UNC Cardiology News

UNC Medical Center is First in the Mid Atlantic to Treat Patients with Next Generation Cardiac Mapping System

New technology enables tailored treatment for patients with cardiac arrhythmias.
UNC Medical Center is First in the Mid Atlantic to Treat Patients with Next Generation Cardiac Mapping System click to enlarge The new cardiac mapping system facilitates complex arrhythmia diagnoses through easy visualization of voltage pathways on a single "SparkleMap." This gives cardiac electrophysiologists a way to visualize the spread of electrical activity in the heart.

January 30, 2017

Tom Hughes
(984) 974-1151

CHAPEL HILL, N.C. – UNC Medical Center is the first in the Mid Atlantic U.S. to treat patients with the EnSite Precision™ cardiac mapping system, a next-generation platform designed to provide automation, flexibility and accuracy for diagnostic mapping used in ablation procedures to treat patients with abnormal heart rhythms (cardiac arrhythmias). UNC Medical Center was among the first sites in the United States to utilize this technology, which recently received FDA clearance.

When physicians use catheter ablation to treat cardiac arrhythmias, several long, flexible tubes with wires - called catheters - are inserted into the heart. Diagnostic catheters record and “map” electrical information from the heart. The Abbott EnSite Precision cardiac mapping system provides highly detailed anatomical models and maps to enable diagnosis of a wide range of arrhythmias, guide therapy and expand procedural options. Ablation catheters deliver radiofrequency energy. The heat from the catheter creates a lesion or scar on the tissue where the abnormal heartbeats originate. As a result, this tissue is no longer capable of conducting or sustaining the arrhythmia.

 “We have been using an earlier cardiac mapping system here at UNC for several years. The new mapping system is much faster – what used to take us hours now can be done in minutes – and it enables us to treat more complex cases than we could before,” said Paul Mounsey, MD, PhD, the Sewell Family/McAllister Distinguished Professor in the UNC School of Medicine and director of heart rhythm services for the UNC Center for Heart & Vascular Care.

“The technology in mapping systems is rapidly advancing. These new tools allow us to more rapidly understand complex arrhythmia circuits and have improved the efficacy of our procedures,” said Anil Gehi, MD, associate professor in the UNC School of Medicine and an electrophysiologist in the UNC Center for Heart & Vascular Care.

One of the distinctive features of the EnSite Precision cardiac mapping system is that it uses intelligent automation tools, which are designed to enable faster and more accurate high density maps allowing tailored treatment for a variety of cardiac arrhythmias, including complex cases. The ability to create rapid high-resolution models speeds up mapping time and minimizes fluoroscopic radiation exposure for both the patient and the clinicians.

The most common arrhythmia is atrial fibrillation, affecting more than 3 million Americans and millions more worldwide. Atrial fibrillation, also called AF or Afib, is a very fast, irregular heartbeat that occurs when the upper chambers of the heart beat so fast that they only can quiver. Atrial fibrillation can be dangerous, as over time it can cause more serious conditions such as stroke.

Marcia Van Riper is one of the first patients to be treated with the EnSite Precision system at UNC Medical Center. A professor and chair of the Family Health Division in the UNC School of Nursing, Van Riper has suffered from atrial fibrillation on and off for the last 10 years. Dr. Gehi performed her ablation procedure in early January.  Nine days later she was back on the job.

“Last week I lectured on family-centered genomic healthcare to my class of 164 nursing students, and it went great!” Van Riper said. “I was very impressed with the care I received at UNC Medical Center. Dr Gehi and his team provided excellent care, as did the nurses and nursing assistants.”

Below is a "SparkleMap" video captured during a cardiac ablation procedure performed at UNC Medical Center. The "SparkleMap" gives cardiac electrophysiologists a way to visualize the spread of electrical activity in the heart during an abnormal rhythm, and allows them to find the proper location for ablation.

About UNC Health Care
With more than 30,000 employees statewide, UNC Health Care has provided high-quality, patient-centered care for more than 60 years. UNC Health Care is a not-for-profit health care system owned by the state of North Carolina and based in Chapel Hill. The system includes UNC Hospitals in Chapel Hill, the UNC School of Medicine and nine affiliate hospitals across the state. To learn more, click here.

UNC's Dr. Sidney Smith receives two major AHA awards

This is the first time that the American Heart Association (AHA) has presented two major awards to one recipient.
UNC's Dr. Sidney Smith receives two major AHA awards click to enlarge Dr. Smith accepts the Chairman's Award and the James B. Herrick Award at the American Heart Association's Scientific Sessions in New Orleans on Nov. 13. copyright American Heart Association/Phil McCarten 2016, Opening Session, Sunday

Below is a press release issued by American Heart Association:

NEW ORLEANS, Nov. 14, 2016 — For the first time, the American Heart Association (AHA) has presented two major awards to one recipient: long-time volunteer leader and former AHA President Sidney C. Smith Jr., M.D., of the University of North Carolina at Chapel Hill.

First, Smith received the James B. Herrick Award of the AHA Council on Clinical Cardiology, an annual honor saluting excellence in the advancement of cardiology practice. Ileana Pena, M.D., council chair, presented the award, a citation and medallion, at a Saturday, Nov. 12, council dinner meeting in New Orleans.

Then, on Sunday, Nov. 13, Smith received the Chairman’s Award, a tribute to outstanding volunteer service on behalf of the AHA. The award was presented during the opening of the American Heart Association Scientific Sessions 2016 at the New Orleans Ernest N. Morial Convention Center. Association Board Chairman Alvin L. Royse of Hillsborough, Calif., presented the award, a citation and $1,000 honorarium.

To read the full release, click here.

Following the ‘Tinman’

Inspired by a genetic discovery by her PhD mentor, UNC heart researcher Li Qian followed the ‘Tinman’ down the yellow brick road to an award-winning career in science, including the Jefferson-Pilot Fellowship in Academic Medicine.
Following the ‘Tinman’ click to enlarge Li Qian, PhD. Photo by Caroline Curran, UNC Health Care / UNC School of Medicine.

Scientist Li Qian, PhD, has forged an award-winning career at the UNC School of Medicine. In just a few short years since joining the faculty, she’s been recognized for her cardiac research by The American Heart Association. She was the first-ever recipient of the Boyalife, Science and Science Translational Medicine Award in Stem Cell and Regenerative Medicine. And now she has earned a UNC School of Medicine Jefferson-Pilot Fellowship in Academic Medicine, which includes $20,000 to be used toward scholarly endeavors.

