Annual Report 2022

A Message From Our Chairman

Welcome to the 2022 Allegheny Health Network (AHN) Cardiovascular Institute annual report. We are excited to share the highlights of our team and programs from 2022. We are very proud of the care and caring provided to our patients and happy to share these highlights and objective evidence of excellence.

Readers of this issue will learn, for example, about AHN’s Heart Failure program, whose quality is recognized by the American Heart Association as among our nation’s best, and will discover that the Joint Commission has designated Allegheny General Hospital as a comprehensive cardiac care center—its highest level of care and a recognition attained by fewer than 20 programs nationwide.

Meanwhile, the Society of Thoracic Surgeons (STS) gave its highest rating of three stars to AHN’s Allegheny General for four different cardiac surgical procedures: coronary artery bypass grafting, transcatheter aortic valve replacement, mitral valve repair/replacement and aortic valve/coronary artery bypass graft surgery. Allegheny General was recognized with a Mitral Valve Repair Reference Center Award by the American Heart Association® and The Mitral Foundation—one of just 22 in the country. The combined Allegheny General/Forbes lung cancer program was also recognized by the STS as a three-star program.

The AHN Cardiovascular Institute also has a robust clinical research program dedicated to developing new and better ways to treat difficult problems. This allows patients to have early access to promising new technologies and treatments. Physicians from around the country routinely travel to AHN to learn these new techniques from our teams.

AHN’s expertise is demonstrated by the fact that the Institute’s physicians and surgeons have amassed impressive numbers for advanced procedures. AHN’s transplant team recently performed their 500th heart transplant.

We are grateful that these acknowledgments, and others, confirm what we knew all along: that the excellence of our physicians and surgeons and our multifaceted, multidisciplinary care lead to great results for our patients. Our culture of collaboration and caring will continue to advance cardiovascular healthcare at AHN.

You are invited to refer patients to our cardiovascular programs or contact us for a consultation. Either way, you will become part of a team working to optimize your patient’s health.


Stephen H. Bailey, MD
Chair, AHN Cardiovascular Institute
[email protected]

American Heart Association is trademarked and used with permission.

Valvular Heart Disease Program Attracts Nationwide Recognition

Approximately 2.5% of the U.S. population suffers from valvular heart disease, a condition that causes about 25,000 deaths annually—most commonly from failure of either the aortic or mitral valves.1

“If a patient is referred to Allegheny Health Network [AHN] with valvular heart disease of any kind, we will make sure that person gets to the right clinician to diagnose, evaluate and treat the condition,” said Stephen H. Bailey, MD, the chair of AHN’s Cardiovascular Institute and the system chair of the AHN Department of Thoracic and Cardiovascular Surgery. “That’s done with a multidisciplinary, collaborative heart team.”

AHN is highly experienced and nationally recognized for treating valvular heart disease in all its forms. Allegheny General Hospital—the flagship academic medical center of AHN—was given the prestigious three-star rating from the Society of Thoracic Surgeons (STS) for both its transcatheter aortic valve replacement (TAVR) program and its aortic valve/coronary artery bypass graft surgery program. AHN has also been recognized as one of only twenty-two centers in the country to receive the Mitral Valve Repair Reference Center Award for excellence by the American Heart Association® (AHA) and the Mitral Foundation, and is also designated a three-star program by the STS.

Among other areas, Dr. Bailey specializes in aortic stenosis. “We tailor the procedure to the patient’s specific aortic valve problem,” he said. “That includes traditional open-heart surgery, minimally invasive surgery or transcutaneous valvular interventions.” The exact procedure is dictated by the patients’ specific medical circumstances and anatomy.”

Surgical aortic valve replacement (SAVR), which can be performed as either an open-heart or minimally invasive procedure, until recently was the treatment of choice for severe aortic stenosis. Most patients are able to go home in 4 days. Although SAVR has been the standard approach for replacing a diseased heart valve, research performed at AHN has helped demonstrate the efficacy of non-invasive procedures like TAVR. TAVR is performed by a team of specialists without the need for incisions or general anesthesia, and patients usually go home the day after the procedure.

“ With the robotic approach—where we’re operating between the ribs and no broken bones are involved—most people are back to work within a month.”

