Cardiothoracic Surgery Division

Adult

Congenital

James Gangemi, MD
Professor
Read Dr. Gangemi’s Bio

Mark E. Roeser, MD
Associate Professor
Read Dr. Roeser’s Bio

Philip C. Smith, MD
Read Dr. Smith’s Bio

The Advanced Cardiac Valve Center formally started in 2008 when UVA was the first in Virginia to start performing transcatheter aortic valve replacement (TAVR). Long before that, UVA cardiac surgeons were known in the region as the go-to specialists for valve surgery. Over the last 10 years, UVA cardiac surgeons and cardiologists work closely together to create a personalized approach for every patient. This allows the best possible outcome. UVA has gained international recognition for our Valve Center with a focus on performing complex high-risk cases, innovative minimally invasive procedures, and a number of novel transcatheter trials.

The Minimally Invasive Valve Program began in 2012. Currently, both low and high-risk patients are eligible to get their valve surgery through less invasive incisions that don’t break the breast bone. In addition, UVA has many novel clinical trials related to valve disease, often being the first to perform procedures in the U.S. Patients often travel from significant distances to be evaluated for less invasive and novel clinical trials. Our aortic valve and mitral valve outcomes have some of the best outcomes in the region, commonly receiving 3 stars (top STS rating) for low mortality and complications.

UVA’s Advanced Heart Failure and Transplant Program is recognized for its expertise throughout the region. UVA has received numerous awards and recognition from the American Heart Association and U.S. News & World Report for outstanding treatment of heart failure. Surgeons and cardiologists with decades of experience lead specialized teams who only focus on treating patients with severe heart failure. UVA’s ventricular assist device (LVAD) program has the most advanced VADs available and participates in numerous clinical trials offering cutting edge therapies. In fact, our LVAD and Transplant program has received numerous accolades for our volume, outcomes, and patient satisfaction scores.

In addition to our heart failure program, UVA’s ECMO team is the only one in Virginia named a Center of Excellence with Gold Status from the Extracorporeal Life Support Organization. In extreme cases of cardiopulmonary failure, UVA can support patients with a special life support machine to act as your heart and lungs and pump blood to the body and vital organs. UVA has developed an ECMO transport system to bring patients who need ECMO to UVA urgently as well as expertise in definitive therapies beyond ECMO which may include LVADs and heart transplantation.

Coronary artery disease remains one of the leading causes of death in Virginia. UVA has long employed a heart team approach to treat patients with complex coronary artery disease combining the expertise of cardiologists and surgeons who specialize in fixing blocked coronary arteries. UVA has received the highest possible rating from the U.S. News & World Report in heart bypass surgery. UVA surgeons can perform complex coronary bypass procedures often using multiple arteries to perform bypass surgery as well as minimally invasive CABG without breaking the breastbone. In addition, UVA has been a leader in numerous NIH and industry sponsored trials and is the only in Virginia to offer cutting edge technologies to patients undergoing CABG surgery including hybrid coronary revascularization (combining stents with minimally invasive CABG).

UVA has long been a major referral center across the state and region for treating patients with complex aortic disease. Recently UVA has created a comprehensive Complex Aortic Disease Center. Our center provides the full array of treatments to patients with aortic disease including percutaneous endografting, complex open surgery, and hybrid approaches combining the two. UVA has access to many of the cutting edge trials and therapies that are in development, giving patients options that they may not have had before. Furthermore, UVA surgeons have developed many techniques over the years that have been employed by other surgeons across the world. Cardiac surgeons, vascular surgeons, cardiologists, and interventional radiologists all work collaboratively at UVA to provide the best care possible to treat aortic diseases, including congenital and acquired aortic diseases.

The Adult Congenital Heart Surgery program is one component of the comprehensive, patient centered care that is provided as part of UVA’s Adult Congenital Heart Disease Program. We work with patients to find the best treatment option whether it be medical, catheter based or surgical. Prior to surgery, all patients are reviewed in a multidisciplinary conference to ensure they receive the highest level of care. Our surgical program offers the full range of treatment options including complex re-operative surgery, the Ross procedure and cardiac transplantation. The congenital heart surgery program is nationally ranked for excellent care in Pediatric Cardiology and Heart Surgery.