We caught up with Qian, assistant professor of pathology and laboratory medicine at the UNC School of Medicine and member of the McAllister Heart Institute, to discuss her research in cardiac reprogramming, her goal to inspire young women to pursue careers in science, and how and why she chose the UNC School of Medicine.   

By Caroline Curran, caroline.curran@unchealth.unc.edu

As a young girl growing up in China, did you ever imagine you’d spend your career in science, studying the heart, at a university in the United States? What were some of the obstacles you’ve had to overcome to follow your dreams?

When I was little, I was always encouraged to do what I wanted and follow my dreams, especially pursuing my interest in science. My parents both work for a university. My dad is a professor of engineering and my mom is an accountant. I was quite fortunate that we lived in a positive and open environment – one that fostered the growth that’s critical for one’s future success.

I was drawn to science by curiosity as a kid. I clearly remember the first time I ever saw a cell under a microscope. It was the onion cell experiment. Ever since then, I have always been fascinated by the question of how a single cell becomes an organ and, ultimately, becomes a whole life form.

At the time I graduated from college in China, one of the best places to do basic research was the States because of its reputation in basic science, the opportunity to work with world-renowned scientists and the strong infrastructure and cutting-edge technology.

I also like the diversity, openness and welcoming atmosphere to people from different backgrounds. However, as an incoming international student, getting started in a completely different environment was extremely challenging. Imagine the language barriers I had when I first came to this country. I could barely understand a sentence if the conversation was not face-to-face. My PhD mentor, Rolf Bodmer, witnessed and complimented me when he realized that I followed the American dream by growing from a shy international student into a dynamic young leader in science.

You always knew that you wanted to pursue some field of science. How did you become interested in the heart?

It was the story of the “Tinman.” In the 1980s, I read in the news that a neurobiologist at the University of Michigan used fruit flies to identify master genes that regulate neuronal cell fate. He was screening for important transcription factors critical in the development of the peripheral nervous system, but serendipitously identified a homeobox gene that, when mutated, resulted in the absence of heart formation in the fruit fly. He was fascinated by this discovery and named the gene the Tinman, which is a reference to “The Wizard of Oz.” This work was published in 1989, and after that follow-up studies identified the vertebrate counterpart of the Tinman gene, NKX2.5. By studying a family in Pennsylvania with a high incidence of congenital heart disease, scientists from Harvard University found that the disease was caused by a mutation in NKX2.5. The scientist who identified Tinman was Dr. Bodmer, my PhD mentor. His work opened up the field and I was lucky to have a chance to work with him in his lab.

Your research is now focused on cardiac reprograming – converting cardiac scar tissue cells into functional cardiomyocytes. What are your immediate and long-term goals for this research?

Basic research is so important. We never know how basic research will be used in identifying factors that cause diseases. When Rolf discovered the Tinman gene, he did not know that there would be a family whose cardiac disease could be traced back to that gene.

For me, I want to see my research and my approach used on a patient. That’s the immediate goal, within five to 10 years. I know there’s so much research that needs to be done to really help a patient one day.

It will take some time, but we are collaborating with many labs in the field and we share with them our unpublished data to accelerate the field. And it’s only if we all work together to accelerate our research that we can realize our goal of helping patients with our approach as soon as possible.

But, in terms of career goals, it never ends. In terms of heart disease, there are always new diseases that are being discovered. One therapy might be a good treatment, but then a better treatment might come along. We always try to address the most urgent, most challenging question in the field. But it’s always changing. I think my lab will continue to take on the major challenges in the field.

Even with reprogramming, our lab will work to develop therapies and targeted medicine beyond the type of cardiac disease we are working on now. Research-wise, there’s just no end. There are so many things I can do.

You’ve mentioned that mentorship – both as a mentor and a mentee – played a big part in your early career and why you made the decision to come to UNC. Why is that so important to you?

It’s incredibly important to me to help mold young scientists, especially young women scientists in this field. My lab has a lot of young women trainees. It’s very rewarding for me to mentor and promote the next generation of scientists. I am grateful that my former mentors trained me in a very positive, encouraging, and supportive manner. It helps to build a positive research environment that fosters the love of science and the spirit of teamwork.

UNC has a lot of brilliant women studying, doing research, and practicing medicine, and that really influenced my decision to join the faculty here. UNC has done such a wonderful job in promoting women scientists. That’s a very effective way to attract young female scientists to come here to start their careers. At multiple levels, they are viewed as role models for young scientists, especially young women scientists.

Your husband is also a basic scientist at UNC who studies the heart. What are your family dinner conversations like? Do you encourage your daughters to pursue careers in science or medicine?  

Although we are both scientists, we talk about a lot of different things at our dinner table, from things that happened in my daughters’ school, their love for ice skating, and, of course, science. Because of these conversations, my older daughter, who is now 10, has asked me about cell reprograming and how it works.

I fully respect their choices they make for their education and their careers when they grow up. I encourage them to find their passions and follow their dreams, but I will also certainly create an environment for them so that they will be exposed to science and technology.

I go to my daughters’ schools to give lectures a few times a year. Science and biology are a big part of it, but it’s not just to share the science. It’s to tell the students: anything is possible; be wild and be crazy with your goals; be brave, and go on to realize your goals and your dreams.

Dr. Sidney Smith to Receive 2 American Heart Association Awards

Dr. Sidney Smith will be the recipient of both the James B. Herrick Award for Outstanding Achievement in Clinical Cardiology and the Chairman's Award at the 2016 American Heart Association Scientific Sessions. The Herrick Award honors a physician whose scientific achievements have contributed profoundly to the advancement and practice of clinical cardiology. The Chairman's Award honors contributions to further the AHA's strategic goals.

Cardiology Research Highlights from the Department of Medicine

UNC Cardiology's research is featured by the Department of Medicine. In-progress research by faculty members Dr. Brian Jensen, Dr. Patricia Chang, Dr. Xuming Dai,  Dr. Jason Katz, and the cardiac electrophysiology group is highlighted.  Check out the the great review of Cardiology research highlights.

