YOURHEART

our commitment


HEARTANDVASCULAROUTCOMESREPORT
 
HEARTANDVASCULAROUTCOMES

T hecardiologistscardiothoracicsurgeonsandvascularsurgeonsfromRogueValleyMedicalCenter
RVMCarepleasedtopresentthisinauguraleditionoftheHeartandVascularOutcomesReport

Thereportreviewstheactualvolumesandpatientoutcomesforeachcardiovascularprocedurecovers
newtechnologiesandprovidesanoverviewoftheentireheartandvascularprogramThisdatareflects
ourdedicationtotreatingawiderangeofcardiovasculardisease

AsphysiciansweallstrivetoprovidethebestpossiblecareforourpatientsSincetheinceptionofthe
cardiacprogramyearsagoatRogueValleyMedicalCenterwehavealwaysbelievedthatteamwork
amongphysiciansisessentialfordeterminingthebesttreatmentoptionforeachpatientWealsoaimfor
excellenceinallareasandtechniquessothatwecanachievethebestpossibleresultsOurperformance
improvementprogramprovidestimelyfeedbacksothatwecanmakecontinuousimprovements

Wehopeyoufindthisinformationinterestingandusefulandwelookforwardtoacontinuedcollaboration
withyousothattogetherwecanprovideyourpatientswiththebestpossibleoutcomes

—ThephysiciansandsurgeonsoftheHeartandVascularCenteratRogueValleyMedicalCenter

OurMission
Asanteexiststoprovide
qualityhealthcareservicesina
TheHeartofRogueValleyMedicalCenter
Cardiac disease is the leading cause of death in Oregon and California. Fortunately, effective therapy is available.
Rogue Valley Medical Center (RVMC), a part of the Asante family, is a tax-exempt -licensed-bed facility created
by and for the people of southern Oregon  years ago. It provides, and is nationally recognized for, highly specialized
heart and vascular care in the region.
  
    
compassionatemannervaluedby
thecommunitiesweserve RogueValley CardiacIntensive FirstCardiac FirstOpen FirstCoronary PatientTower
MedicalCenter CareUnitOpens Catheterization HeartSurgery Balloon Constructed
Opens LaboratoryOpens Angioplasty

OurVision
CardiacFacilitiesatRVMC OtherTeamMembers physician
Asantewillberecognizedfor t
Cardiac Intensive Care Unit ( beds) assistantsnursestechnicians
medicalexcellenceforoutstanding t
Heart Center ( telemetry beds) cliniciansetc
t
Cardiac Catheterization Labs The first number represents the total number of
customerserviceandasa people working in that department. Numbers in
·  outpatient labs at Cardiovascular
greatplacetowork Institute of Southern Oregon, LLC (CVISO) parenthesis represent people with  years or more
experience in that particular field.
·  inpatient labs at Rogue Valley Medical Center
t
Cardiovascular Recovery Unit t
Operating Room  ()
t
 Operating Rooms for cardiovascular procedures t
Cardiac Perfusionists  ()
TheValuesin ·  dedicated to open heart procedures t
Cardiac Catheterization Laboratory
WhichWeBelieve · The region’s only endovascular angiographic suite · RVMC  ()
t
Imaging Department · CVISO  ()
Excellenceineverythingwedo · Echocardiography t
Cardiovascular Recovery  ()
· Stress Nuclear t
Cardiac Intensive Care Unit  ()
Respectforall · Cardiac CT t
Heart Center  ()
t
Nurse Educators  ()
Honestyinallourrelationships t
Cardiac Rehabilitation  ()
Physicians allboardcertified
t
 Cardiologists t
Echocardiographers  ()
Servicetothecommunity
t
 Cardiothoracic Surgeons t
Vascular Ultrasound  ()
physiciansandeachother t
 Vascular Surgeons t
Stress Testing  ()
t
 Anesthesiologists t
Cardiopulmonary  ()
Teamworkalways t
Clinical Quality Analysts  ()
t
 Intensivists
t
 Hospitalists


 HEARTANDVASCULAROUTCOMES 

Table of Contents
CoronaryArteryDisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
–
CardiacCatheterizationandCoronaryIntervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CardiovascularInstituteofSouthernOregonLLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MyocardialInfarctionTheASSETProgram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HypothermiaforCardiacArrestPatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
EnhancedExternalCounterpulsation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
DiagnosticElectrophysiologyStudies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
IntracardiacAblation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

DeviceImplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

CardiacSurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
CardiothoracicSurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
CoronaryArteryBypassGra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
ValveProcedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
MinimallyInvasiveValveProcedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
TransmyocardialRevascularization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

VascularSurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
ComprehensiveVascularCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
AorticAneurysmRepair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
CarotidEndarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CarotidStenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
–
NoninvasiveDiagnosticTesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
CardiacCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
CoronaryCalciumScore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

PreventiveCardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .–
CardiacRehabilitationProgram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
CardiacEducators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

HeartTransplantCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
QualityOurApproach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . –
PhysicianBiographies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 
ContactInformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


CORONARYARTERYDISEASE
CORONARYARTERYDISEASE

CardiacCatheterizationandCoronaryIntervention
Cardiac catheterization facilities at Rogue Valley Medical Center (RVMC) were established in . Five catheterization
and angiographic laboratories are dedicated to state-of-the-art diagnostic coronary angiography, coronary interventions,
peripheral angiography and interventions, electrophysiologic procedures, and device implants. Board certification in
 Coronary cardiology is required of all cardiologists. Cardiologists who perform coronary interventions are board certified in
interventional cardiology.
interventionalprogram
Expertise is maintained by focusing procedural experience within a small group of high-volume, experienced
startedatRVMC
interventionalists whose complication rates and outcomes exceed national benchmarks. Coronary interventional
volume for the institution and for each interventionalist exceeds volume recommendations established by the
Leapfrog Group, Thomson Healthcare, and the American College of Cardiology. A proven record of satisfactory
outcomes and active participation in quality improvement programs is mandatory for all physicians.

RVMC continues to adhere to the percutaneous

coronary intervention (PCI ) guidelines written and
recommended by the American Heart Association,
the American College of Cardiology, and the Society
of Cardiac Angiography and Interventions. These
guidelines are as follows:*
t
Operators perform at least  procedures at
high-volume hospitals (more than  procedures
per year) with on-site cardiac surgery.
t
Operators and institutions should have outcomes
comparable to those reported in contemporary
national data registries.
t
For ST-segment elevation myocardial infarction
(STEMI), emergent PCI should be performed
by experienced operators who do more than 
elective PCI procedures per year and, ideally, at
least  PCI procedures for STEMI each year.
Ideally, these procedures should be conducted in
institutions that perform more than  elective
PCIs per year and more than  primary PCI
procedures for STEMI per year.

*SmithSCJrFeldmanTEHirshfeldJWJrJacobsAKKernMJKing
SBIIIMorrisonDAO’NeillWWSchaffHVWhitlowPLWilliamsDO
RVMCcathlabcrew ACC/AHA/SCAIguidelineupdateforpercutaneouscoronary
intervention AreportoftheAmericanCollegeofCardiology/American
HeartAssociationTaskForceonPracticeGuidelines
ACC/AHA/SCAI
WritingCommieetoUpdatetheGuidelinesforPercutaneous
CoronaryIntervention Circulation  –


 HEARTANDVASCULAROUTCOMES 

AnnualVolumeofDiagnosticCoronaryAngiograms

CVISO RVMC CombinedVolume

 Thefiveinterventional

 cardiologistsareboardcertified


inbothcardiovascular
 diseaseandinterventional

cardiologyandprovide

around-the-clockcoverage

 


        

AnnualVolumeofCoronaryInterventionalProcedures CurrentUseofBareMetalStents
atRogueValleyMedicalCenter andDrug-ElutingStents

 TypeofStentUsed

 Year BareMetalStent Drug-ElutingStent

   

   

   


        

RVMCcardiovascularrecoverystaff


CORONARYARTERYDISEASE
CORONARYARTERYDISEASE

Awiderangeofdiagnostic
andinterventionalprocedures
areperformedatRVMC
Stent
infivestate-of-the-art CourtesyofCordis

catheterizationlaboratories

cardiac
catheterizationshavebeen
performedatRVMCsince
Stentbetweenfingers
CourtesyofCordis

Workhorseballoonforangioplasty
CourtesyofBostonScientific

Intravascularultrasoundimage Cuingballoonwithsurgicalbladesmounted Diamond-coatedburrthatspinsat  revolutions

cross-sectionalviewofacoronaryartery ontheballoon perminutetodrillthroughheavilycalcifiedlesions
withaneccentricatheromatousplaque CourtesyofBostonScientific CourtesyofBostonScientific
CourtesyofVolcano


 HEARTANDVASCULAROUTCOMES 

CardiovascularInstituteofSouthernOregon
The Cardiovascular Institute of Southern Oregon, LLC, (CVISO) opened in December  and is a joint venture between
Rogue Valley Medical Center (RVMC); Cardiology Consultants, PC; The Heart Clinic of Southern Oregon and Northern
California, PC; and Oregon Surgical Specialists, PC. Each year  cardiologists and five vascular surgeons perform a
high volume of diagnostic cardiac catheterizations, peripheral angiograms, and peripheral vascular interventions at CVISO.
Located in a comfortable, state-of-the-art facility within the outpatient facilities of the Cardiovascular Institute on the
RVMC campus, CVISO allows elective studies to be performed conveniently; total stays average just four hours.