—Walter E. McGregor, MD, AHN’s Director, Cardiac Surgery Division

AHN’s mandate includes a vibrant research program focused on answering the most important clinical questions and fostering early access to novel technologies. Critical clinical research at AHN (i.e., the PARTNER 3 trial2) led to the approval of TAVR for the lowest risk category of patients. Under Dr. Bailey’s leadership, AHN is currently enrolling patients in the ALIGN-AR trial, a study of the JenaValve®, a novel percutaneous device designed for aortic insufficiency. AHN is the only site in the region offering access to this novel device.

AHN is also the largest U.S. enrolling site for the SMART Trial,3 the world’s only head-to-head comparison of the two most commonly used TAVR valves. The study is being conducted in a subset of patients with symptomatic severe aortic stenosis with a small aortic valve annulus to help guide optimal valve choice and patient outcomes.

Leadership of the mitral valve program falls to Walter E. McGregor, MD, the director of AHN’s Cardiac Surgery Division. Dr. McGregor’s expertise includes robotic heart surgery, transcatheter mitral valve repair/replacement and complex surgical reconstructive techniques. The key to success, he said, is understanding which patients will respond best to which procedure, and identifying that subset of patients who are not suited for a procedural intervention but are optimally treated with medical management of their disease.

“The mitral disease program is structured around an interdisciplinary approach to patient care,” Dr. McGregor explained. “For each individual, we take a team approach in deciding the best course.”

Robotic mitral valvular procedures at AHN show exceptional patient outcomes, with a surgical repair rate well above the 95% threshold of the Mitral Reference Center designation.4 “With the robotic approach—where we’re operating between the ribs and no broken bones are involved—most people are back to work within a month,” Dr. McGregor said.

This expertise is reflected by the program’s numerous excellence recognitions from the AHA and the STS.

AHN’s mitral valve repair program is also actively involved in the most important clinical research, offering patients early access to the most promising new technologies.

2. N Engl J Med 2019;380:1695-1705.
3. Am Heart J 2022;243:92-102.
American Heart Association is trademarked and used with permission.
JenaValve is a trademark of JenaValve Technology and is used with permission.

Electrophysiology Program Offers Comprehensive Arrythmia Care

The electrophysiology experts at Allegheny Health Network (AHN) take a comprehensive approach for treating even the most difficult heart rhythm problems.

“Our electrophysiology program has a very sharp focus on efficacy and safety,” said Amit J. Thosani, MD, the director of cardiac electrophysiology for AHN and vice chair of the AHN Cardiovascular Institute.

To help achieve these goals, Dr. Thosani and his colleagues incorporate state-of-the-art electrophysiologic technology into the diagnosis and care of their patients. This includes a low- or no-fluoroscopy approach to catheter ablation, which minimizes patient exposure to radiation during these procedures.

The electrophysiology experts also integrate advanced mapping and imaging systems into their practice, an innovation that virtually eliminates the need for preprocedural imaging, thereby reducing the number of visits that patients need to make to the hospital. High-power, short-duration catheter ablation leads to improved lesion creation, with less risk for damage to surrounding structures. Leadless pacemakers are also among some of the newer devices used in AHN’s cardiac electrophysiology practice, as well as conduction system pacing that uses the heart’s natural electrical pathways to create more physiologic pacing conditions.

“We are fortunate to host physicians from around the country who come to observe how we operate,” Dr. Thosani pointed out. “So, we lead, we innovate and we teach.”

AHN offers a comprehensive continuum of care for patients with arrhythmias, which begins the moment a patient first develops symptoms, and continues through diagnosis, medical/surgical management and postoperative care. At AHN, treatment includes not only that for refractory arrhythmias that have not responded to traditional therapies, but also advanced surgeries, which are performed in conjunction with the network’s cardiovascular surgeons.

Ultimately, it’s the combination of all these features that makes AHN’s electrophysiology department a smart destination for patients throughout the region. “We offer the full gamut of arrhythmia care,” Dr. Thosani noted. “As a complete cardiac care referral center, we treat patients both with de novo arrhythmias as well as those who have had treatments elsewhere and are still having rhythm issues,” Dr. Thosani said. “There are very few things we cannot treat.”

AHA-Recognized Heart Failure Program Offers Full Treatment, Surgical Options

Allegheny Health Network (AHN) has one of the premier programs for heart failure (HF) in the United States, and is experienced in virtually every aspect of HF diagnosis and treatment—excellence that has been recognized by the American Heart Association®.