Heart Failure Feature: Podcast with Dr. Patty Chang

Heart Failure Feature: Podcast with Dr. Patty Chang click to enlarge Dr. Patty Chang, UNC Cardiology

Dr. Patty Chang, Associate Professor of Medicine in the Division of Cardiology and Director of the Heart Failure and Transplantation Program, is featured in a Chair's Corner podcast interview. She discusses the latest research and treatment options for heart failure with Dr. Ron Falk, Chairman of UNC's Department of Medicine.  Listen to the podcast and learn about UNC's Heart Failure Program.

UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks

To address full cardiac arrest of hospital patients, new measures reduced the average time between symptom onset and the start of treatment by 72 percent.
UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks click to enlarge George A. Stouffer, MD
UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks click to enlarge Xuming Dai, MD, PhD

Media contact: Tom Hughes, 984-974-1151,

September 21, 2016

CHAPEL HILL, NC – In 2012, UNC Hospitals launched an initiative aimed at reducing the time it takes hospital staff to recognize when a patient is having a STEMI (ST elevation myocardial infarction) heart attack – the sudden and complete blockage of a heart artery – and to begin appropriate treatment. Now, encouraging results from that effort have been published as a research letter in JAMA Cardiology.

“These results show that it is possible to expedite care of these patients,” said George A. Stouffer, MD, chief of cardiology at UNC Hospitals and senior author of the JAMA letter. “Our study was not large enough to determine whether these changes will result in improved survival across the country but the results are encouraging."

STEMI is considered to be more serious and life-threatening than a non-STEMI heart attack, in which a coronary artery is severely narrowed but not completely blocked.

Nationwide, there are approximately 11,000 cases of STEMI each year among hospital inpatients, and about 4,300 deaths in this group.

“When patients who are in the hospital for a non-cardiac condition have a STEMI, the onset is not usually heralded by chest pain and thus health care providers may not suspect that a coronary artery has occluded,” said Xuming Dai, MD, PhD, an interventional cardiologist at UNC Hospitals who was first author on the manuscript.. “As a result, the time it takes for restoration of coronary blood flow for inpatients may be much slower and more variable than it is for patients brought to a hospital emergency department because of a suspected heart attack.”

One key component of the STEMI quality improvement program was empowering nurses and other non-physician health care providers to activate the response team when they suspected a patient was having a STEMI. Once activated, the team rapidly identified and triaged inpatient STEMIs, following a protocol that closely resembles the model used by paramedics and other first responders in the outpatient setting. These combined measures reduced the average time between symptom onset and the start of treatment by 72 percent.

“This is one of the first studies to identify ways to improve care of patients who have a heart attack while in the hospital,” said Stouffer, who is also a member of the UNC McAllister Heart Institute. “Based on our encouraging results, Dr. Dai and Dr. Smith at UNC are coordinating a study of 17 leading hospitals around the United States that are implementing these changes. We anxiously await the results, as this would be the first study to show that the very high mortality associated with in-hospital STEMI could be reduced."

In addition to Stouffer, authors of the study are Xuming Dai, MD, PhD; Dane Meredith, MD, MPH; Edward Sawey, MD; Prashant Kaul, MD; and Sidney C. Smith Jr., MD. All are in the division of cardiology in the UNC School of Medicine.


Challenging the status quo: Katz examines training, staffing and research in cardiac intensive care

Jason Katz, MD, MHS, medical director of UNC’s cardiac intensive care unit, examines the challenges facing cardiac intensive care units and clinicians, and offers innovative recommendations for training, staffing and research for this emerging field.
Challenging the status quo: Katz examines training, staffing and research in cardiac intensive care click to enlarge Jason Katz, MD, MHS. Photo by Max Englund, UNC Health Care.

Media contact: Caroline Curran, caroline.curran@unchealth.unc.edu, (984) 974-1146

CHAPEL HILL, NC – Jason Katz, MD, MHS, associate professor of medicine at UNC School of Medicine and medical director of the cardiac intensive care unit, was the lead author of a recently published manuscript in the Journal of the American College of Cardiology that examined the early growth and maturation of critical care cardiology, and the challenges and uncertainties that threaten to stymie the growth of this fledgling discipline.

Katz’s recent piece followed a scientific statement he was previously tasked with crafting for the American Heart Association and the American College of Cardiology that outlined the evolution of care required to treat critically ill cardiovascular patients, and how those evolving requirements should shape training, staffing, and research.

On the training front, for example, dedicated fellowships for critical care cardiology do not currently exist at most medical schools. There are ways to receive training, Katz said, but not in a streamlined track similar to those seeking specialty certification in pulmonary and critical care medicine. Katz wants to help establish a more formal fellowship pathway at the UNC School of Medicine.

“We’re trying to create a critical care program at UNC that’s not specifically catered to the cardiovascular specialists, but that would lend itself to critical care training for our medicine subspecialist, in general, and then could be tailored to the specific interests and goals of the trainee,” Katz said. “For instance, someone can finish cardiology subspecialty training and then come to do our fellowship and be trained in critical care medicine with a focus on cardiovascular critical care.”

In his paper, Katz examines staffing challenges facing cardiac intensive care units and clinicians – one of which is determining whether an open or a closed model of care is more appropriate for the unit.

In an open ICU model, a physician can admit a patient to the ICU and will continue to provide care throughout the patient’s hospital stay, while in a closed ICU, the patient’s care is transferred to a dedicated critical care team, which can provide comprehensive, multidisciplinary care during their ICU course.

Katz recently shifted UNC’s cardiac intensive care unit from an open to a closed unit.

“As a result, we’ve improved care efficiency and outcomes in many areas, and – perhaps most importantly – we’ve improved nurse-physician relations and the educational experience for our trainees,” he said.

It is imperative to address training and staffing issues, Katz said, because the care patients require is becoming more complex. As modern medicine continues to advance, cardiac intensive care unit patients require a more specialized and disciplined level of care.

“In this paper we also highlight imperatives necessary to optimize care for the increasingly complex group of patients who now occupy our cardiac intensive care and the requisite skills our physicians must now possess to effectively and safely care for them,” Katz said. “In order to provide the highest quality of care, one must now not only understand a patient’s cardiovascular illness, but also must understand how multi-system organ injuries and critical illnesses play a role in their hospital course.”