PeripheralInterventionVolume PeripheralAngiographyVolume

 

 

 
CVISOcathlabstaff
 

 

 

             

Includesarteriesofthearmsandlegsrenalarteries Includescarotidangiographyrenalangiographymesenteric
mesentericarteriesandiliacarteries angiographyupper-andlower-extremityangiography
andabdominalangiography

CardiacCatheterization/CoronaryAngiographyVolume
PeripheralAngiographyComplications

 Physicianshowingcoronaryangiogramto
patientimmediatelyaerprocedure
   
  


Stroke Myocardial Deaths Memberof

Infarction
CardiovascularOutpatient
 CenterAlliance

      

Nostrokemyocardialinfarctionordeathin


CORONARYARTERYDISEASE
CORONARYARTERYDISEASE

MyocardialInfarctionTheASSETProgram
ASSETProgram ASSET (Acute ST-Segment Elevation Task Force) is a regional heart attack response team that coordinates the simultaneous
activation of paramedics, emergency departments, and the heart catheterization laboratory at RVMC for rapid
MissionStatement
identification, triage, and treatment of ST elevation myocardial infarction patients (severe heart attacks) throughout
southern Oregon and northern California. The ASSET program has received national recognition for its dramatic reduction
Tofacilitatetheaccurateandrapid in death rates from heart attacks and is serving as a model for other programs in development across the country.
diagnosistreatmentandtransport
CorePartnership—Hospitals
ofpatientswithacuteST-Segment Ashland Community Hospital · Fairchild Medical Center · Providence Medford Medical Center
ElevationMyocardialInfarction Rogue Valley Medical Center · Three Rivers Community Hospital

STEMI fromthroughouttheregion CorePartnership—EmergencyServices

American Medical Response (AMR) · Ashland Fire & Rescue · Jackson County Fire District 
totheRogueValleyMedicalCenter
Medford Fire Department · Mercy Flights · Northern Siskiyou Ambulance · Rogue River Fire District
cathlabforemergentPercutaneous
ParticipatingHeartSpecialists
CoronaryIntervention
PCI  Cardiology Consultants, PC · Asante Cardiovascular and Thoracic Surgeons
The Heart Clinic of Southern Oregon and Northern California, PC

ASSETServiceArea

Coos Bay O R E G O N
ASSETServiceArea
Coquille
Bandon Roseburg ASSETRegional cardiologistsandfour
Myrtle Point SupportServicesArea
Myrtle Creek
cardiothoracicsurgeonsworktogether
Port Orford toprovidecarearound-the-clock
Paisley
Chiloquin
Grants Pass
Redwood
Gold Beach RVMC
Rogue River
Medford
Cave Junction Klamath Falls Altamont Sevenparamedicunits
Brookings Ashland Lakeview
Harbor
Dorris
Malin andfivehospitalsarecurrently
5 Tulelake
Happy Camp collaboratingintheASSETprogram
Yreka Montague
Crescent City
C A L I F O R N I A


 HEARTANDVASCULAROUTCOMES 

MyocardialInfarctionTimeIsMuscle ActualCoronaryAngiogram
Cross-sectionalimageoftheleventricleduringan
inferiormyocardialinfarction
Blockedartery

hours hours hours

Ballooninflation
Healthyheartmuscle

Deadheartmuscle
iemyocardialinfarctionheartaack

CoronaryArteryStenting

Coronaryarteryatheroscleroticplaque
Stentwithopenartery

Low-profilestentandballoonadvancedacrossblockage

Ballooninflationresultsinstentdeployment

Balloonremovedstentmaintainsanopenartery


CORONARYARTERYDISEASE
CORONARYARTERYDISEASE

–ASSETPatientsAverage MedianTimetoTreatmentforSTEMI

Timeat Paramedic EmergencyDepartmentDoor CardiacCathLabArrival

ReferringHospital TransportTime toCardiacCathLabDoorTime toOpenArtery

    minutes
RVMCdoor–to–wiretime
AllASSETPatientsJun –Dec n


  
minutes
RVMCdoor–to–wiretime
AllASSETPatientsJun–Aug n

    minutes
RVMCdoor–to–balloontime
AllASSETPatientsJan–Dec n

    minutes
RVMCdoor–to–balloontime
AllASSETPatientsJan–Dec n

       
TimeinMinutes

ArrivalatRVMC

ASSETPatientsAverage MedianTimetoTreatmentforSTEMI

Paramedic Timeat Paramedic EmergencyDepartmentDoor CardiacCathLabArrival

TimeonScene ReferringHospital TransportTime toCardiacCathLabDoorTime toOpenArtery

   
Patientsbroughtdirectlyto
TransferfromReferringHospitaln  thecardiaccatheterization
laboratorybyparamedics
   
Paramedicn

 
RVMCn
 PatientfirstevaluatedinRVMCEmergencyDepartmentASSETTeamnotified

    minutes
RVMCdoor–to–balloontime
AllASSETPatientsn

       
TimeinMinutes

ArrivalatRVMC



Primarypercutaneouscoronary
interventionisthemostcomplex
multidisciplinaryandtime-sensitive
therapeuticinterventioninthe
worldofmedicinetoday
Theprocess
ismeasuredinminutes
Theoutcomes
aremeasuredinmortality
Teamworkandsmooth
transitionsareessential
—DrIvanRokos
STEMISystemsMay
 Dr. Richard Schaefer; Mercy Flights; American Medical Response; Ashland Fire & Rescue; Rogue River
percentofpatientshadhospital
door–to–balloontimeswithin
minutesinmakingASSET
oneoftheelitemyocardialinfarction
programsinthecountry
HEARTANDVASCULAROUTCOMES 
NationallyRecognized
An Approach to Shorten Time to Infarct Artery
Patency in Patients with ST-Segment Elevation
Myocardial Infarction
American Journal of Cardiology
;:–.
Brian W. Gross, MD
Kent W. Dauterman, MD
Mark G. Moran, MD
Todd S. Kotler, MD
Stephen J. Schnugg, MD
Paul S. Rostykus, MD, MPH
Amy M. Ross, PhD, RN, CNS
W. Douglas Weaver, MD
Acknowledgements:
We thank Karen A. Bales, RN, BSN;
Dr. Douglas Burwell; Dr. Nicholas Dienel;
Dr. John Forsyth; Dr. Gary Foster; Dr. Michael
Fugit; Dr. Mark Huth; Dr. Ken Lightheart; Dr. David Martin;
Dr. Minor Mathews; Dr. Brian Morrison; Dr. Bruce Patterson; Dr. Eric Pena; Dr. Brad Personious;
Fire District; Northern Siskiyou Ambulance; Medford Fire Department; Jackson County Fire District #;
Rogue Valley Medical Center and PCI team; Providence Medford Medical Center; Ashland Community
Hospital; Three Rivers Community Hospital; Fairchild Medical Center; Jane Sawall, RN, CNS;
Heather Freiheit, RN, BSN; and Jo Jacavone, RN, MS
patientstreatedatRVMCforSTEMI
fromJunethroughDecember

CORONARYARTERYDISEASE
CORONARYARTERYDISEASE

ASSETisagreatprogramWeareexceedinglypleasedThesearededicatedcrews
EveryoneisreadytogoEverybodywantsittosucceedThereisnowaitingatanystage
Thesystemissmooth

—DougHowardMDEmergencyMedicine
ThreeRiversCommunityHospital

TheEMTsfeelgoodaboutthedramaticimprovementincaretheycanprovide
andtheyappreciatethetrustthey’vebeengivenbytheEmergencyDepartment
physiciansandcardiologists

—KenParsonsGeneralManager
MercyFlights

WesawthebenefitimmediatelyItbroughtthemortalityratedownandkeptitdown
It’spreysimpleTheprogramworksItistherightthingtodoandwedoit

—DaveMathewsJosephineCountyOperationsManager
AmericanMedicalResponse
AMR

Thestrengthoftheprogramisthecollaborativeeffortofalltheparticipantsonan
equalfooting—EMScardiologistscathlabemergencydepartmentsandhospitals

—PaulRostykusMDSupervisingPhysician
JacksonCountyEmergencyMedicalServices


 HEARTANDVASCULAROUTCOMES 

HistoricalMyocardialInfarctionMortalityRates

HistoricalNationalHospitalMortalityRatesforSTElevationMyocardialInfarction HeartA!ack

 

 




 s 
 s 

s ASSETProgramatRVMC
 – n
ClinicalPracticeGuidelinesAHCPRPublicationNo-

STElevationMyocardialInfarctionIn-hospitalMortalityComparisonRVMCVersusOtherHospitals
 GlenaRasmussen

 
Mrs. Rasmussen is an active dance instructor
 who awoke at  a.m. with severe chest
tightness. After her husband brought her to

the Rogue Valley Medical Center Emergency

 Department, a -lead electrocardiogram
showed an acute anterior ST elevation

myocardial infarction. Emergent coronary
 angiography revealed an occlusion in the
NationalRegistryof RVMC   ASSET proximal left anterior descending artery.
MyocardialInfarction  ServiceArea The artery was promptly opened with a
“SimilarHospitals” balloon, and a stent was deployed. Her chest
discomfort resolved, and she was discharged
home three days later.