Atrial fibrillation is the most common arrhythmia and can result in stroke and death. UVA provides comprehensive care for all aspects of atrial fibrillation. The cardiac surgeons work closely with the cardiologists to tailor a personalized treatment plan for each patient. In some cases, this is a catheter-based ablation while in others it is a surgical ablation in conjunction with other cardiac surgery. In some cases, a hybrid approach is used with a minimally invasive surgical ablation followed by catheter-based ablation. UVA cardiac surgeons have extensive experience with surgery to ligate the left atrial appendage, dramatically reducing the risk of stroke. Furthermore, our surgeons were the leaders in placing a novel clip to ligate the appendage that led to FDA approval.

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When it comes to cancer care, there have been tremendous breakthroughs in the last few years and our team is at the forefront – not only offering, but authoring and leading several clinical trials to push our field forward to help our patients beat their cancer diagnoses, and live long healthy lives. We are committed to adopting, and in some cases developing, the newest and best approaches to treating thoracic surgical diseases. Working as a multidisciplinary team is of paramount importance as we incorporate the latest advances in lung cancer  and esophageal cancer.

UVA Thoracic Surgery has gained international acclaim for developing a Thoracic Enhanced Recovery Program in 2016. The Program improves the patient experience from start to finish, in terms of comfort, speed and quality of recovery, optimizing pain management while minimizing use of opioid medications. This program also focuses on patient education about every step of the surgical journey. Patients recover faster, have fewer complications, and better pain control all while using 60-80% less opioid pain medication. Results have shown that Enhanced Recovery Programs After Surgery make it more likely that patients will be able to receive other treatments they need to beat their cancer, such as chemotherapy or radiation. Patients return to full function more rapidly after surgery and don’t face delayed or missed treatment doses as they have in the past.

The management of esophageal disease requires a multidisciplinary approach. At UVA we have an esophageal disease program made up of experts in the diagnosis and treatment of all aspects of esophageal disease. Some of the more commonly treated conditions include hiatal hernias, acid reflux, failed prior surgery, achalasia, esophageal diverticulum and esophageal cancer. We offer minimally invasive and robotic approaches for most of these conditions. Whether it is an evaluation for first time or reoperative surgery, we have a team of experts with the knowledge and experience to tailor a treatment plan unique to every patient.

UVA specializes in the diagnosis and surgical management of diseases affecting the diaphragm. Diaphragm paralysis and hernias whether from trauma, prior surgery or unknown causes, can cause significant lifestyle altering symptoms. At UVA we have nationally recognized surgical experts in the management of this disease process. We offer all modalities of surgical treatment, including minimally invasive and robotic techniques.

Robotic surgery has increasingly emerged as an option to perform surgery with a less invasive approach, thereby reducing recovery time, pain and disability. At UVA, we are leading the way in robotic surgery and have a high volume robotic thoracic surgery program. We offer all aspects of robotic thoracic surgery – lung and esophageal cancer, esophageal disorders, diaphragm diseases and mediastinal tumors.

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A unique feature of our division, Dr. Christopher Scott  has developed a comprehensive, team approach to evaluating and treating people who suffer from severe shortness of breath due to chronic pulmonary emboli (blood clots). Very few programs in the country offer this treatment.

Including lung biopsies for Interstitial lung disease – Our lung transplant program started in the early 1990s and is going strong today with around 30 transplants each of the last three calendar years.  Dr. Scott and Dr. Carrott work with our pulmonary team to evaluate and treat patients with end-stage lung disease that may not have other options than transplant.  More information can be found on our dedicated Lung Transplant Website.

If you are having trouble breathing due to a lung condition that could be causing scaring on the lung, you may be advised a lung biopsy is needed.  We may be requested by your pulmonary physician to perform this, which only takes a few minutes, but involves a general anesthesia, and a night in the hospital.