Katz is hopeful that as more intensivists embrace the cardiac aspect of critical care in their training and staffing, patients will be the ultimate beneficiaries.

“We owe it to our patients. We owe it to our nurses. We owe it to our patients’ families to continue to innovate; to be willing to think outside the box, to better understand optimal care practices for these patients,” Katz said. “The status quo is not good enough anywhere in medicine, but particularly here in this rapidly evolving field.”

Katz is the medical director of the UNC Cardiac Intensive Care Unit and Critical Care Services, the medical director of the UNC Cardiothoracic Intensive Care Unit and Critical Care Service, the medical director of the UNC Mechanical Heart Program, and the director of cardiovascular clinical trials at UNC.

TAVR program continues growth, fosters integration

UNC Medical Center’s Structural Heart Team offers patients a chance at a more active life, promotes collaboration across the UNC Health Care system.
TAVR program continues growth, fosters integration click to enlarge Purcell Kimsey and Barry Cheek, MD
TAVR program continues growth, fosters integration click to enlarge UNC Medical Center's Structural Heart Team

By Jamie Williams, jamie.williams@unchealth.unc.edu

In May, World War II veteran Purcell Kimsey traveled to Chapel Hill for a transcatheter aortic valve replacement (TAVR) procedure. He brought his cardiologist with him.

Barry Cheek, MD, a cardiologist with High Point Regional Hospital has been treating Kimsey for three years. When he referred Kimsey to UNC Medical Center to undergo the TAVR procedure, he knew he and his practice partners Kurt Daniel, MD, and Joe Rossi, MD, would be able to coordinate closely with the TAVR team at UNC Medical Center to ensure Kimsey received the highest quality care. Daniel travelled from High Point Regional to Chapel Hill and assisted with the surgery, and the physicians’ constant communication ensured that Kimsey’s follow-up appointments could occur in High Point.

“The fact that we can have this collaboration and provide continuity of care to our patients is an incredible asset,” Cheek said.

In addition to treating Kimsey, Cheek said he has known the Kimsey family for several years through the High Point church they both attend.

John Vavalle, MD, assistant professor of cardiology, and Tommy Caranasos, MD, assistant professor of surgery, both co-directors of the UNC TAVR program, said the collaboration between physicians from UNC Medical Center and High Point Regional is representative of the integrated network that UNC Health Care has established across North Carolina to provide the highest level of care for patients.

“This patient’s family was comforted by the fact that someone who they know and trust was there to assist with the surgery,” Vavalle said. “That’s a level of service that I don’t think is available a lot of other places.”

“The collaborative relationship we’ve fostered  with High Point Regional and other practices across the state is really representative of the care that we aim to provide here at UNC for all patients in North Carolina,“ Caranasos said.

Kimsey’s granddaughter, Kimsey Parker, was reassured by the amount of care her grandfather received.

“The commitment was heartwarming, and honestly a surprise,” Parker said. “I knew that we had great people taking care of him.”

In addition to providing benefits to patients, the partnership is also beneficial for High Point Regional and its physicians.

“There are many procedures that are now being performed in academic medical centers that in the future may be more accessible in a larger community hospital like High Point Regional,” Daniel said. “So I want to be there to learn; I want to be able to collaborate and be involved. That’s a great advantage for us and it provides important continuity for our patients.”

The first TAVR procedure was performed at UNC Medical Center in late 2014. Now, Vavalle & Caranasos expect the number of cases in year two of the program to triple. Much of that increase can be attributed to great patient outcomes, coupled with the work done to establish relationships with cardiologists across North Carolina.

“In the first year, I think the natural instinct is for people to sit back, watch, and really make sure we know what we’re doing,” Vavalle said. “Now, we can get out, meet with cardiologists across the state, and show them our results.”

TAVR provides a treatment option for aortic valve replacement for many patients who previously had no other options or were considered too high-risk for conventional open heart surgery. With TAVR, physicians have the ability to provide aortic valve replacement via minimally invasive approaches, providing outcomes that are just as good as, and sometimes better than, surgical valve replacements.

The UNC program has pioneered a number of innovations aimed at expanding the availability of TAVR to more patients who may not have been eligible for the procedure before. The team has introduced the suprasternal TAVR approach, a point of differentiation from other TAVR programs. The team has also participated in the rollout of a next-generation valve that can be repositioned, helping to ensure proper placement.

The team is able to offer the procedure to patients like Kimsey, who at 95, is the oldest they have treated.

“This procedure is all about improving the quality of life for these patients,” said Cassie Ramm, AGNP-C, Structural Heart Disease Nurse Practitioner. “Our patients are at a point with their symptoms where they really aren’t able to get outside, aren’t able to visit their families. Many say they’ve lost their independence. We are able to give them that back.”

Even at 95, Kimsey shows no signs of slowing down. The lifelong High Point resident is a former Golden Gloves champion boxer and Navy veteran. He’s had many successful business ventures in High Point and even had a hand in founding Camp Cheerio, a summer camp in the North Carolina Mountains.

Following his procedure he was excited to pursue one of his principle hobbies, painting, while also spending the summer traveling to the beach with his children and grandchildren.

These stories are becoming familiar to the UNC Structural Heart Team.

“We’ve recently been seeing our first group of patients returning for their 12-month checkup, and these are people who have regained their ability to get out and live their lives,” Vavalle said. “I see a lot of vacation pictures.”

UNC Hospitals honored with Mission: Lifeline achievement award

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed.

June 14, 2016

UNC Hospitals has received the Mission: Lifeline® Gold Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks. 

Every year, more than 250,000 people experience an ST elevation myocardial infarction (STEMI) the most deadly type of heart attack caused by a blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication.

The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call and continuing through hospital treatment. UNC Hospitals is recognized for having a 85% composite adherence and at least 24 consecutive months of 75% or higher compliance on all Mission: Lifeline STEMI Receiving Center quality measures to improve the quality of care for STEMI patients.

“UNC Hospitals is dedicated to improving the quality of care for our patients who suffer a heart attack, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that goal through nationally respected clinical guidelines,” said George Stouffer, MD, chief of cardiology. “We are pleased to be recognized for our dedication and achievements in cardiac care, and I am very proud of our team.”

