Progress ReportDivision & Section Reports

Cardiothoracic Surgery

Craig R. Smith, MD
Cardiothoracic Surgery

Craig R. Smith, MD
Chief, Division of Cardiothoracic Surgery

In most subspecialties, the Division of Cardiothoracic Surgery stands alone in the region and among the best in the world. CUMC's open-heart surgery program consistently performs over 1,500 open-heart procedures annually, and reports some of the lowest mortality rates for coronary bypass procedures in Manhattan and one of the lowest in the state. CUMC surgeons perform an unusually high percentage of valve procedures, and are recognized for innovation and expertise in valve repair.

The Heart Transplant Program, directed by Donna Mancini, MD, was one of the first in the nation, has completed its 25th year, and has consistently been among the most active programs in the United States.

Mehmet C. Oz, MD, and Yoshi Naka, MD lead an internationally recognized program in ventricular assist devices, which has become an important center for training, testing and implementation of new devices. A noteworthy recent achievement of this program was the publication of the landmark REMATCH trial, of which Dr. Eric A. Rose, Chairman of the Department of Surgery, was Prinicipal Investigator. This three-year, multicenter study demonstrated that implanted heart pumps can extend and significantly improve the quality of life of terminally ill heart failure patients.

CUMC has long been widely known as a regional and national leader in congenital heart surgery, under the direction of Jan M. Quaegebeur, MD. The New York State database for complex congenital procedures shows an astounding 1.5 percent mortality rate at CUMC compared to 15 percent statewide. This program continues to expand, with the recent addition of pediatric cardiothoracic surgeon Jonathan M. Chen, MD, and an innovative and rapidly growing program focusing on adults with congenital heart disease.

In July 2001, as part of the Division's exciting new program in robotic surgery, directed by Michael Argenziano, MD, CUMC surgeons performed the nation's first robotically-assisted atrial septal defect (ASD) repair, without a chest incision of any kind. The operation marked the beginning of a clinical trial of robotic ASD repair, approved by the Food & Drug Administration. At this writing, Dr. Argenziano has performed eleven robotic ASD repairs. In January 2002, CUMC surgeons performed the nation's first robotically-assisted coronary artery bypass, initiating another FDA trial of this new technology. Craig R. Smith, MD is the site Principal Investigator in a third, ongoing FDA trial of robotic mitral valve repair. At this writing, eight robotic mitral valve repairs have been performed, all highly successful. CUMC is the national training center for two of the three existing FDA trials of robotic cardiac surgery.

In the very near future Dr. Argenziano will perform the world's first robotic procedure to correct atrial fibrillation without a chest incision, and another FDA trial of this procedure is expected to begin shortly thereafter. The robotic procedure for treatment of atrial fibrillation is part of a larger Arrhythmia Treatment Program developed in close collaboration with Hasan Garan, MD from the Division of Cardiology. CUMC surgeons are international leaders in developing new procedures to treat atrial fibrillation. These procedures are being performed in patients at CUMC with increasing frequency, and CUMC is the national training center for many of these procedures.

Institutional Affiliations

In the purely clinical realm, we have contractual agreements to establish and manage cardiac surgery programs at New Jersey Medical School in Newark, New Jersey; Arnot Ogden Hospital in Elmira, New York; Mary Imogene Bassett Hospital in Cooperstown, New York and Good Samaritan Hospital in Suffern, New York. These programs have proven profitable and have clearly demonstrated our ability to transfer the methodology of outstanding patient care and the key elements in a clinically and financially successful program from one center to another without changing their identity.

We are actively exploring opportunities for cooperation that build on the combined strengths of both institutions, such as training programs, joint bidding on health care contracts and shared infrastructure. The opportunities in cardiothoracic surgery are especially appealing, with the combined services performing more than 3,300 open-heart procedures a year in all conceivable subspecialty areas. The combined entity is one of the largest cardiothoracic enterprises in the nation. We have already achieved a fully integrated program in congenital heart surgery at both sites under Dr. Quaegebeur. New developments involving infrastructure include combination of the existing surgical ICUs into a single 28-bed unit under unified leadership, and installation of a new computerized bedside data acquisition system that should improve patient management. Development of a new Morgan Stanley Children's Hospital of New York-Presbyterian at Columbia University Medical Center ICU dedicated to cardiac surgery is also under way.

The division remains an active part of the Heart Institute, which is an interdisciplinary entity combining all medical, surgical and diagnostic cardiac services. The institute has recently been further empowered by the addition of budgetary influence over all hospital-based cardiac services, under my leadership and that of Allan Schwartz, MD, as Clinical Directors of the Heart Institute at Columbia University Medical Center.

Cardiothoracic Program
www.columbiaheart.com