Amortalityrateisamongthe I’mbacktoteachingtap
lowestreportedinthenation dancingandIfeelgreat


CORONARYARTERYDISEASE
CORONARYARTERYDISEASE
GregWard 
This elementary school teacher was driving
his car when he went into cardiac arrest. His
-year-old son stopped the car, called --,
and provided chest compressions until
paramedics arrived. They found Mr. Ward
in ventricular fibrillation and promptly
converted him to sinus rhythm. His -lead
electrocardiogram showed normal ST
HypothermiaforCardiacArrestPatients
Cardiac arrest (ventricular fibrillation) results in
impaired blood flow to the brain. A prolonged cardiac
arrest (more than five minutes) can cause brain damage
(anoxic encephalopathy). On occasion the heart can
be stabilized, but the patient remains unresponsive
due to inadequate cerebral perfusion. Inducing
mild hypothermia to a core body temperature of 
degrees C via an external cooling blanket reduces
cerebral metabolism and edema and increases the
likelihood of making a meaningful neurologic recovery.
This treatment has been proven to save one additional
life for every seven patients treated and is currently RVMCcardiopulmonaryandEECPstaff
recommended by the American Heart Association.
At Rogue Valley Medical Center,  patients were
treated from November  through December
CumulativeSurvivalinthe
. Six patients survived, and only one required
HypothermiaandNormothermiaGroups
rehabilitation care.
Hypothermia Normothermia
segments and pre-excitation. Mr. Ward was 


unresponsive with decerebrate posturing and
Glasgow Coma Scale . Due to his anoxic

brain injury, the hypothermia protocol was

Survival 
initiated and he was cooled to  degrees C.
Over the next week, he made a dramatic 
and complete neurologic recovery. He was
diagnosed with Wolff-Parkinson-White 
Syndrome (AV reentrant tachycardia) and
underwent successful radiofrequency ablation
of his left lateral accessory pathway. He is    
now back to teaching full-time and studying
Days
to be a school principal.
Source TheHypothermiaaerCardiacArrestStudyGroupNew
EnglandJournalofMedicine –
Idon’thavetotakemedicationand
Ihavegainedallmystrengthback
I’vebeengivenacleanbillofhealth

CourtesyofAbboNorthwesternHospital



EnhancedExternalCounterpulsation
For patients with debilitating chronic angina not
amenable to coronary revascularization (stent or
bypass surgery), enhanced external counterpulsation
(EECP) is a well-tolerated, atraumatic, noninvasive
FDA
andMedicare
procedure that can reduce the symptoms of angina
pectoris, presumably by increasing coronary blood
flow to ischemic areas of the heart.
HEARTANDVASCULAROUTCOMES 
Although the mechanism at work is unclear Approvedbythefederal
(possibly improved collateral flow), studies have
repeatedly shown that  to  percent of patients FoodandDrugAdministration
experience the following results:
t
Reduced frequency and intensity of chest pain
t
Increased exercise tolerance
t
Reduced need for antianginal medications
(such as nitroglycerin)
The EECP device uses a series of compressive cuffs t
Improved sense of well-being and quality of life percentimprovementindistance
wrapped around the patient’s calves, thighs, and
buttocks and synchronizes their inflation and deflation Patients typically undergo  one-hour sessions thatcanbewalkedinsixminutes
to the cardiac cycle. During diastole the cuffs inflate over a seven-week period and should first be evaluated
sequentially from the calves proximally, resulting by a cardiologist. There have been  patients since
in augmented diastolic central aortic pressure and the program was established in .
increased coronary perfusion pressure (when coronary
artery flow is maximal). Rapid and simultaneous
decompression of the cuffs at the onset of systole reduces
the systolic pressure and the cardiac workload. ChangeinNitroglycerinUse
n"

AtCompletionofTherapy OneYearLater

ChangeinChestPain n"  

CompletionofTherapy OneYearLater  

  

   

   

 
Large Slight Unchanged Worse DuringanEECPtreatment
  Reduction Reduction thepatient’scalvesandthighsare
inUse inUse wrappedwithcompressivecuffsthat
  areinflatedanddeflatedaccordingtothe
cardiaccycleThisresultsinimproved
diastoliccentralaorticpressureand
Good Slight Unchanged Worse
increasedcoronaryperfusionpressure
Improvement Improvement


ARRHYTHMIAS
ARRHYTHMIAS

Rogue Valley Medical Center’s electrophysiology (EP) program provides comprehensive diagnostic and therapeutic
management of simple and complex heart rhythm disorders, device management for heart failure, evaluation
and management of syncope, and sudden-death risk assessment and management. Our large procedure volumes,
well-equipped electrophysiology laboratories, and highly experienced electrophysiologists and staff account for the
excellent patient outcomes and are comparable to the nation’s highest-rated programs.

DiagnosticElectrophysiologyStudies TiltTableTesting
Diagnostic EP studies are routine heart catheterization This simple noninvasive test is used to evaluate
procedures used to identify and guide the treatment of for neurocardiogenic (vasovagal) physiology as part
heart rhythm disorders. Sophisticated, state-of-the-art of the evaluation of patients with syncope. The test
three-dimensional electroanatomical mapping systems is often used to evaluate patients with recurrent
RobertJones
are used (like a heart GPS) to guide the clinician’s syncope of unknown cause unlikely to be related
understanding and treatment of complex arrhythmia to pathologic arrhythmia, such as those with
Mr. Jones retired from a package delivery
mechanisms. Often these diagnostic procedures are structurally normal hearts.
service due to progressive fatigue and the
done in the same setting as therapeutic intracardiac
inability to do his work. He was diagnosed
ablations, pacemaker insertions, or defibrillator implants
with severe congestive heart failure. He was 

TiltTableStudies
as indicated. These tests have a complication rate 
noted to be in atrial fibrillation, and an
well below  percent. 
echocardiogram showed severe systolic

Noof
dysfunction with a left ventricular ejection 
fraction of  percent. His atrial fibrillation EPStudies LoopRecorderImplants
could not be controlled with antiarrhythmic
   
medications. He underwent radiofrequency 
ElectrophysiologyStudies

ablation, which terminated the atrial

fibrillation. He also required cardiac 
NoofDiagnostic

resynchronization therapy (biventricular 

pacing) and an implantable cardioverter
defibrillator. His cardiac function has 
returned to normal, with a left ventricular 
ejection fraction of  to  percent.

BothelectrophysiologistsatRVMC
MydoctorknewIwasintrouble
     arecertifiedbytheAmericanBoard
andifhedidn’tdosomething
ofInternalMedicineincardiovascular
itwouldbebadHemadesure
diseaseandelectrophysiology
IgotthecareIneededandhestill
checksinwithmeIhaveallthe
praiseintheworldformydoctor


 HEARTANDVASCULAROUTCOMES 

IntracardiacAblation
Ablations are catheter-based procedures performed to treat a variety of arrhythmias, including many supraventricular Fromtotherehave
tachycardias, atrial flutter, atrial fibrillation, and some types of ventricular tachycardia. Radiofrequency energy is used
beennoprocedure-relateddeaths
to ablate arrhythmia foci and reentrant circuits to manage tachyarrhthmias. Cure rates for many arrhythmias exceed
 percent, with complication rates usually less than  percent.



NoofAblationProcedures

             
Fromtotherehavebeennoprocedure-relateddeaths

CartoDmapofleatriumwithlesions
atrialfibrillationablation
PulmonaryVeinAntralIsolation
Pulmonary vein antral isolation, also known as atrial fibrillation ablation, is used to treat problematic atrial
fibrillation when antiarrhythmic medications fail. The procedure isolates nests of atrial fibrillation–generating tissue
in the posterior part of the left atrium and sometimes the superior vena cava. Mapping systems are used to generate
atrial geometry that is then merged with computed tomography scans of the posterior atria and pulmonary veins to
guide ablation and electrical isolation of areas of the heart that trigger and sustain atrial fibrillation. Cure rates vary Pacemakersanddefibrillatorsare
with the extent of cardiac pathology and range from  to  percent.
implantedandmanagedonlyby
physicianswhoarecertifiedbythe
HeartRhythmSociety


ARRHYTHMIAS
ARRHYTHMIAS

DeviceImplantation
RVMC’s electrophysiology laboratory implants the full range of cardiac rhythm management devices, including
pacemakers, implantable cardioverter defibrillators (ICDs), implantable loop recorders, and cardiac resynchronization
(biventricular, or Bi-V) devices for the management of heart failure. ICDs have dramatically reduced arrhythmic
and all-cause mortality in at-risk individuals. Biventricular pacing (with and without an ICD) has become a routine
part of managing patients with advanced heart failure. Pacing leads are used to synchronize activation of the right and
left ventricles to improve contractile dynamics, left ventricular ejection fraction, exercise capacity, and survival.
RVMCparticipatesin
theAmericanCollegeof
PacemakerandImplantableCardioverterDefibrillatorVolumes DistributionofDeviceImplantation
Cardiology’sICDRegistry
 ICDs Bi-VDevices Pacemakers

Population TotalCombined
  


             

DeviceImplantationComplicationRates

    


PercentageofPatients






Biventricularpacing/ICDleadsinheart  
CourtesyofBostonScientific

Procedure- Infections Hematoma Pneumothorax Lead Chamber
related Requiring Dislodgement Perforation
Deaths Re-exploration

ComplicationratesareforpacerbiventricularpacerandICDimplantsFordeviceimplantscomplicationratesaredefinedasprocedure-relatedmortality
infectionhematomarequiringre-explorationpneumothoraxleaddislodgmentandperforation


 HEARTANDVASCULAROUTCOMES 

LeadExtractions IndicationsforICDTherapy
The effectiveness and the dramatic increase in
the use of implanted cardiac devices have resulted
in the need for complex device management and,
at times, the removal of implanted pacing and ICD
daysaermyocardialinfarction
systems, including leads that have been in place for
an extended time. Laser lead extraction is used to
remove highly fibrosed lead systems from the heart
and vascular system after extended use. Although
serious intrathoracic bleeding can occur during
  PrimarypreventionofSCDinpatientswith
lead removal, careful planning, monitoring, and
technique by experienced physicians have led to
a high success rate.
SuddenCardiacDeathinHeartFailureTrial