In addition to receiving the Mission: Lifeline Gold Receiving award, UNC Hospitals has also been recognized as a recipient of Mission: Lifeline’s Gold-Plus award, which recognizes the hospital has not only reached an achievement score of 75 percent or greater on all Mission: Lifeline Receiving Center Quality Measures, but also for achieving at least a 75 percent achievement on First Door to Device time under 120 minutes  for STEMI transfer patients from other facilities.

“The Mission: Lifeline Gold Receiving Award was earned through teamwork and a dedication to saving lives,” says Prashant Kaul, MD, medical director of the UNC Chest Pain Center. “The team of UNC cardiologists, emergency department physicians, cardiac catheterization lab staff, emergency department staff, coronary intensive care unit nurses, EKG staff, and performance improvement staff worked together and in partnership with Orange County Emergency Medical Services (EMS), First Health Carolinas EMS, Durham County EMS, and Alamance County EMS to achieve this recognition.”

“We commend UNC Hospitals for this achievement award, which reflects a significant institutional commitment to the highest quality of care for their heart attack patients,” said James G. Jollis, MD, Chair of the Mission: Lifeline Advisory Working Group. “Achieving this award means the hospital has met specific reporting and achievement measures for the treatment of their patients who suffer heart attacks and we applaud them for their commitment to quality and timely care.”

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed. Eligible hospitals must adhere to these measures at a set level for a designated period to receive the awards.


About UNC Health Care
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care.

UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; Caldwell Memorial Hospital in Lenoir, NC; Chatham Hospital in Siler City, NC; High Point Regional Health System in High Point, NC; Johnston Health in Clayton and Smithfield, NC; Lenoir Memorial in Kinston, NC;  Nash Health Care in Rocky Mount, NC; Pardee Hospital in Hendersonville, NC; UNC Physicians Network; UNC REX Healthcare and its provider network in Wake County; and Wayne Memorial Hospital in Goldsboro, NC.
Learn more about UNC Health Care at http://www.unchealthcare.org.

About Mission: Lifeline
The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology Foundation clinical treatment guidelines.  For more information, visit heart.org.

SUDDEN investigators sign collaboration agreement with Cuban research group

The agreement resulted from a two-day scientific meeting held in February at the University of Havana's Center for Demographic Studies.
SUDDEN investigators sign collaboration agreement with Cuban research group click to enlarge Ross J. Simpson, Jr. MD, PhD, is principal investigator for the SUDDEN Project at UNC.

April 7, 2016

CHAPEL HILL, N.C. — Researchers from the University of North Carolina School of Medicine have reached an agreement with researchers in Cuba to develop strategies to prevent sudden unexpected death (SUD).

“Researchers and preventive cardiologists at the University of North Carolina and the University of Havana will be working together to understand the causes of sudden death,” said Ross J. Simpson, MD, principal investigator for the SUDDEN Project at UNC. “A better understanding of these causes will help us prevent many of these premature deaths in the U.S. and in Cuba."

"We look forward to working with the SUDDEN team from UNC to prevent sudden unexpected death in both countries," said Luis A. Ochoa Montes, DSc, principal investigator of the Cuban Sudden Death Study.

SUD is a malfunction of the heart that results in a rapid loss of blood flow through the body leading to death. It is a very rapid process and may have few or no known warning signs. SUD is a common cause of death in the United States, killing approximately 1,000 people each day, or one every two minutes.

The agreement resulted from a two-day scientific meeting held in February at the University of Havana's Center for Demographic Studies. Ross J. Simpson, MD and Irion W. Pursell, RN, leaders of the SUDDEN Project at UNC, met with researchers  from GIMUS (Sudden Death Research Group of Cuba). Researchers from both groups presented data on the impact of sudden death in their respective communities and discussed prevention strategies.

"This historic collaboration between UNC and the University of Havana will help pave the way for new, effective strategies to prevent sudden unexpected death," Pursell said.

As a result of the agreement, the researchers will conduct a pilot project that will screen sudden death cases in Cuba using existing SUDDEN methodology. Research findings from the collaboration will be disseminated through international meetings, conferences, and manuscript publications.

Sudden death is a major public health problem in the United States and globally, accounting for an estimated 10 percent of deaths each year. There are many inconsistencies in the reporting and characterization of sudden death. The SUDDEN Project has taken an innovative approach to the problem, using new methods to capture every potential sudden death in the state of North Carolina. GIMUS' efforts have brought light to the critical need for a generally accepted clinical definition of sudden death and targeted heath policy for high-risk groups.

The SUDDEN Project at UNC is a retrospective epidemiologic study conducted in 18 counties throughout the United States. SUDDEN is designed to investigate the epidemiological, genetic, and pathophysiological causes of SUD.  The study aims clarify risk factors, estimate incidence and underlying pathophysiology of SUD by sampling broadly in a diverse, socioeconomically and ethnically representative populations. To date, the SUDDEN study has published several articles in peer-reviewed journals and presented findings in various meetings including the U.S. Centers for Disease Control and Prevention (CDC), the American Heart Association, EuroPrevent, and Patient-Centered Outcomes Research Institute (PCORI).

Adding stress management to cardiac rehab cuts new heart incidents in half

UNC’s Alan Hinderliter, MD, teamed up with Duke doctors to quantify the benefit of stress management to heart health.
Adding stress management to cardiac rehab cuts new heart incidents in half click to enlarge Alan Hinderliter, MD

Media contact: Mark Derewicz, 984-974-1915, mark.derewicz@unch.unc.edu

March 21, 2016

CHAPEL HILL, N.C. – Patients recovering from heart attacks or other heart trouble could cut their risk of another heart incident by half if they incorporate stress management into their treatment, according to research from Duke Health and UNC Health Care.

The findings, published March 21 in the American Heart Association journal Circulation, are the result of a randomized clinical trial of 151 outpatients with coronary heart disease who were enrolled in cardiac rehabilitation due to heart blockages, chest pain, heart attacks, or bypass surgery. They ranged in age from 36 to 84 years old.

About half of the patients participated in three months of traditional cardiac rehabilitation, which included exercise, a heart-healthy diet, and medications to manage cholesterol and high blood pressure.

The other half went to cardiac rehab and also attended weekly, 90-minute stress management group meetings that combined support, cognitive behavior therapy, muscle relaxation, and other techniques to reduce stress. Patients were followed for an average of three years after rehab.