As part of its 360-Degrees of Care Program, AHN’s Heart Failure Clinic offers patients access to a wide range of cutting-edge medical, surgical and device treatment options, as well as mechanical circulatory support and cardiac transplantation.

“Ours is a very large and diverse program,” said Manreet Kanwar, MD, the director of AHN’s Mechanical Circulatory Support and Transplant Program. “It is a patient-centered program that practices an evidencebased approach, with multiple professionals working together on behalf of the patient.”

This approach enables Dr. Kanwar and her colleagues to target subgroups of patients who require special attention, particularly those with uncommon causes of cardiomyopathy, such as amyloidosis, hypertrophic cardiomyopathy, inherited cardiomyopathy, etc.

Hypertrophic cardiomyopathy can sometimes result in life-threatening arrhythmias or sudden death, yet many patients present with few, if any, symptoms and the condition is difficult to diagnose. In recent years, AHN’s hypertrophic cardiomyopathy program, led by Craig Alpert, MD, and Pietro Bajona, MD, PhD, has grown rapidly, becoming an important regional referral center with a burgeoning national reputation.

Dr. Kanwar’s team continues to develop expertise and enhance its reputation in the field of advanced heart failure and cardiogenic shock. For decades, cardiogenic shock has had a fatality rate of approximately 50%.1,2 Given this risk, treatment requires a focused, organized multispecialty approach to address the needs of these patients in critical moments.

AHN has organized a “hub and spoke” model to help triage and transfer patients in any regional center who present in cardiogenic shock. “With this program, our shock survival rate over the past year was over 60%, which is far better than traditional statistics,” Dr. Kanwar said.

Another innovative program, led by Matthew Lander, MD, and Azam Hadi, MD, treats patients with cardiac sarcoidosis, an uncommon yet potentially deadly inflammatory condition in which granulomas form in heart tissue, interfering with normal heart function and potentially causing arrhythmias, cardiomyopathy or heart failure.

Dr. Kanwar and her team are known for their expertise in “advanced” heart failure, but also are committed to prevention and early detection of disease—an approach that often takes advantage of rapidly evolving remote monitoring, including implantable and wearable devices.

Implantable technology aims to leverage and integrate data from such devices as defibrillators and pacemakers. An example of this technology is the CardioMEMS™ implantable hemodynamic monitor, which provides early warning of HF decompensation and may help to prevent hospitalization.

Advances in wearable technology—from external patches to devices like the Fitbit® and Apple Watch®— also allow AHN physicians to remotely assess patient wellness.

“Leveraging this technology ensures that we can recognize problems as soon as they occur, and develop solutions before these patients end up in an emergency room or require hospitalization,” Dr. Kanwar said.

Despite treatment, HF progresses to an advanced stage in some patients. For these individuals, AHN offers therapeutic options such as mechanical circulatory support and cardiac transplantation—procedures that demand the highest level of clinical expertise. Mechanical circulatory support supplements or replaces the action of the failing heart using a variety of technologies, including temporary options such as extracorporeal membrane oxygenation, intra-aortic balloon pumps, and the Impella® or TandemHeart® devices, or long-term therapies such as left ventricular assist devices (LVADs).

“These surgeries, both of which we offer here, require a high level of expertise and ICU care in a multidisciplinary fashion,” said Masaki Tsukashita, MD, PhD, the surgical director of the Mechanical Circulatory Support and Cardiac Transplantation programs at AHN.

In a small subset of patients with advanced HF, the only viable therapeutic option is cardiac transplantation. While the procedure is exceptionally complex, Drs. Kanwar and Tsukashita and their teams are approaching an important milestone: They will soon perform their 500th heart transplant. This extensive experience is one reason why AHN is designated by The Joint Commission® as a comprehensive cardiac care center—the highest possible level of care.

“Not many health systems are certified for both mechanical circulatory support and cardiac transplantation as a treatment option for advanced cardiac disease,” Dr. Kanwar said.

As a complex, multifaceted condition and a chronic disease, HF requires a lifelong approach to care. “No matter where the patients are on their journey, we have developed the processes and programs that allow them to get the finest long-term care possible and achieve the best possible outcomes,” Dr. Kanwar said.