  Patientswithpotentiallylethalgeneticdisorders

 a ProlongedQTsyndrome
MortalityRate

 CardiacarrestduetoventricularfibrillationVF
orventriculartachycardiaVTunrelatedtoa
reversiblecause
 SustainedVTassociatedwithstructural
heartdisease
 Syncopeofundeterminedoriginwithinducible
VTattimeofelectrophysiologicstudiesEPS
 NonsustainedVTinpatientswithischemic
cardiomyopathyejectionfractionEF≤ 
percentandinduciblesustainedVTatEPS
 “Cardiacsyncope”inpatientswith
cardiomyopathyandnoexplanationof
mechanismofsyncopeaerEPS
a Syncopeinseingofcardiomyopathy
warrantshospitalizationandreferralto
arrhythmiaspecialist
andhigh-riskcharacteristics
i Recurrentsyncopedespitetreatment
 PrimarypreventionofSCDinpatientswith
ischemiccardiomyopathyandEF≤ percent
a Receivingoptimalmedicaltherapy
b Atleast
c Lifeexpectancyofatleastoneyearwithgood
functionalstatus
d ClassI–IIIcongestiveheartfailureCHF
e ClassIVCHFifcandidateforbiventricularpacing
nonischemiccardiomyopathyandEF≤ percent
a Receiptofoptimalmedicaltherapyfor
pastthreetoninemonths
b ClassII–IIICHF
c ClassIVCHFifcandidateforbiventricularpacing
BasedontheDeviceImplantationGuidelinesandtheSeptember
PreventionofSuddenCardiacDeathGuidelines
IndicationsforBiventricularPacing
 withbeta-blockers  ClassIIIorIVheartfailuresymptomswithle
ii Significantfamilyhistoryofunexplained bundlebranchblockLBBBorintraventricular
suddencardiacdeathSCDespecially conductiondefectIVCDwithQRS
ms


ifpatienthassyncope a Receiptofoptimalmedicaltherapyfor
iii VF pastthreetoninemonths

 b Brugadasyndrome b EF≤ percent

   
i SyncopewithspontaneousBrugadaEKG  Anypatientwithsignificantcardiomyopathythat
Months ii VF requiressustainedventricularpacingsupport
c Hypertrophiccardiomyopathy a Rightventricularapicalpacingisknown
TreatmentGroups i Hypertrophy≥ 
mm tobedetrimentalinthispatientsubset
Amiodarone-yearmortalityrate
 ii Significantfamilyhistory b Itisreasonabletoupgradeapatientfroma
iii NonsustainedVT dual-chamberpacingdeviceifEF≤ percent
Placebo-yearmortalityrate 
iv Syncope andClassIII–IVCHFsymptomsarepresent
ICDTherapy-yearmortalityrate
 v Abnormalbloodpressureresponsetoexercise  Patientswithatrialfibrillationwhorequire
Source BardyGetalKaplan-Meierestimatesofdeathfromany
vi VT/VF atrioventricularnodalablation
causeNewEnglandJournalofMedicine

- d Rightventriculardysplasia a Heartfailuresymptoms
i Syncope b Leventriculardysfunction
ii SignificantfamilyhistoryofSCD
iii VT/VF


CARDIACSURGERY
CARDIACSURGERY

CardiothoracicSurgery
The cardiothoracic program at Rogue Valley Medical Center has been in existence for more than
 years, during which time more than , cardiac operations have been performed by six surgeons.
Excellence in cardiothoracic surgery requires an integrated team effort and represents the collective
Cardiacsurgicalprogram experience gained over the many years of the program as well as a continuing commitment to innovation
and expertise provided by physicians, operating room staff, Coronary Care Unit (CCU) nurses, and
establishedyearsago support staff. A team of four cardiothoracic surgeons, each of whom individually performs more than
 operations per year, along with their cardiac anesthesia colleagues perform more than  cardiac
operations each year. Excellence in postoperative care is achieved by a team of highly experienced CCU
nurses, who along with intensivists and cardiologists have cared for thousands of cardiac patients.

CardiacSurgeriesPerformed·–YearTotal"


NumberofSurgeriesPerformed





 


 
 
 
 



       

 
 
 
 
 
 

      


 HEARTANDVASCULAROUTCOMES 

MedianLengthofStayCardiacPatients

Days

              RichardSilvawithwifeGloria
Mr. Silva () is a retired carpenter who
noted mild right-side chest and upper-back
discomfort. A diastolic heart murmur was
noted, and an echocardiogram showed severe
aortic regurgitation and an ascending aortic
DistributionofCardiacProcedures
aneurysm (. cm in diameter). A CT scan
  showed an aneurysm extending from the
ascending aorta to the aortic arch (. cm in
  diameter). An aneurysm was also noted in the
 descending thoracic aorta at the level of the
  diaphragm. Coronary angiography revealed a
  percent stenosis in the right coronary artery.



   Mr. Silva underwent open heart surgery
 
with aneurysm resection in the ascending
aorta and arch, replacement of the aortic valve,
CoronaryArtery AorticValve MitralValve MitralValve SurgicalAtrial and placement of a bypass graft to the right
BypassGraing Replacement Replacement RepairTotal Fibrillation coronary artery. Four months later, a stent graft
CABGTotal AVRTotal MVRTotal AblationMaze
was placed via the femoral artery approach,
Isolated Isolated Isolated Transmyocardial effectively sealing off the descending thoracic
CABG AVR MVR Revascularization aortic aneurysm. Mr. Silva recovered from his
staged operations and is currently doing well.

Isurvived—thatwasafeatinitself
Thedoctorsnursesandeveryone
involvedhaveallbeengreat


CARDIACSURGERY
CARDIACSURGERY

CoronaryArteryBypassGra#

CABGMortalityRateforFirstOperation

RVMC SocietyofThoracicSurgerySTSComparableHospitalBenchmark




cardiacoperations

performedsince

             
n  n n
 n n
 n  n n 

MortalityRateforSecondThirdorFourth
CABGSurgery Reoperation

RVMC STSBenchmark

 






          
n n n n
 n n

Board-certifiedAnesthesiologists
AnAbiomedleventricularassist
deviceisavailableforpatientswith
severeleventriculardysfunctionand
associatedcongestiveheartfailure Leventricularassistdevice
CourtesyofAbiomed


 HEARTANDVASCULAROUTCOMES 

ValveProcedures

ValveProcedureVolume

 







RVMCIntensivists






              Thesixintensivistsat

DistributionofPrimaryValveProcedures RVMCareboardcertifiedin

criticalcaremedicineandfour
–Distributionof arepulmonologists
PrimaryValveProcedures n"




PrimaryValveOperations Anintensivistispresentinthe
ValveReoperations hospitalaround-the-clockHospitals

IsolatedAorticValve AorticValveRepair/ withanintensivistprogramare

Repair/Replacement ReplacementCABG
associatedwithbeeroutcomes
IsolatedMitralValve MitralValveRepair/ andlowermortalityrates
Repair/Replacement ReplacementCABG

TricuspidValve Aortic/MitralValve
Replacement/ Repair/Replacement
Annulplasty CABG


CARDIACSURGERY
CARDIACSURGERY

MinimallyInvasiveValveProcedures Standardsternotomy Smallthoracicincision

The minimally invasive thoracoscopic video-assisted

mitral/tricuspid valve procedure allows valve repair
or replacement to be performed without sternotomy.
Rogue Valley Medical Center cardiac surgeons use
this technique primarily for patients who require
mitral valve replacement, mitral valve repair for
degenerative prolapse, or tricuspid valve repair.

Minimally invasive surgery offers a better cosmetic

JoeMaxeywithwifeDixie outcome and can reduce pain, likelihood of infection,
and length of hospital stay.
Mr. Maxey () is a part-time machinist
who noted progressive shortness of breath over
the past year. When he walked uphill to the
mailbox, he had to walk at a very slow pace Vascularaccess
and stop frequently due to dyspnea and fatigue.
Standardsternotomyonleminimallyinvasive
His physical examination was remarkable approachformitralvalverepaironright
for a / blowing holosystolic murmur at the CourtesyofEdwardsLifesciences
apex. A -lead electrocardiogram showed
atrial fibrillation. An echocardiogram revealed
severe mitral regurgitation due to prolapse
of the posterior mitral valve leaflet. Further Flailmitralvalveleaflet Severeregurgitantjet
evaluation showed moderate pulmonary Le#atrium
hypertension but no coronary artery disease.
Transesophageal echocardiography revealed
both mitral valve prolapse and chordal rupture.
Mr. Maxey underwent minimally invasive
mitral valve repair and a Maze radiofrequency
ablation for his atrial fibrillation. Four days
after surgery, he went home. Mr. Maxey is
currently active and has no mitral regurgitation
or atrial fibrillation.

Icandomorenowthanwhen
IwasyearsoldIt’sbeena Valveleaflettipsdonotcoapt Dopplersignalshowingtheseverelyleakyvalve
JoeMaxeytransesophagealecho Le#ventricle JoeMaxeytransesophagealecho
life-changingexperience


 HEARTANDVASCULAROUTCOMES 

ProstheticHeartValves

Intraoperativetransesophageal
echocardiographyisperformed
routinelyonpatientsundergoing
valvesurgeryatRVMC

Pericardialtissuevalvebioprosthetic Porcinetissuevalvebioprosthetic
CourtesyofEdwardsLifesciences CourtesyofMedtronic

Repairedvalve$noregurgitation

StJudeMedicalmechanicalvalve
Valveaerrepairleafletstouchnomitralregurgitation CourtesyofStJudeMedical
JoeMaxeytransesophagealecho

Implantedmechanicalaorticandmitralvalves
CourtesyofCarboMedics


CARDIACSURGERY
CARDIACSURGERY

MinimallyInvasiveValveProcedures IsolatedMitralValveRepairMortalityRate

RVMC STSBenchmark

IsolatedMitralValveReplacementMortalityRate n"
 

RVMC STSBenchmark
 


 
        
 n  n n  n  n


 
JackFrost GreatVessels

Mr. Frost noted progressive dyspnea and ThoracicAorticProcedures
was diagnosed with congestive heart failure. 
He was subsequently diagnosed with severe  EndovascularThoracicStent
aortic stenosis, severe mitral regurgitation,
 
multivessel coronary artery disease, and  
severe left ventricular systolic dysfunction  
with a left ventricular ejection fraction of          
 to  percent. He underwent open heart n n n n n
surgery, requiring the replacement of both 
heart valves, and four-vessel coronary artery

bypass graft surgery. Mr. Frost’s heart
function returned to normal, and he is IsolatedAorticValveReplacementMortalityRate n"  
currently running his business, Jack Frost RVMC STSBenchmark
Marine, where he repairs outboard motors         
on a full-time basis. 
 Endovascular Treatment of Thoracic Aortic
Ineverhadanounceof
 Aneurysm: Until recently, treatment of a descending
painandIplayedholes thoracic aortic aneurysm required an open and morbid
 surgical procedure associated with a significant risk of
ofgolfinatournamentsix  paraplegia. A new endovascular approach is safer and
less invasive, and involves accessing the femoral artery,
monthsaermysurgery     advancing a stent graft to the descending thoracic aorta,
 and deploying the stent graft across the aneurysm to
         seal it off. Patients often go home in one to two days.
n
 n n n  n 


 HEARTANDVASCULAROUTCOMES 

TransmyocardialRevascularization
Transmyocardial revascularization (TMR) is an option for patients with stable angina refractory to medical treatment
and not amenable to standard coronary revascularization. A carbon dioxide laser is used to fire single high-energy
pulses to create smooth, straight microchannels in the wall of the left ventricle. TMR is occasionally used in conjunction
with standard CABG to treat an area of myocardium that cannot be revascularized with bypass grafts or stents.
Clinical trials have demonstrated TMR to be a safe and effective means of obtaining long-term relief of angina,
improved heart muscle perfusion, and improved quality of life. This technology was introduced at Rogue Valley
Medical Center in .