Thirty-three percent of patients who received only cardiac rehabilitation had another cardiovascular event such as a heart attack, bypass surgery, stroke, hospitalization for chest pain or death from any cause. By comparison, 18 percent of the patients who participated in stress-management training during their cardiac rehabilitation had subsequent cardiovascular trouble – about half the rate of the other group.

Both sets of patients that went to rehab fared better still than recovering heart patients who elected not to attend rehab; 47 percent of the latter group later died or had another cardiovascular incident, according to the article. 

Reducing stress may seem like an obvious part of any plan for improving heart health, said lead author James Blumenthal, PhD, a clinical psychologist and professor in psychiatry and behavioral sciences at Duke.

“Over the past 20 to 30 years, there has been an accumulation of evidence that stress is associated with worse health outcomes,” Blumenthal said. “If you ask patients what was responsible for their heart attacks, most patients will indicate that stress was a contributing factor.” But stress management is typically not part of most cardiac rehabilitation programs, he said.

“I think part of the issue is that stress is hard to define, and there’s no universally accepted way of measuring it or treating it,” Blumenthal said. “The data we provide indicate that by reducing stress, patients can improve clinical outcomes, even beyond the benefits that we know exercise already has on reducing stress and improving cardiovascular health.”

For the trial, patients’ stress levels were measured using five standard instruments on which participants self-reported their levels of depression, anxiety, anger, and perceived stress. Overall, those who participated in stress management reported reductions in anxiety, distress, and their overall level of perceived stress.

Both groups that participated in cardiac rehabilitation saw similar and significant physical improvements in their cholesterol levels and proteins that indicate heart disease-related inflammation, as well as their exercise capacity.

“We have known for some time that participation in a supervised exercise program is beneficial in patients with coronary heart disease,” said Alan Hinderliter, MD, associate professor of medicine in the division of cardiology at the UNC School of Medicine and co-investigator on the trial. “The results of this study suggest that stress management is also a very important element of a comprehensive cardiac rehabilitation program. The intervention was clearly helpful in reducing stress levels, but we need additional research to confirm the benefits of stress management in improving cardiovascular outcomes.”

Although death rates from heart disease have improved, it remains the number one cause of death in the United States and is growing worldwide, according to the American Heart Association.

Dr. Hinderliter is a member of the McAllister Heart Institute and the UNC Center for Heart and Vascular Care. 

In addition to Blumenthal and Hinderliter, study authors included Andrew Sherwood, PhD; Patrick J. Smith PhD; Lana Watkins PhD; Stephanie Mabe; William E. Kraus, MD; Krista Ingle, PhD; and Paula Miller, MD.

The National Heart, Lung, and Blood Institute, a component of the National Institutes of Health, supported this study.

UNC Hospitals’ care earns Blue Distinction® Center+ Designation for Quality and Cost-Efficiency for Five Service Lines

Blue Cross and Blue Shield of North Carolina ranked UNC Hospitals’ bariatric surgery, cardiac care, knee & hip replacement, spine surgery, maternity and complex & rare cancer service lines highly as part of the Blue Distinction Specialty Care program

March 7, 2016

CHAPEL HILL, NC – Blue Cross and Blue Shield of North Carolina (BCBSNC) designated UNC Hospitals a Blue Distinction® Center+ in bariatric surgery, cardiac care, knee & hip replacement, spine surgery, and maternal health and a Blue Distinction Center® in complex & rare cancers. Blue Distinction Centers are nationally designated health care facilities shown to deliver improved patient safety and better health outcomes, based on objective measures that were developed with input from the medical community.
Research shows that facilities designated as Blue Distinction Centers demonstrate better quality and improved outcomes for patients compared with their peers. On average, facilities designated as a Blue Distinction Center+ are 20 percent more cost efficient in an episode of care compared to non-Blue Distinction Center+ designated health care facilities.
“This distinction demonstrates our commitment to provide exemplary care to our patients,” said UNC Hospitals President Gary Park.
Quality is key. Only those facilities that first meet nationally established quality measures were considered for designation as a Blue Distinction Center+. UNC Hospitals is proud to be recognized by BCBSNC for meeting the rigorous selection criteria for each of its specialties set by the Blue Distinction Specialty Care program.
“We’re doing the homework for our customers by putting a spotlight on hospitals and facilities that offer high quality services at a fair price.” said Dr. Brian Caveney, chief medical officer of BCBSNC. “With health care costs continuing to rise, patients want to know how much value they are getting for their health care dollar. Identifying which providers meet or exceed industry standards is an important part of that equation.”
Since 2006, the Blue Distinction Specialty Care program has helped patients find quality providers for their specialty care needs in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, maternity care, spine surgery and transplants, while encouraging health care professionals to improve the care they deliver.
For more information about the program and for a complete listing of the designated facilities, please visit www.bcbs.com/bluedistinction.

About UNC Hospitals
UNC Hospitals is an 840-bed public, academic medical center operated by and for the people of North Carolina. The Hospitals' mission is to provide high quality patient care, to educate health care professionals, to advance research and to provide community service. UNC Hospitals includes North Carolina Cancer Hospital, North Carolina Children's Hospital, North Carolina Memorial Hospital, North Carolina Neurosciences Hospital, North Carolina Women's Hospital, and UNC Hospitals Hillsborough Campus. Each year UNC Hospitals cares for patients from all 100 counties in North Carolina and several surrounding states.
Blue Cross and Blue Shield of North Carolina improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.91 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. We have been recognized as one of the World’s Most Ethical Companies by Ethisphere Institute every year since 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. All other marks are the property of their respective owners.

About Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for nearly 105 million members – one in three Americans. For more information on the Blue Cross Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.

About Blue Distinction Centers
Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A Local Blue Plan may require additional criteria for facilities located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable health care. Each facility’s cost of care is evaluated using data from its Local Blue Plan. Facilities in CA, ID, NY, PA and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.

‘I was in good hands’

Hillsborough hospital employee and Haw River resident Dennis Clayton has enjoyed working at the new medical facility since 2012 – and after suffering a recent heart attack while at home, he feels fortunate to live nearby.
Dennis Clayton (Photo by Max Englund/UNC Health Care)
Dennis Clayton (Photo by Max Englund/UNC Health Care)

One evening last fall, Dennis Clayton was with his wife, Sharon, at their home in Haw River when a feeling of indigestion set in. Dennis had experienced it before, so he took a couple tablets to relieve the discomfort. Time passed but the feeling only intensified. He decided to try baby aspirin but there was no change.