1.J Am Heart Assoc 2021;10(15):e021061.
2. mcs-cardiogenic-shock.
American Heart Association is trademarked and used with permission.
CardioMEMS is a trademark of Abbott Laboratories and is used with permission.
Fitbit is a trademark of Google and is used with permission.
Apple Watch is a trademark of Apple and is used with permission.
Impella is a trademark of OSF HealthCare and is used with permission.
TandemHeart is a trademark of LivaNova and is used with permission.
The Joint Commission is trademarked and used with permission.

Notable Clinical Research/Registries: 2022

Allegheny Health Network Cardiovascular Institute physicians are involved in multiple clinical trials. Here is a sampling of a few, and why the study is noteworthy:

  • Heart Failure
    BMAD (PI: Azam Hadi, MD)
    Title: Benefits of Microcor® in Ambulatory Decompensated Heart Failure (BMAD-TX) NCT04096040
    Notable for: High enrolling site in the US

  • CORCINCH (PI: Manreet Kanwar, MD)
    Title: Randomized Clinical Evaluation of the AccuCinch® Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study NCT04331769
    Notable for: Innovative device

  • PHDEV (PI: Venkatraman Srinivasan, MD)
    Title: Non-Invasive point-of-care Diagnosis using machinE learNing and signal analyTIcs to transForm earlY detection of Pulmonary Hypertension
    Notable for: High enrolling site in the US

  • Electrophysiology REAL-AF (PI: Joshua Silverstein, MD)
    Title: Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation
    Notable for: Large-scale clinical outcomes study

  • cMRI/Imaging RESONANCE (PI: Robert Biederman, MD)
    Title: REgiStry Of the NAtural history of recurreNt periCarditis in pEdiatric and adult patients
    Notable for: High enrolling site in the US

  • Interventional ECLIPSE (PI: David Lasorda, DO) Title: Evaluation of Treatment Strategies for Severe CaLcIfic Coronary Arteries: Orbital Atherectomy vs. Conventional Angioplasty Technique Prior to Implantation of Drug- Eluting StEnts: The ECLIPSE Trial (ECLIPSE)
    Notable for: Orbital Atherectomy versus conventional balloon angioplasty technique

  • Optimize PRO (PI: Ramzi Khalil, MD) Title: Optimize PRO TAVR Post Market Study NCT04091048 Notable for: High enrolling site in the US

  • Cardiac Surgery ALIGN-AR (PI: Stephen Bailey, MD) Title: A study to assess safety and effectiveness of the JenaValve Trilogy™ Heart Valve System in the treatment of high surgical risk patients with symptomatic, severe aortic regurgitation (AR)
    Notable for: This is a new clinical trial for a valve specifically designed for severe aortic insufficiency, which is a current gap in the transcatheter field.

  • SUMMIT (PI: Walter McGregor, MD) Title: Clinical Trial to Evaluate the Safety and Effectiveness of Using the Tendyne™ Transcatheter Mitral Valve System for the Treatment of Symptomatic Mitral Regurgitation NCT03433274 Notable for: Randomized trial comparing the new Tendyne Transcatheter Mitral Valve System to the Mitraclip device

  • General Cardiology ATRIUM (PI: Valentyna Ivanova, MD) Title: A Phase 3, Investigator-Initiated, Randomized, Double-Blind, Placebo- Controlled Study to Evaluate the Efficacy and Safety of Abatacept Compared to Placebo in Hospitalized Participants with Immune Checkpoint Inhibitor Associated Myocarditis NCT05335928
    Notable for: Collaborative study with Oncology

AccuCinch is a trademark of Ancora Heart and is used with permission.
Microcor is a trademark of Zoll Medical and is used with permission.
Orencia (abatacept) is a trademark of Bristol Myers Squibb and is used with permission.
Tendyne is a trademark of Abbott and is used with permission.
Trilogy is a trademark of JenaValve Technology and is used with permission.

Allegheny General Hospital Structural Heart Disease Statistics: 5-Year Trends

Even through the pandemic years, consults and cases for structural heart disease have remained strong.
LAAO, left atrial appendage occlusion;TAVR, transcatheter valve replacement. TriClip is a trademark of Abbott and is used with permission.