TransmyocardialRevascularizationProcedureVolume


RVMCCardiacIntensiveCareUnitstaff

 havemorethanadecadeof
 experienceincardiaccare

      

AtrialFibrillation
MazeProcedureVolume


 RVMCopenheartsurgicalteam


havemorethanadecadeof

experienceincardiaccare
 RVMCHeartCenterstaff


havemorethanadecadeof

       experienceincardiaccare


VASCULARSURGERY
VASCULARSURGERY

ComprehensiveVascularCare
The vascular surgical section of the Cardiovascular
Institute of Southern Oregon, LLC, (CVISO) consists
of five board-certified vascular surgeons who provide
around-the-clock elective and emergent care for a wide
spectrum of peripheral vascular disorders. Outpatient
angiography and peripheral vascular interventions are
performed in the outpatient angiography suite within
CVISO. Complex surgical reconstructive procedures,
including a high-volume endovascular program for
the management of abdominal aortic aneurysms, are
performed within our region’s only state-of-the-art
dedicated endovascular angiographic operating room
located at Rogue Valley Medical Center.
Vascular surgeons, cardiothoracic surgeons, and
cardiologists provide an integrated approach to the
management of complex thoracic and abdominal aortic
disease combining thoracotomy and endovascular
approaches to the management of thoraco-abdominal
aortic aneurysms and acute aortic dissections.
Vascular surgeons, interventional cardiologists,
and neurologists work together to provide a
comprehensive management of carotid artery
disease utilizing either surgical endarterectomy
or percutaneous stent procedures.

PeripheralAngiographyVolumeatRVMCandCVISO
Abdominal


aorticaneurysm








      
Includescarotidangiographyrenalangiographymesenteric
angiographyupper-andlower-extremityangiography Abdominalaorticaneurysm
andabdominalangiography CourtesyofMedtronic

Theperipheralvasculature
CourtesyofAbboVascular


 HEARTANDVASCULAROUTCOMES 

ElectiveAbdominalAorticAneurysmSurgicalVolume

TotalRepairs OpenSurgicalRepair EndovascularStentGraRepair

 


Leapfrogrecommends

AnnualHospitalVolumesfor




abdominalaorticaneurysmrepair
bemorethanperyear
        

Femoralarteryaccess

ElectiveEndovascularStentGra#Repair
In-hospitalMortalityRate


Opensurgicalrepairofabdominalaorticaneurysm Endovascularapproachvia 
CourtesyofMedtronic thefemoralarterieslessinvasive
CourtesyofMedtronic 
 

 
Iliacarteries Aneurysm   

        
Aorta
n n n  n  n 

Stentgra#

Stentgraplacedacrossaneurysmeffectivelysealingitoff
CourtesyofMedtronic


VASCULARSURGERY
VASCULARSURGERY

RVMCistheonly
JointCommission–approved

strokecenterinsouthern

CarotidEndarterectomy
While the patient is under general anesthesia, an
incision is made in the skin over the carotid artery.
The carotid artery is clamped and incised, and the TotalCarotidArteryRevascularizationProcedures
atherosclerotic plaque is removed (endarterectomy).
This is similar to removing the inner layers of CarotidStent
an onion. The artery and the skin are then SimultaneousCarotidEndarterectomy
surgically closed. andCardiacSurgery
IsolatedCarotidEndarterectomy
NaturalHistoryofCarotidDisease
RiskofIpsilateralStroke 
 

Symptomatic Patients (TIA/Stroke)  
Oregonandhasreceivedthe t
 to  percent stenosis: . percent per year 

AmericanHeartAssociation t
 to  percent stenosis: . percent per year

Asymptomatic Patients
GetWithTheGuidelines –Stroke
SM

t
> percent stenosis:  to  percent per year 

awardtwice Source NASCETNASCETIIACASandACSTtrials


IsolatedCarotidEndarterectomy 
In-hospitalDeath/StrokeRate

Death Stroke         
Carotidstentprogrambeganin






 

     

        
n
 n  n  n n


 HEARTANDVASCULAROUTCOMES 

NewTechnologyProfileCarotidStenting
Angiogramof
carotidartery
priortostent

Acculinkstent Accunetfilterwith -micronporestopermitbloodflow

CourtesyofAbboVascular CourtesyofAbboVascular

Angiogramof
carotidartery
a#erstent
Stentacross Bloodflow
carotidartery tobrain
plaque

FDAapproval
Filtertraps inAugust
Equipment particlesfrom
placedvia plaquebut
femoralartery permits
inleg bloodflow
Medicareapproval

Internal
inspring
carotidartery
Carotidstentdeployedfilternotyetretrieved
CourtesyofAbboVascular


VASCULARSURGERY
VASCULARSURGERY

WhoShouldBeConsidered CriteriaforIncreasedSurgicalRisk
forCarotidStenting? t
Congestive heart failure Class III/IV and/or
High surgical risk patient: left ventricular ejection fraction < percent
t
Symptomatic patient with ≥ percent stenosis t
Open heart surgery indicated
t
Asymptomatic patient with ≥ percent stenosis t
Recent myocardial infarction
t
Unstable angina
Normal surgical risk patient: t
Severe pulmonary disease
t
Standard of care is carotid endarterectomy t
Contralateral carotid occlusion
t
National Institutes of Health (NIH)–sponsored t
Contralateral laryngeal nerve palsy
CREST study randomly assigns patients to either t
Irradiated neck
carotid stenting or surgical endarterectomy t
Previous carotid endarterectomy
with recurrent stenosis
t
High cervical internal carotid artery lesions
t
Common carotid lesions below the clavicle
t
Severe tandem lesions

HighSurgicalRiskPatients

Stenting Endarterectomy

 
FreedomfromMajor

 
AdverseEvent

Theregion’sonlystate-of-the-art  
P 
dedicatedendovascularangiographic  
operatingroomislocatedatRVMC


       

 

DaysA#erInitialProcedure
Source TheSAPPHIREStudyNewEnglandJournalofMedicine 


 
HEARTANDVASCULAROUTCOMES

CarotidStentinginHigh-RiskSurgicalPatients PatientsatNormalSurgicalRisk
ComparisonwithMAVERICIICarotidStentRegistry NIH–sponsoredCRESTTrial
 -DayOutcomes
Rogue Valley Medical Center is one of  centers in
MAVERICII RVMC North America chosen to participate in the National
Institutes of Health–sponsored CREST trial. This

study randomizes normal surgical risk patients with
   carotid artery disease to carotid endarterectomy
versus carotid stenting with distal emboli protection.

The screening process for treating physicians is rigorous;
 only experienced physicians with an excellent

track record are chosen. Fiveboard-certified
  
 NeurologicalAssessment vascularsurgeonsprovide
Death Death Stroke Stroke Myocardial
Stroke Major Minor Infarction Neurologist Walter Carlini, MD, sees all patients around-the-clockcoverage
Myocardial before and after carotid stent procedures to provide
Infarction an objective assessment of neurological function.
The information is forwarded to a central database
PatientsseenbyneurologistatRVMCbeforeandaerprocedure
as part of the CAPTURE carotid stent registry
and NIH-sponsored CREST trial.

CarotidStentVolume



 




    


IMAGING
IMAGING

NoninvasiveDiagnosticTesting
Rogue Valley Medical Center offers a full spectrum of noninvasive diagnostic testing for cardiovascular diseases:
t
Echocardiography (transthoracic, t
MUGA scans t
Cardiac MRI (provided through
transesophageal, pediatric) t
Holter/event monitors Oregon Advanced Imaging)
t
Treadmill stress testing t
Tilt table testing t
Cardiac CT angiography, coronary
t
Nuclear stress testing t
Vascular imaging calcium scoring

Echocardiography is a noninvasive ultrasonographic Treadmill stress testing provides electrocardiogram

assessment of cardiac structure and function, including
evaluation of ischemic and nonischemic ventricular
dysfunction, cardiomyopathy, valvular heart disease,
and congenital malformations. Invasive transesophageal
assessment is also performed in the inpatient and
outpatient settings, as well as intraoperative assessment
of cardiothoracic surgical procedures.
(ECG) assessment for exercise-induced ischemia or
arrhythmias, including chronotropic competence.
Treadmill testing is used predominantly in patients who
are able to exercise and have a normal baseline ECG.
TotalStressTests—RVMCandTRCH
Echocardiogram  
EchocardiographyVolumes—RVMCandTRCH 




Echo TransesophagealEcho PediatricEcho 


 


  
Transesophagealechois 
availablearound-the-clock

atRVMC




 

 

  