“I told Sharon, ‘We have to go to the hospital,’” says Dennis, who has worked in Plant Engineering at UNC Hospitals’ Hillsborough medical campus for nearly four years. “The pressure on my chest was so great it was like there was an elephant or something huge sitting on it. I was hoping it wasn’t a heart attack but in my mind I knew it was.”

Dennis and Sharon have lived in Haw River for more than twenty years, a few miles off Interstate 40, west of Mebane, in Alamance County. They got in the car, hopped on the highway, and drove to the Hillsborough hospital, where Dennis had been earlier that day as part of the three-man team that takes care of the HVAC units at the medical facilities.

In the past, if Dennis or Sharon needed to go to the hospital for any reason, they drove to Chapel Hill, taking Highway 54. That drive, familiar to Dennis because he spent five years working at UNC Hospitals before transitioning to the Hillsborough medical campus, took him close to 40 minutes.   

“Part of the reason I moved to the Hillsborough hospital for work was because of its proximity to our house – it’s only about 15 minutes away,” he says. “That night I knew that it would be quicker for us to get to Hillsborough and that the care would be just as good. It’s more convenient for me.”

Sharon pulled up to the front of the Hillsborough Emergency Department. Dennis got out of the car, entered the building, and told the guard and receptionist that his chest was hurting badly and that he thought he was having a heart attack. They immediately brought him a wheelchair and took him into the examining room. After an initial exam, he was moved to another room, where they ran an electrocardiogram of his heart.

“They confirmed that I was having a heart attack,” he says. “After awhile, the nitroglycerine they’d given me wasn’t helping, so they transferred me to Chapel Hill. I’m glad I went in, because they evaluated me quickly, took great care of me, and sent me on for more immediate care. I was in good hands.”

When he arrived in Chapel Hill, it was clear Dennis was going to require surgery on an artery that was 98 percent blocked. So, he went straight from the Chapel Hill Emergency Department to the cardiac catheterization lab for surgery.

“It all happened so quickly,” he says. “But they knew what they needed to do – they had to go in around my groin and blow up one of the veins around my heart and put a stent in.”

The surgery was a success, and two days later he returned home to Haw River. He has since been rehabilitating three times a week, for two hours per session, which has helped him regain his strength. He has also completely changed his diet. He confesses that Thanksgiving and Christmas, while great to be with family, were challenging from a food standpoint.

“No more salt – and I love salt,” he says. “I’m eating more fresh vegetables and staying away from steak and ham and bacon – I don’t eat anything like that anymore. When it comes to meat, it’s just chicken and fish.”

All told he’s lost 22 pounds in the last few months.

“I feel much better,” he confirms. “I’m just thankful to be alive.”

Dennis and Sharon have two children together, and since his heart attack, he's gained even greater appreciation of all that he has. His daughter and two granddaughters live next door to him and Sharon and his son, with whom he enjoys drag-racing, lives in Roxboro.

“We’re a close bunch,” he says. “I was just so happy to have been there with them over the holidays.”

Dennis has to go back for an appointment in a few months because of a leaky valve and three more arteries that are 40 percent blocked. He hopes that medication will help prevent another surgery. In the meantime, he’s glad to be working again at the Hillsborough hospital.

“Everyone in my department was supportive,” he says. “It’s a nice bunch of people working here and everything is state of the art – it’s fun to come to work.”

by Zach Read - zachary.read@unchealth.unc.edu

UNC enrolling patients in Momentum 3 Clinical Trial

UNC is one of 60 medical centers nationwide chosen to participate in the MOMENTUM 3 Clinical Trial to evaluate the effectiveness and safety of the Thoratec® HeartMate 3™ Left Ventricular Assist Device (LVAD). This multi-center study will compare the HeartMate 3 LVAD to the HeartMate II® LVAD in advanced stage heart failure patients.
UNC enrolling patients in Momentum 3 Clinical Trial click to enlarge Jason Katz, MD

Media Contact: Jamie Williams, jamie.williams@unchealth.unc.edu, 984-974-1149

The HeartMate 3 is an investigational implantable device that helps to circulate blood throughout the body. Occasionally referred to as a “heart pump”, it is designed to supplement the pumping function of the heart in patients whose hearts are too weak to adequately circulate blood on their own. The Thoratec HeartMate II is the most commonly implanted LVAD and has supported well over 20,000 patients with end-stage heart disease but, Jason Katz, MD, said that the HeartMate 3 investigational device has many added features that may help to reduce the risk of complications and improve patient outcomes.  The MOMENTUM 3 Clinical Trial is designed to evaluate the performance and safety of the HeartMate 3 at six months of LVAD support in subjects with advanced heart failure.*

Katz, director of Cardiovascular Clinical Trials and medical director, UNC Mechanical Heart Program, said that cardiologists across the UNC Health Care system should consider referring their patients with advanced, left ventricular heart failure for consideration of enrollment in this trial. Patients who would qualify are those who have had frequent hospitalizations and a declining quality of life.  

Katz, is one of two principle investigators conducting the trial – along with Brett Sheridan, MD, surgical director of Mechanical Circulatory Support and Transplantation. He added that the novel study design of this trial may allow for greater patient eligibility and enhanced device applicability.

“Historically, studies have separated patients into categories based on whether or not they are transplant eligible. This study includes patients in both categories and we are hopeful that broad eligibility will lead to robust enrollment,” Katz said.

At UNC Hospitals, six study participants have already enrolled in the trial, and enrollment will continue until the 60 participating sites enroll just over 1,000 patients. The device is being evaluated for long-term support for patients who are not candidates for cardiac transplant as well as for short-term support as a bridge to cardiac transplantation.

Katz said several technological advancements make the HeartMate 3 a potentially exciting development for both patients and physicians.

“There are several features of the investigational device researchers hope will work better with the body and the blood [during and after the surgical implantation].  These features may help to reduce risk factors like bleeding and stroke which have plagued the field of mechanical support,” Katz said.  The MOMENTUM 3 Clinical Trial will be evaluating the effectiveness and safety of the HeartMate 3 to determine whether these features will reduce the risk of complications and improve patient outcomes as compared to the currently approved model, the HeartMate II. 