Management of complications of Emphysema/ COPD such as lung bullae or lung volume reduction surgery (LVRS). Patients with emphysema from smoking may develop lung issues that are not cancer.  These involve the hyper-inflation or destruction of lung tissue that may result in inability for the diaphragm and lungs to work properly.  In these instances, the destroyed or ballooned lung tissue may need to be removed with surgery.  We do have a regular meeting to discuss these complex patients with our pulmonary colleagues, where endobronchial valves may be discussed as well as surgery, to tailor the treatment to each patient.

Management of other lung disease such as pneumothorax, pleural effusions, and infections such as empyema –  Our team treats all diseases related to the lungs, chest wall, and pleural space (the chest space containing the lungs).  This can include urgent and emergent conditions such as those listed above, which will affect your breathing and may involve your pulmonologist and possibly PCP or an emergency room visit.  Typically, when fluid or air collects outside of the lungs, this will become symptomatic, resulting in impaired breathing.  Air will collect from some injury or damage to the lung, or the rupture of blebs, which are small, thinly walled bubbles off the lung, usually in young patients or patients with emphysema/ COPD.  These conditions may need urgent chest drainage and may need a surgery due to persistent injury or infection.

Pleural effusions may be due to a variety of reasons, and will likely warrant investigation where your doctor may advise a thoracentesis or drainage procedure to diagnose what is causing the fluid.  If an infection or pneumonia develops, surgery or drainage with a larger tube may be necessary.  The fluid may also be due to cancer (mesothelioma, lung cancer, or cancer from other sites), or medical conditions, such as heart, liver, or kidney disease.  Managing these conditions may take input from other physicians, and may also need a number of labs or other tests to treat.  In any case, we are often key to management of these complex issues.

Rib fractures are another condition that is usually an urgent or emergent presentation due to a traumatic injury.  We will also see patients as outpatients for non-healing, or non-union rib fractures that can be painful for months after the initial injury.  Ribs can be repaired at any time, but are often seen by thoracic surgeons soon after the injury in the hospital, or much later, typically after a period of healing that may avoid surgery, although some patients have difficulty in how their bones heal.  Evaluation of the injuries and how they affect daily life will be considered prior to surgery, which may or nay not be needed.

Here at UVA, we are treating patients over the age of 18 with pectus excavatum, using the Nuss procedure or minimally invasive pectus excavatum repair.  A camera and retractor for the sternum are used to facilitate placement of a bar that will allow the sternum (breastbone) to remodel with the ribs and correct the pectus.  This allows the heart to be positioned normally within the chest and function normally, not compressed by the chest wall.  We have treated patients of all ages, even up to age 70 with this condition, in the appropriate setting.

Our team of cardiac surgeons and engineers has developed a novel intraventricular stent (VADstent) to prevent suction events and attenuate adverse RV remodeling in patients with continuous flow ventricular assist devices (VAD). The VADstent is deployed during implantation of the inflow cannula and stents the left ventricle open to prevent collapse, keep the septum midline, and align the cannula with the mitral valve. We performed proof of concept studies in swine and ovine models. The VADstent was able to prevent suction events and maintain the geometry of the left ventricle. Importantly, no ventricular arrhythmias, hemolysis, mitral valve injury or other adverse events were noted during these experiments. Currently we have updated our prototype based on previous results and are ready to move into a long-term animal model to assess durability prior to first in human studies.

UVA cardiac surgeons have patented and developed a novel laparoscopic port that allows surgeons to cauterize any bleeding from the abdominal or chest wall by using the port itself. In collaboration with the School of Engineering, early prototypes have been developed and proven effective in early animal studies.

For over two decades, the Kron/Laubach lab has been investigating lung injury as it pertains to ischemia/reperfusion, during lung transplantation, and during cardiopulmonary bypass. Dr. Roeser’s research focuses on innovative technologies to treat ARDS and burn injuries. Collectively, this lab has had numerous grants from the NIH, DOD, and American Heart Association.

Our team at UVA has been highly prolific in investigations that strive for the best possible outcome. Whether it is deciding on which patients benefit the most from an operation, or risk factors for specific complications, our surgeons are constantly trying to provide the best possible care based on up-to-date knowledge. We also work closely with and serve leadership positions in the Virginia Cardiac Surgery Quality Initiation (VCSQI) the largest regional clinical outcomes collaborative in the U.S. targeted at improving cardiac outcomes.