Treadmillstresstesting



StressTestTypes  An event monitor is worn for approximately
NuclearStress
StressEcho
TreadmillOnly
Nuclear stress testing allows a noninvasive assessment
of coronary blood flow and cardiac function; it is
performed with exercise or pharmacologic stress
protocols. It is useful in assessment of ischemia with
a baseline abnormal ECG, a nonspecific or possibly
false-positive treadmill result, moderate probability
for coronary artery disease (CAD), localization of
ischemia in known coronary artery disease, or risk
stratification after a cardiac event.
Multiple gated acquisition scans are used for evaluation
of right and left ventricular systolic performance.
A Holter monitor continuously records a patient’s
heart rhythm for  hours. The patient notes any
symptoms, which allows correlation of the heart
rhythm to any concerning symptoms.
ElectrophysiologyVolumes—RVMCandTRCH
HEARTANDVASCULAROUTCOMES 
one month. When a patient has symptoms (such
as palpitations, lightheadedness, or dizziness), the
patient pushes a button to record the heart rhythm.
This information is then transmitted over the
telephone to the physician for review.
Tilt table testing is a noninvasive assessment for
vasovagal (neurocardiogenic) syncope.
Vascular imaging consists of ultrasonographic
assessment of carotid and peripheral vascular disease,
including atherosclerotic blockage, aneurysm formation,
and deep venous thrombosis.
Cardiac magnetic resonance imaging (MRI) is used Nuclearstresstesting
to evaluate for arrhythmogenic right ventricular
dysplasia, constrictive pericarditis, and myocardial
viability following infarction.
PeripheralVascularImagingVolumes—RVMCandTRCH
ArterialUltrasoundofArmsandLegs
CarotidArteryUltrasound
Cardiologiststrainedin
VenousUltrasoundofLegs
Transesophageal

 
  echocardiography
Holter/LoopEventMonitor TiltTable



Nuclearstresstests 






CardiacCT 
  












 


 

  

  


IMAGING
IMAGING

NewTechnologyProfileCardiacCT MedicareCoverage
Coronary calcium score is a screening heart forCoronaryCTAngiography
scan used to detect calcium deposits found in t
Patients with acute chest pain presenting in an
atherosclerotic plaque in the coronary arteries. emergency room (or equivalent) when necessary
The calcium score is then used to evaluate risk to rapidly differentiate among reasonably probable
for future coronary heart disease and events. aortic, pulmonary, and/or coronary etiologies
t
First-line testing for CAD in nondiabetic
Coronary CT angiography consists of patients with intermediate risk factors presenting
high-resolution, three-dimensional pictures in an emergency room (or equivalent) with chest
of the moving heart and great vessels that pain syndrome or other symptoms strongly
are used to determine whether a patient suggestive of coronary disease, and who have
has significant coronary atherosclerosis normal or borderline enzymes and EKGs, when
or any structural abnormality of the heart negative findings will result in avoiding invasive
and surrounding structures. coronary angiography
LightspeedVCT
t
Equivocal or suspected inaccurate stress (or stress
CourtesyofGEHealthcare
imaging) test in patients with low to intermediate
risk factors when a negative CTCA will result in
avoiding invasive coronary angiography
t
Clinical findings strongly suggestive of a
congenital anomaly of the coronary vessels
or great vessels

DcardiacCTimage
CourtesyofGEHealthcare


 
HEARTANDVASCULAROUTCOMES

CoronaryCalciumScore
Coronary arterial calcification is part of the development
of atherosclerosis (hardening of the arteries), occurs
almost exclusively in atherosclerotic arteries, and is
absent in the normal vessel wall. A score of  implies
a low likelihood of coronary obstruction but cannot
totally exclude the presence of atherosclerosis. A high
score indicates a significant plaque burden and an -sliceCTscanners
increased relative risk of future heart and vascular
events. It should be understood that calcification does areavailableatRogueValley
not imply significant obstruction nor is it site specific
MedicalCenterandThreeRivers
for a stenotic lesion, but rather indicates the extent
of atherosclerosis throughout the coronary arteries. CommunityHospital

RVMCnuclearimagingstaff
CoronaryArteryCalciumScore

–  – >


CumulativeIncidenceofCoronaryEvents

  



 



 
    
YearstoEvent

Source DetranoRetalCoronaryArteryCalciumScoreNewEngland
JournalofMedicine  -

RVMCechocardiographyimagingstaff


PREVENTIVECARDIOLOGY
PREVENTIVECARDIOLOGY
Cardiacrehabilitationis
recommendedbytheAmerican
HeartAssociationandtheAmerican
CollegeofCardiology
RVMCandTRCHareboth
certifiedbytheAmerican
AssociationofCardiovascular
andPulmonaryRehabilitation
percentofpatients
experiencedanobjective
improvementinstrength
CardiacRehabilitationProgram
Cardiac rehabilitation consists of a monitored exercise
and educational program that provides an essential
service to patients with chronic angina and those
who have had a cardiac event such as a myocardial
infarction. Individuals who have undergone an
interventional procedure, such as coronary artery
stenting, bypass surgery, or valve replacement, also
benefit from cardiac rehabilitation. Research data
have shown that participation in a certified cardiac
rehabilitation program results in a  to  percent
reduction in mortality and up to a  percent
improvement in physical strength and endurance.
The RVMC Cardiac Rehabilitation program has been RVMCcardiacrehabstaff
in place since . RVMC’s program and the one at
Three Rivers Community Hospital (TRCH) are two
of the  certified programs in the state of Oregon.
Together with the program at Curry General Hospital,
they are the sole providers of cardiac rehabilitation
programs in Jackson, Josephine, Klamath, Del Norte,
Curry, Lake, and Siskiyou counties. These programs percentofpatients
are directed by cardiologists, and all the nurses are
trained in Advanced Cardiac Life Support. haveagreaterthanpercent
improvementinexercisecapacity
NumberofPatientsOverFiveYears
andendurance 

percentofpatients
Fewerthanpercentof 
wereverysatisfied
patientshadunacceptable
 withtheirexperience
bloodpressureatthecompletion
oftheircardiacrehabilitation 

RVMC TRCH


 HEARTANDVASCULAROUTCOMES 

Goals RogueValleyMedicalCenter
t
Optimize a sense of well-being and function CardiacRehabilitation
t
Increase endurance Third Floor Northwest
t
Educate patients and families  East Barnett Road
regarding cardiac disease Medford, OR 
t
Learn healthy habits, particularly diet () -
and exercise
t
Determine the level at which a patient can ThreeRiversCommunityHospital
safely exercise CardiacRehabilitation
Cardiac rehabilitation is recommended for the following Washington Outpatient Center
conditions if they occurred within the past year:  NW Washington Blvd.
t
Myocardial infarction Grants Pass, OR 
t
Acute coronary syndrome () -
t
Coronary artery bypass graft surgery
t
Percutaneous coronary intervention CurryGeneralHospital
(such as a coronary stent) CardiacRehabilitation
t
Stable angina pectoris  East Fourth Street
t
Heart valve surgical repair or replacement Gold Beach, OR 
t
Heart or lung transplantation () -

CardiacEducators Heart Transplant Care

RVMC cardiac educators, who are all registered
nurses, visit with patients who have had heart failure,
angina, or a heart attack. They teach patients about
the nature of their illnesses and the steps they can
take to avoid future problems. These nurses also work
with patients who have cardiac procedures, such as
open heart surgery, placement of a coronary or carotid
stent, insertion of a pacemaker, or implantation of a
defibrillator. Nurse educators provide an additional
level of care and answer patients’ questions. They
review important instructions, discuss the procedure,
and show patients actual balloons, stents, pacemakers,
and defibrillators. The purpose of their visits is to
ensure that patients understand their medical condition
and upcoming outpatient care plan.
Mark Huth, MD, PhD, FACC, specializes in
the care of patients who have had heart transplants.
He earned both his doctor of philosophy and his
medical degree and served as an assistant professor of
medicine at the University of Washington in Seattle.
Myocardial biopsies are performed to monitor for
rejection. Coronary angiography and intravascular
ultrasonography are available to monitor coronary
allograft vasculopathy.

RVMCcardiaceducators


QUALITYOURAPPROACH
QUALITYOURAPPROACH

Itisourbeliefthat…
Experiencedboard-certifiedphysicians
%patientvolume
%well-designedhospitalsystem
%regularoutcomesreviewwithappropriatefeedback
"Quality goodoutcomes
The divisions of cardiology and cardiothoracic surgery LeapfrogEBHR
believe in the importance and value of a robust quality Evidence-BasedHospitalReferralSafetyStandard
improvement approach to the delivery of healthcare.
RecommendedAnnualVolume
With the assistance of the chief quality officer for
Asante Health System, Patricia Martinez, MD, and  RVMCVolume
the performance improvement staff, clinical outcomes 
are compared with external benchmarks to continuously
RVMCperformanceimprovementstaff identify areas of potential improvement and provide 
patients with information useful in their own
healthcare decisions.


AmericanHeartAssociation
“GetwiththeGuidelines”
Volume
RVMC has participated in the development of Centers 
for Medicare & Medicaid Service (CMS) projects
and strives to achieve high levels of compliance with 
the current CMS Core Measures for Best Practice. 
Guidelines and best practices from a wide range
AwardRecipient·· of resources, including the Leapfrog Group, the 


Institute for Healthcare Improvement K Lives

Best Practices campaign, the American College of Percutaneous AorticValve
Cardiology, and the American College of Thoracic Coronary Replacement
Surgery, are used to define standards of care and Intervention
Thomson
Solucient
Top goals for future improvement. CoronaryArtery AbdominalAortic
BypassGraing AneurysmRepair
Hospitals® Cardiovascular Through participation in national initiatives, we support
transparent public reporting of healthcare quality data
BenchmarksforSuccessAward
and participate in the following initiatives:
···· t
Joint Commission Performance Measurement
Initiative (www.qualitycheck.org)
t
Centers for Medicare and Medicaid
t
Hospital Compare (www.hospitalcompare.hhs.gov)


 HEARTANDVASCULAROUTCOMES 

LeapfrogGuidelines CMSCoreMeasuresBestPractices

CoronaryArteryBypassGra#ing CABG AcuteMyocardialInfarctionCMSQualityMeasure

t
Favorable hospital volume   December 
( or more procedures per year)
t
Participation in Society of Thoracic Surgeons  
(STS) data collection

Compliance

t
STS score better than national average
for risk-adjusted mortality  
t
Minimum surgeon volume per year for CABG 
( cases per year)