Heart Transplants at Allegheny General Hospital: By the Numbers

The transplant donor pool and eligibility will expand with the new “donation after circulatory death” (DCD) heart transplant program. In addition, cardiogenic shock team consultation has expanded throughout the Allegheny Health Network.
* g/?organ=heart&recipientType=adult&donorType=
Source: Society of Thoracic Surgeons 2021 report

Selected CVI Highlights

Allegheny General Hospital is the first hospital in Pennsylvania to receive the Mitral Valve Repair Reference Center Award from the American Heart Association® and the Mitral Foundation

Ranked as the only ‘High Performing’ transcatheter aortic valve replacement (TAVR) Program in Western PA and West Virginia, by U.S. News

Rated the No. 1 hospital in Southwestern PA for Medical Excellence in Major Cardiac Surgery, Coronary Bypass Surgery, and Interventional Carotid Care1

Three-star (i.e., best) ratings in four different cardiac surgical procedures, including coronary artery bypass grafting (CABG), combined CABG and aortic valve replacement (AVR), TAVR, and mitral valve repair/ replacement (MVRR) by the Society of Thoracic Surgeons (STS)

Three-star (best) rating for the lung cancer lobectomy surgery program by the STS

Allegheny General Hospital is the first hospital in Pennsylvania and one of just 16 in the United States to earn a Gold Seal of Approval for Comprehensive Cardiac Center Certification by The Joint Commission®

AHA Get With The Guidelines®—Heart Failure Achievement Award with Gold Plus Designation (the highest level of achievement, at AGH, Allegheny Valley, Forbes, Jefferson, Saint Vincent and West Penn) and Atrial Fibrillation Achievement Award with Silver Plus Designation at AGH

AHA certification as a Comprehensive Hypertension Center at AGH and West Penn Hospital

Extracorporeal Life Support Organization® (ELSO) Distinguished Center of Excellence for extracorporeal membrane oxygenation (ECMO) program—Gold Level at AGH

Source: 2021 CareChex® by Quantros
American Heart Association is trademarked and used with permission.
The Joint Commission is trademarked and used with permission.
Get With the Guidelines is a trademark of the American Heart Association and is used with permission.
Extracorporeal Life Support Organization is trademarked and used with permission.

Multipronged Approach a Hallmark of AHN’s Coronary Artery Disease Treatment

Coronary artery disease treatment at Allegheny Health Network (AHN) starts with medical management, the particular expertise of Indu Poornima, MD, the director of nuclear cardiology at AHN.

“The philosophy behind the medical management of coronary disease at AHN is that by adequately treating the underlying disease process, we can prevent or hinder its progression,” Dr. Poornima said. This involves the mitigation of risk factors such as high cholesterol, high blood pressure, diabetes, smoking, obesity and stress, she added.

The evidence in favor of medical management of coronary artery disease is compelling, Dr. Poornima said, and founded on two landmark investigations, the COURAGE trial1 and the ISCHEMIA trial,2 which together demonstrated that medical management of coronary artery disease is at least comparable to more invasive therapeutic approaches in certain patient populations.

“I think there’s been a paradigm shift in the way we approach this disease,” Dr. Poornima explained, “and it really speaks to the whole concept of preventive cardiology, which plays a huge role in the management of coronary disease.”

David M. Lasorda, DO, the director of interventional cardiology at AHN, and his colleagues use catheterbased approaches to treat coronary artery disease and structural heart disease.

The interventional cardiologists are skilled at diagnostic angiograms and interventional procedures such as angioplasty, with stenting usually performed through the radial artery at the wrist.

“We perform the entire range of diagnostic and therapeutic procedures, from very straightforward to extremely complicated. However, the hallmark of our program is the really challenging patients that have been turned down elsewhere and then referred to AGH for another opinion.

“We’ve worked hard to ensure that we can treat virtually any patient that walks or wheels in our doors,” Dr. Lasorda said.

Of course, there are instances where the severity of a patient’s disease requires more than nonsurgical management. When surgery is a patient’s best option, they can turn to AHN’s cardiothoracic surgeons, including M. Scott Halbreiner, MD, whose expertise spans virtually every procedure available. Dr. Halbreiner can perform coronary artery bypass graft (CABG) surgery for patients with coronary artery disease as either a traditional open or minimally invasive procedure.

