in our department over the last few years, following the national trend in this exciting area. Our department offers a broad range of both short- and long-term devices to support patients with end-stage heart failure. The short-term devices include the TandemHeart, Abiomed BVS and ventricular systems, and Impella devices. Long-term options include the Thoratec Heartmate II, and more recently the Heartware LVAD for which UT Southwestern is a designated site for the Heartware Bridge to Transplant Trial. The department will also participate in the Heartware Destination Trial, another area of anticipated increase in patient and physician interest for end-stage heart failure.

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.

Basic Science Research

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.

Opportunities exist for one and two year fellowships in our research laboratories under the guidance of one of several faculty members. 

Clinical/ Multi-Center Trials

Members of the department also serve as co-investigators on a number of national multi-center trials.  Representative studies include: 

• 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].
• Omega-3 fatty acids for prevention of post-operative atrial fibrillation (OPERA)
• Effect of Acadesine on clinically significant adverse cardiovascular and cerebrovascular events in high-risk subjects undergoing CABG surgery using cardiopulmonary bypass (RED-CABG).
• A study to evalutate the efficacy, immunogenicity, and safety of a single dose of staphylococcus aureus vaccine in adult patients scheduled for cardiothoracic surgery. 

National Registries and Outcomes Databases

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.