PercutaneousCoronaryIntervention PCI Aspirin Smoking Beta-blocker
atDischarge Cessation atDischarge
t
Favorable hospital volume
( or more procedures per year)
Aspirin ACEInhibitor/Angiotesin Beta-blocker PercutaneousCoronary
t
Participation in the American College of Cardiology atArrival ReceptorBlockerforLV atArrival InterventionWithin
National Cardiovascular Data Registry (ACC-NCDR) SystolicDysfunction
Minutes
or >  percent adherence to the Leapfrog Expert Panel
t
Endorsed Process Measures for Quality
t
Score better than the national average for
risk-adjusted mortality CoronaryArteryBypassGra#SurgeryCMSQualityMeasure
t
Minimum surgeon volume per year for PCI
  December 
( cases per year)
 
CongestiveHeartFailureCMSQualityMeasure
Compliance


  December 
 
 

Compliance



  AntibioticsWithin
Hour


 Aspirin AntibioticsDiscontinued
LeVentricularLV Smoking atDischarge WithinHours
Assessment Cessation

Discharge ACEInhibitor/Angiotesin
Instructions ReceptorBlockerforLV
SystolicDysfunction


PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES
CharlesCarmeciMDFACS
CardiovascularandThoracicSurgery
Specialties Coronary artery bypass graft surgery,
valve surgery, thoracic aortic aneurysm repair,
minimally invasive valve surgery, thoracic oncology,
minimally invasive thoracic surgery
MedicalDegree Medical College of Virginia
Internship/Residency General Surgery at Stanford
University Medical Center
CardiothoracicSurgeryFellowship University of
Wisconsin
BoardCertification American Board of Surgery,
American Board of Thoracic Surgery
Honors/Awards Graduated with honors from
George Washington University (undergraduate
degree) and Medical College of Virginia

Asante Cardiovascular and Thoracic Surgeons
DavidLFolsomMDFACS RogerVHallMD
CardiovascularandThoracicSurgery CardiovascularandThoracicSurgery
Specialties Coronary artery bypass graft surgery, Specialties Cardiovascular and thoracic surgery
valve surgery, thoracic aortic aneurysm repair, MedicalDegree University of Utah
minimally invasive valve surgery, thoracic oncology,
minimally invasive thoracic surgery Internship/Residency General Surgery at
Madigan Army Medical Center
MedicalDegree University of Utah
CardiothoracicSurgeryFellowshipLetterman
Internship/Residency General Surgery at Army Medical Center
Case Western Reserve University
BoardCertification American Board of
CardiothoracicSurgeryFellowshipCase Western Thoracic Surgery
Reserve University
BoardCertification American Board of Surgery,
American Board of Thoracic Surgery
Honors/Awards Chairman, Department of Surgery
at Rogue Valley Medical Center –; Allen
Research Fellow at Wade Park VA Medical Center
 HEARTANDVASCULAROUTCOMES 

GeorgeRWilkinsonMDFACS
CardiovascularandThoracicSurgery HeartClinicofSouthernOregon AsanteCardiovascularand
andNorthernCaliforniaPCstaff ThoracicSurgeonsstaff
Specialties Cardiovascular and thoracic surgery
MedicalDegree University of Iowa
Internship/ResidencyGeneral Surgery at
Tripler Army Medical Center
CardiothoracicSurgeryFellowshipLetterman
Army Medical Center
BoardCertification American Board of
Thoracic Surgery

CardiologyConsultantsPCstaff OregonSurgicalSpecialistsPCstaff


PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES

Cardiology Consultants, PC—Grants Pass

DouglasTBurwellMDFACC BradleyEPersoniusMDFACC RichardLSniderMDFACC

Cardiology Cardiology Cardiology

Specialties Consultative cardiology, preventive
cardiology, echocardiography, nuclear cardiology,
coronary angiography
MedicalDegree University of California,
Los Angeles
Internship/Residency Internal Medicine at
University of California, Irvine
CardiologyFellowship University of
California, Irvine
BoardCertification Internal Medicine, Cardiology
Dr. Burwell received his undergraduate degree from
Stanford University.
Specialties Consultative cardiology, transesophageal
echocardiography, pacemakers, complex lipid
disorders, preventive cardiology, cardiac CT,
nuclear cardiology, cardiac catheterization
MedicalDegree Loma Linda University
School of Medicine
Internship/Residency Internal Medicine at Wilford
Hall Medical Center, Lackland Air Force Base, Texas
CardiologyFellowshipWilford Hall Medical Center
BoardCertification Internal Medicine, Cardiology,
Cardiac Device Specialist
Specialties Consultative cardiology, valvular
heart disease, complex lipid disorders, congestive
heart failure, echocardiography, nuclear cardiology,
cardiac catheterization
MedicalDegree Georgetown University
Internship/Residency Internal Medicine at
University of New Mexico
CardiologyFellowshipUniversity of New Mexico
BoardCertification Internal Medicine, Cardiology
Dr. Snider graduated with a bachelor’s degree
in biomedical engineering and worked in the
Hematology Department at Walter Reed Army
Institute of Research.



Cardiology Consultants, PC—Medford
NicholasHDienelMDFACC
Cardiology
Specialties Consultative and preventive cardiology,
complex lipid disorders, congestive heart failure,
echocardiography, nuclear cardiology
MedicalDegree University of Pennsylvania
Internship/Residency Internal Medicine at
University of Michigan
CardiologyFellowshipUniversity of Pennsylvania
BoardCertification Internal Medicine, Cardiology
Honors/Awards Graduated with highest honors from
Pennsylvania State University (undergraduate); Alpha
Omega Alpha Medical Honor Society

HEARTANDVASCULAROUTCOMES
ToddSKotlerMDFACC
Cardiology
Specialties Consultative cardiology, interventional
cardiology, general cardiology, nuclear cardiology
MedicalDegree Stanford University School
of Medicine
Internship/Residency Internal Medicine at
University of California, Los Angeles
CardiologyFellowshipCedars-Sinai Medical
Center, UCLA
BoardCertification Internal Medicine, Cardiology,
Interventional Cardiology
Honors/Awards Highest honors from University
of California, Santa Cruz (undergraduate)

PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES
KennethMLightheartMDFACC
Cardiology
Specialties Consultative cardiology, transesophageal
echocardiography, nuclear cardiology, coronary
angiography, cardiac CT
MedicalDegree Oregon Health Sciences University
InternshipInternal Medicine at Legacy
Portland Hospitals
Residency Internal Medicine at David Grant
Medical Center, Travis Air Force Base, California
CardiologyFellowshipWilford Hall Medical Center,
Lackland Air Force Base, Texas
BoardCertification Internal Medicine, Cardiology,
Nuclear Cardiology
Honors/Awards Summa cum laude from Brigham
Young University, cum laude from Oregon Health
Sciences University, Alpha Omega Alpha Honor
Society in medical school, Housestaff Scientific
Research Second Place Award

Cardiology Consultants, PC—Medford
KristinMLinzmeyerMDFACC
Cardiology
Specialties General and invasive cardiology, heart
disease in women
MedicalDegree Oregon Health Sciences University
Internship Internal Medicine at University of Utah
ResidencyInternal Medicine at Oregon Health
Sciences University
CardiologyFellowshipUniversity of New Mexico
BoardCertification Internal Medicine,
Cardiovascular Disease
DavidJMartinMDFACC
Cardiology
Specialties Electrophysiology, intracardiac
ablation, pacemakers, defibrillators, invasive and
noninvasive cardiology
MedicalDegree Dartmouth Medical School
Internship/Residency Internal Medicine at
Cedars-Sinai Medical Center, UCLA
CardiologyFellowshipCedars-Sinai Medical Center
BoardCertification Clinical Cardiac
Electrophysiology, Cardiovascular Disease
Honors/Awards Alpha Omega Alpha Honor Society
in medical school, Phi Beta Kappa

MarkGMoranMDFACCFSCAI
Cardiology
Specialties Interventional cardiology, pacemaker
and defibrillator implantation and follow-up, invasive
and noninvasive cardiology, nuclear cardiology
MedicalDegree University of California,
Los Angeles
Internship/Residency UCLA Medical Center
CardiologyFellowship UCLA Medical Center
BoardCertification Internal Medicine, Cardiology,
Interventional Cardiology; Testamur NASPExAM;
Certified Cardiac Device Specialist IBHRE
Honors/Awards California Heart Association
Research Fellow; bachelor’s degree in biology with
highest honors from University of California, Santa
Cruz; Department of Medicine Intern of the Year,
UCLA Medical Center; Fellow Society for Cardiac
Angiography and Interventions

HEARTANDVASCULAROUTCOMES
BrianJMorrisonMDFACC
Cardiology
Specialties Consultative cardiology, adult and
pediatric heart disease, cardiac CT, transesophageal
echocardiography, nuclear cardiology,
cardiac catheterization
MedicalDegree University of Illinois, Chicago
Internship/ResidencyInternal Medicine at University
of Colorado Health Sciences Center, Denver
CardiologyFellowshipMassachusetts General
Hospital, Harvard Medical School, Boston
BoardCertificationCardiology
Honors/Awards Grove Outstanding Senior Award
Finalist, University of Illinois College of Medicine;
Outstanding Resident Teaching Award, University
of Colorado Health Sciences Center
Dr. Morrison’s training included a senior clinical
research fellowship at Boston Children’s Hospital. He
also spent one year as an instructor and staff physician
at the Adult Congenital Heart Disease Center at the
University of California, Los Angeles.

PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES

Heart Clinic of Southern Oregon and Northern California, PC

JonRBrowerMDFACC KentWDautermanMDFACCFSCAI BrianWGrossMDFACC

Cardiology Cardiology Cardiology

Specialties Consultative cardiology, echocardiography,
transesophageal echocardiography, nuclear cardiology,
coronary angiography
MedicalDegree University of Arizona
Internship/Residency Neurology and Internal
Medicine at University of Arizona
CardiologyFellowship University of Arizona
BoardCertification Internal Medicine,
Cardiovascular Disease
Honors/Awards Residency Excellence in
Teaching ( years)
Dr. Brower completed residencies in both neurology
and internal medicine.
Specialties Interventional cardiology (coronary stent),
carotid artery disease and intervention (stent), coronary
artery and valvular heart disease, transesophageal
echocardiography, cardiac CT
MedicalDegree Johns Hopkins School of Medicine
Internship/Residency University of California,
San Francisco
ChiefResidency University of California,
San Francisco
CardiologyFellowship University of California,
San Francisco
InterventionalCardiovascularFellowship
Cleveland Clinic
BoardCertification Cardiovascular Medicine,
Interventional Cardiology
Honors/Awards Valedictorian, College of Arts
and Sciences, University of Toledo; Top Three
Graduate, Johns Hopkins School of Medicine
Dr. Dauterman served as a Peace Corps public
health volunteer in Zaïre.
Specialties Interventional cardiology, consultative
cardiology, heart catheterization, echocardiography,
nuclear imaging
MedicalDegree University of Rochester School
of Medicine and Dentistry, New York
Internship/Residency Dartmouth, New Hampshire
CardiologyFellowship University of Washington
BoardCertification Internal Medicine,
Cardiovascular Medicine, Interventional Cardiology
Honors/Awards Washington Research Award
(American Heart Association), Intern and Resident
of the Year; Oregon Fire Chief’s Award–Meritorious
Service Award; All American Selection to the All
New England Soccer Team
Dr. Gross served as an assistant professor at the
University of Washington, Division of Cardiology.



MarkMHuthMDPhDFACC
Cardiology
Specialties General cardiology, heart failure, heart
transplant, echocardiography, nuclear cardiology,
coronary angiography
MedicalandDoctorateDegrees Louisiana
State University
Internship/Residency Louisiana State University
CardiologyFellowshipUniversity of Washington
PostdoctoralFellowshipPhysiology at University
of Washington
BoardCertification Internal Medicine, Cardiology
Honors/Awards Honors in physiology from
Rutgers University (undergraduate); Outstanding
Intern and Resident of the Year; Chairman of the
American College of Cardiology’s Oregon GAP
Project in Congestive Heart Failure
Dr. Huth served as an assistant professor at the
University of Washington, Division of Cardiology.
HEARTANDVASCULAROUTCOMES 
BrucePa!ersonMDFACC RVMCHospitalists
Cardiology
Specialties Consultative cardiology, echocardiography,
transesophageal echocardiography, preventative
cardiology, nuclear cardiology, coronary angiography
MedicalDegree University of Pennsylvania
Internship/Residency Internal Medicine at Brigham
and Women’s Hospital, Harvard Medical School Seventeenhospitalists
CardiologyFellowship Boston University
Medical Center providecareformanycardiac
BoardCertification Internal Medicine, Cardiology patientsAllhospitalists
Honors/Awards Cook Memorial Prize in Economics areboardcertified
at Pomona College, California; President, Alpha Omega
Alpha Honor Society, University of Pennsylvania
School of Medicine
Dr. Patterson earned his master’s degree from the
Princeton Theological Seminary in New Jersey.

PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES

Heart Clinic of Southern Oregon and Northern California, PC

EricAPenaMDFACC StephenJSchnuggMDFACC
Cardiology Cardiology

Specialties Cardiology, electrophysiology Specialties Consultative cardiology, interventional

MedicalDegree University of South Florida cardiology, cardiac catheterization, echocardiography

Internship/Residency Emory University, MedicalDegree University of California,

Atlanta, Georgia Los Angeles

CardiologyFellowship Emory University Internship/Residency Internal Medicine at

Wadsworth VA Medical Center
BoardCertification Cardiology, Electrophysiology
CardiologyFellowship Wadsworth VA
Honors/Awards Chief Medical Resident Medical Center
Dr. Pena has served on the faculty of the Heart Rhythm BoardCertification Internal Medicine, Cardiology,
Society’s International Meeting for the past three years. Interventional Cardiology



Oregon Surgical Specialists, PC
JuanMCastilloMDFACS
VascularGeneralandBariatricSurgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree New York University
Medical Center
Internship/Residency General Surgery at
University of Texas Southwestern Medical
Center and Parkland Memorial Hospital
VascularSurgeryFellowshipNew York University
Medical Center
BoardCertification General Surgery,
Vascular Surgery
Honors/Awards Honors program at New York
University Medical Center
Chairman, Committee on Cancer by American
College of Surgeons for Rogue Valley Medical Center
and Providence Medford Medical Center
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CAPTURE II and CREST carotid
stent studies
MarkAEatonMDFACS
VascularGeneralandBariatricSurgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree University of New Mexico
Internship/Residency General Surgery at
University of Texas Southwestern Medical Center
and Parkland Memorial Hospital
VascularSurgeryFellowship University of Tennessee
BoardCertification General Surgery,
Vascular Surgery
Honors/Awards Alpha Omega Alpha Honor Society
in medical school
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CAPTURE II and CREST carotid
stent studies

HEARTANDVASCULAROUTCOMES 
WilliamEFaughtMDFACS
VascularandGeneralSurgery
Specialties General, vascular, and endovascular
surgery, including laparoscopic surgery
MedicalDegree Southern Illinois University
Internship/Residency General Surgery at
University of Utah
VascularSurgeryFellowship Southern
Illinois University
BoardCertification General Surgery,
Vascular Surgery
Honors/Awards Alpha Omega Alpha Honor Society
in medical school
Research Subinvestigator in PIVOTAL small
aneurysm study, Endologix large neck aneurysm
study, and CAPTURE II and CREST carotid
stent studies
PHYSICIANBIOGRAPHIES
PHYSICIANBIOGRAPHIES

Oregon Surgical Specialists, PC

NancyO’NealMDFACS DavidLStreetMDFACS DavidKTraulMDFACS

GeneralSurgery VascularGeneralandBariatricSurgery VascularGeneralandBariatricSurgery

Specialties General surgery, including laparoscopic,
breast, and oncologic surgery
MedicalDegree University of Texas Southwestern
Medical School, Dallas
Internship/Residency General Surgery at University
of Texas Southwestern Medical Center and Parkland
Memorial Hospital
BoardCertification General Surgery
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree University of California, Davis
Internship/Residency General Surgery at
University of California, Davis
VascularSurgeryFellowship University of Rochester
School of Medicine and Dentistry
BoardCertification General Surgery,
Vascular Surgery
Honors/Awards Graduation with distinction,
Point Loma College
Research Primary investigator in Endologix
large neck aneurysm study and CAPTURE II
carotid stent study
Subinvestigatior in PIVOTAL small aneurysm study
and CREST carotid stent study
Specialties Vascular, endovascular, bariatric, and
general surgery, including laparoscopic surgery
MedicalDegree Medical College of Wisconsin
Internship/Residency General Surgery at Medical
College of Wisconsin
VascularSurgeryFellowship Cleveland Clinic
BoardCertification General Surgery,
Vascular Surgery
Honors/Awards Best Junior Surgical Resident
Research Primary investigator in PIVOTAL small
aneurysm study
Subinvestigatior in CAPTURE II and CREST
carotid stent studies


 HEARTANDVASCULAROUTCOMES 
Contact Information
RogueValleyMedicalCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - CoastalCardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
Admissions Hotline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . () - Coastal Cardiology is an outreach cardiology  Alder Street
Emergency Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .() - clinic serving the southern Oregon and northern Brookings, OR 
California coastal communities, staffed by physicians Fax: () -
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .() - from Cardiology Consultants and The Heart Clinic. Scheduling Fax: () -
TDD Hearing-impaired Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .() - Consultative cardiology, event monitors, holters,
Imaging Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . () - echocardiography, stress testing, and nuclear stress
tests are all provided in an outpatient facility.
Cardiac Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . () -
Lifeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . () -
HeartClinicofSouthernOregon
andNorthernCaliforniaPC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -


AsanteCardiovascularandThoracicSurgeons. . . . . . . . . . . . . - 
Jon R. Brower, MD, FACC  Medical Center Drive, Suite 
Charles Carmeci, MD, FACS  Siskiyou Blvd. Kent W. Dauterman, MD, FACC, FSCAI Medford 
David L. Folsom, MD, FACS Medford  Brian W. Gross, MD, FACC Toll-free: ---
Roger V. Hall, MD Fax: () - Mark M. Huth, MD, PhD, FACC Fax: () -
George R. Wilkinson, MD, FACS Bruce Patterson, MD, FACC E-mail: heart@the-heartclinic.com
Eric A. Pena, MD, FACC Web site: www.the-heartclinic.com
CardiologyConsultantsPC—GrantsPass . . . . . . . . . . . . . . . . . . . . . . . . - Stephen J. Schnugg, MD, FACC

Douglas T. Burwell, MD, FACC  SW Ramsey Avenue, Suite 

Bradley E. Personius, MD, FACC Grants Pass  OregonSurgicalSpecialistsPC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -


Richard L. Snider, MD, FACC Toll-free: --- Juan M. Castillo, MD, FACS  Medical Center Drive, Suite 
Fax: () - Mark A. Eaton, MD, FACS Medford 
Web site: www.theheartpeople.com William E. Faught, MD, FACS Fax: () -
Nancy O’Neal, MD, FACS E-mail: surgery@oregonsurgical.com
CardiologyConsultantsPC—Medford . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
 David L. Street, MD, FACS Web site: www.oregonsurgical.com
David K. Traul, MD, FACS
Nicholas H. Dienel, MD, FACC  Medical Center Drive, Suite 
Todd S. Kotler, MD, FACC Medford 
Kenneth M. Lightheart, MD, FACC Toll-free: --- CardiovascularInstituteofSouthernOregonLLC . . . . . . . . . . . . . -


Kristin M. Linzmeyer, MD, FACC Fax: () -
 Medical Center Drive, Suite 
David J. Martin, MD, FACC Web site: www.theheartpeople.com Medford 
Mark G. Moran, MD, FACC, FSCAI Fax: () -
Brian J. Morrison, MD, FACC E-mail: reachus@cviso.com


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