Most of AHN’s coronary artery disease interventions are multidisciplinary efforts, which Dr. Halbreiner sees as a tremendous advantage for his patients, particularly in the complex cases in which he and his colleagues specialize. Patients can be confident that they are getting the expert opinion of an entire team and a solution carefully crafted to their specific situation.

“We can have as many as 12 professionals discussing a patient to help formulate a strategy and a care plan,” Dr. Halbreiner said. Such efforts, he added, also include the critical, postoperative period.

AHN’s expertise has been recognized by its 3-star rating for CABG surgery from the Society of Thoracic Surgeons, an achievement reserved for only the finest programs in the country and which few other institutions can claim.

“It means our CABG surgery program is in the top tier in the country in terms of outcomes,” Dr. Halbreiner said. “What’s more, it’s a rating we’ve maintained for several years now.”

Whether it’s recognition by the most prestigious professional body in the country, a multidisciplinary approach to disease prevention or innovative therapeutic techniques, coronary artery disease treatment at AHN is a multifaceted affair, where all patients will find a dedicated team prepared to work hard to ameliorate their disease process.

1. N Engl J Med 2007;356[15]:1503-1516.
2. N Engl J Med 2020;382[15]:1395-1407.

Vascular Surgeons Use Latest Procedural and Device Innovations to Improve Outcomes

The vascular surgeons at Allegheny Health Network (AHN) employ the latest innovations, including transcervical carotid stenting, a minimally invasive surgical technique that is quickly becoming the gold standard for treatment of carotid artery disease.

Also known as transcarotid artery revascularization (TCAR), the procedure is performed via a tiny incision in the neck, through which the surgeon works to stabilize plaque from inside the artery and restore normal blood flow to the brain.

“Carotid endarterectomy has historically been the gold standard for treating carotid stenosis,” explained Satish C. Muluk, MD, the director of the Division of Vascular Surgery at AHN. “Although it has very low rates of serious complications like stroke and death, it has to be performed under general anesthesia.” TCAR also avoids the potential for cranial nerve injury.

The incidence of major adverse events such as stroke and death is even lower with TCAR than carotid endarterectomy.1 Recently, Dr. Muluk and his colleagues performed their 300th TCAR procedure, making AHN one of the most active TCAR centers in the country. The department has tracked patient outcomes through the Society for Vascular Surgery® Vascular Quality Initiative® clinical registry and found incidence rates of death or stroke to be less than 1%.2

The vascular surgery team at AHN has abundant expertise in repairing abdominal aortic aneurysms (AAA), using both open and endovascular surgery. An open repair replaces the aneurysm with a synthetic graft. Endovascular aneurysm repair uses a catheter to place a stent and graft to support the aneurysm.

“Endovascular aneurysm repair is not appropriate for everyone,” Dr. Muluk said. “There are patients whose aneurysms just aren’t well suited for an endovascular approach, and we can’t sacrifice outcomes just for convenience.”

For this reason AHN strikes a balance between both approaches to AAA repair—a philosophy that allows surgeons to maintain their skills in each.

“You should not be a hammer looking for a nail, and you shouldn’t always be looking for an endovascular solution,” Dr. Muluk said. “Because if you do that, then you risk losing your familiarity and comfort with open surgery.”

An exciting innovation in endovascular AAA repair is IOPS®, for Intra-Operative Positioning System. This technology offers several advantages, including less patient exposure to radiation and contrast dye.3

“The beauty of the IOPS system is that it allows us to perform anatomically complex catheterization procedures without fluoroscopy,” Dr. Muluk noted. “We’re currently in the process of analyzing when and how we use it so that we maximize the benefits of the technology.”

1. JAMA 2019;322[23]:2313-2322.
3. J Endovasc Ther 2021;28[5]:796-803.
Society for Vascular Surgery is trademarked and used with permission. Vascular Quality Initiative is trademarked and used with permission. IOPS is a trademark of Centerline Biomedical and is used with permission.

Thoracic Surgery Program One of Nation’s Best

There is no more prestigious recognition for a thoracic surgery program than receiving a three-star rating from the Society of Thoracic Surgeons, which is precisely the distinction earned by Allegheny Health Network’s (AHN’s) Allegheny General and Forbes hospitals for lung cancer resection.

“There are only 27 three-star programs in the nation,” said Benny Weksler, MD, the system chief of thoracic surgery at AHN. “And here in western Pennsylvania, there is no other.”

AHN’s clinical expertise is not limited to the operating room. One of the hallmarks of AHN’s lung cancer initiative is its comprehensive screening program, a vital component for a disease that is typically not discovered until it has reached incurable stages. AHN’s robust screening initiatives lead to early detection, which can significantly reduce mortality.

Another important factor is that each patient’s care is truly multidisciplinary, which allows AHN’s surgeons, interventional pulmonologists, medical oncologists and radiologists to decide together the best course of action. Often, this does not lead to surgery.

“If the findings of those screenings are not discussed at length, then you may end up having many more patients undergoing surgery than is necessary,” Dr. Weksler said. Nonsurgical treatment regimens include chemotherapy, immunotherapy and radiation therapy.

Thoracic conditions treated at AHN include lung cancer as well as esophageal cancer and benign esophageal disease. If surgery is required for malignant disease, physicians such as Hiran Fernando, MD, the director of thoracic surgery at Wexford Hospital, are experts in the use of minimally invasive techniques, such as videoassisted thoracoscopic surgery.

“Minimally invasive approaches to esophageal cancer have a lower risk for pneumonia and infections, and quicker return to normal activity,” Dr. Fernando said.

There have also been significant advances in minimally invasive therapies for benign disease. For instance, the implementation of the cutting-edge LINX® reflux management system for a weak gastroesophageal sphincter and hiatal hernia. Similarly, transoral incisionless fundoplication is an endoscopic procedure used to treat disorders such as gastroesophageal reflux disease, and peroral endoscopic myotomy is effective for patients with muscle disorders of the esophagus, such as achalasia.

This variety of surgical and nonsurgical approaches helps AHN’s thoracic surgeons tailor their therapeutic approach for any patient. AHN also has a robust clinical trials program offering patients early access to the most important and effective new therapies.

LINX is a trademark of Ethicon and is used with permission.

Wide Expertise Offered at Comprehensive Pulmonary Hypertension Center

In 2015, Allegheny Health Network (AHN) became the first center in western Pennsylvania to be certified as a Pulmonary Hypertension Care Center by the Pulmonary Hypertension Association—a designation it carries today.

“We care for all forms of pulmonary hypertension,” said Amresh Raina, MD, the associate medical director of AHN’s Pulmonary Hypertension Program, including pulmonary arterial hypertension, pulmonary hypertension related to left-sided heart disease, pulmonary hypertension related to interstitial lung disease and hypoxia and chronic thromboembolic pulmonary hypertension (CTEPH).

One exciting development in the management of pulmonary hypertension due to interstitial lung disease is treprostinil, a synthetic analog of prostacyclin. AHN participated in INCREASE,1 a landmark study that found treatment with the novel agent improved participants’ physical exercise capacity.

“This was a significant development,” Dr. Raina explained. “Previously, there was no treatment for these patients, and they were instead referred for lung transplantation, assuming they were viable candidates.”

Gone are the 1990s, when there was one FDA-approved medication—a continuous prostacyclin infusion. “Now there are 14 FDA-approved drugs, which we usually use in combinations to maximize their effectiveness and utilize potential synergistic effects,” Dr. Raina said.

Of the different forms of pulmonary hypertension treated at AHN, one of the rarest is CTEPH. AHN is one of only a handful of elite medical programs in the country—and the only one in western Pennsylvania— with the expertise to perform two highly advanced surgical procedures to treat CTEPH.

The procedures are percutaneous balloon pulmonary angioplasty and surgical pulmonary endarterectomy, the latter of which is curative for CTEPH. For eligible candidates, pulmonary endarterectomy is the gold standard treatment for the surgical removal of blood clots and scar tissue in the pulmonary arteries.

“CTEPH has a nuanced disease process and is often underdiagnosed,” said Candice Lee, MD, a cardiac surgeon at AHN, who specializes in pulmonary thromboendarterectomy. As Dr. Lee explained, the smaller, more distal clots that often characterize CTEPH are especially difficult to remove and require exceptional technique and judgement.

Dr. Lee and her colleagues are rapidly approaching their 100th pulmonary thromboendarterectomy, with a survival rate of 100% at the time of this writing.

1. N Engl J Med 2021;384[4]:325-334.

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