The results of the first 50 patients participating in a trial in Europe, the HeartMate 3 CE Mark clinical trial, were recently presented at the Heart Failure Society of America National Conference, and, Katz said the results were positive.

 To be considered for the MOMENTUM 3 Clinical Trial, patients:

• will have heart failure symptoms that are difficult to manage, even with medical treatment

• are unable to perform physical activity without discomfort

• have noticed a decline in quality of life due to the disease

• have been hospitalized one or more times for heart failure in the past six months

All randomized subjects will be followed for 24 months or to outcome (transplant, explant, or death), whichever occurs first.

Physicians who would like to refer patients to the clinical trial team should utilize the UNC Center for Heart & Vascular Care’s Open Access Referral System. This one-call referral service can be reached at (866)862-4327. More information is also available here.

For more information regarding the MOMENTUM 3 Clinical Trial visit http://www.thoratec.com/vad-trials-outcomes/ongoing-clinical-trials/hmiii-usa.aspx.

* US: Caution: Investigational Device: Limited by Federal United States law to investigational use.

How HeartMate 3 Works:

The HeartMate 3 LVAS includes a Full MagLev™ centrifugal blood pump and is designed to supplement the pumping ability of the weakened heart’s left ventricle, which is responsible for pumping oxygen-rich blood from the lungs throughout the body. The device is implanted above the diaphragm, immediately next to the native heart, and is attached to the aorta (the main artery that feeds blood into the entire body), leaving natural circulation in place while providing all of the energy necessary to propel blood throughout the body. The patient wears an external, wearable controller and battery system that powers the pump. The HeartMate 3 LVAS can pump up to 10 liters of blood per minute.

New Device will make TAVR procedure available to more patients

UNC’s Center for Heart & Vascular Care has been offering Transcatheter Aortic Valve Replacement (TAVR) for less than a year. In that time, the team has built a national reputation for excellence, allowing UNC to be among the first phase of the rollout of a next generation TAVR device, Evolut-R, developed by Medtronic. This valve is the first repositionable transcatheter valve ever available.
New Device will make TAVR procedure available to more patients click to enlarge UNC's TAVR Team (L to R): John Vavalle, MD, Thomas Caranasos, MD, Michael Yeung, MD, Cassie Ramm, MSN, RN, AGPCNP-C
New Device will make TAVR procedure available to more patients click to enlarge Judith Merritt

By Jamie Williams, jamie.williams@unchealth.unc.edu

“When we learned that this device was nearing approval, we obviously wanted to bring it to UNC as soon as possible. To be included in the first phase of the rollout is a great testament to our team and the confidence Medtronic has in our new program,” said John Vavalle, MD, assistant professor of Medicine in the Division of Cardiology.

TAVR provides a treatment option for aortic valve replacement for many patients who previously had no other options or were at high risk for conventional open heart surgery. With TAVR, physicians have the ability to provide aortic valve replacement via minimally-invasive approaches, providing outcomes that are just as good as, and sometimes better than, surgical valve replacements.

Vavalle called the new device a “game changer” that will open the procedure up to more patients and add an additional level of patient safety.

“The least invasive way to do TAVR is through the femoral arteries in the groin, but the patient’s arteries have to be large enough to accommodate the delivery sheaths,” Vavalle said. “Since this new delivery system is much smaller, the femoral approach will be available to more patients.”

In fact, the first patient who received the TAVR procedure with this new device would not have qualified for TAVR if UNC was not able to offer this new technology, and was previously turned away from two other experienced TAVR centers in the area.

But, Judith Merritt of Evergreen, North Carolina, was able to receive TAVR at UNC. Only hours after her procedure, she was up and walking around her hospital room, and was home from the hospital after only a few days.

“I really couldn’t ask for anything better than the care I received here at UNC,” Merritt said. “Without this I don’t know what I would have done.”

Vavalle said without TAVR Merritt would have required an open heart procedure, which would have presented tremendous risk and prolonged recovery for the 71-year-old.

“For her, this was a tremendous advantage,” Vavalle said. “This new technology made her a TAVR candidate at UNC, whereas previously it may have been too risky. She has done remarkably well.”

Thomas Caranasos, MD, assistant professor of Cardiothoracic Surgery, another member of the TAVR team, added that this new device is also much safer due to the fact that the operators have the ability to recapture and reposition the valve once it has been deployed.

“Previously, you had one shot to get it right,” Caranasos said. “With this valve you have the ability to recapture and reposition it, which adds a new level of safety to the procedure.”

The UNC TAVR team looks forward to continued success and rapid growth of their program, and are appreciative that both patients and developers of TAVR technology have already recognized UNC as a leader in the field.


UNC’s Wolfgang Bergmeier, PhD, earns Bridge Grant

The American Society of Hematology fills gap in decreased federal funding, supports 13 blood research projects.
UNC’s Wolfgang Bergmeier, PhD, earns Bridge Grant click to enlarge Wolfgang Bergmeier, PhD

Earlier this year, Wolfgang Bergmeier, PhD, professor of biochemistry and biophysics in the UNC School of Medicine, discovered that the protein Rasa3 is critical during the process by which the anti-clotting drug Plavix dissolves arterial clogs that trigger heart attacks. This week, Bergmeier received funding to continue researching the complex mechanisms involved in heart-related conditions. He was one of 13 recipients of an American Society of Hematology Bridge Grant, a one-year, $150,000 award designed to bridge the gap between an investigator’s National Institute of Health (NIH) grants.

The NIH is the world’s top provider of medical research grants, but a decade of flat funding followed by across-the-board spending cuts has drastically reduced the agency’s budget. As a result, the NIH is no longer able to fund as many high-scoring proposals as it did in the past. This has led to vigorous competition for NIH R01 awards and prevents otherwise worthy projects from receiving vital financial support. In some cases, this means that important veins of research must be halted.

In an effort to preserve hematology research projects amid this uncertain funding environment, in 2012 the American Society of Hematology (ASH) committed $9 million to create the ASH Bridge Grant program, which is designed to allow researchers to continue their critical work while obtaining additional data to strengthen their grant applications. Since the beginning of the program, ASH has funded 74 researchers.

“When NIH does not have the adequate funds to support medical research, science loses,” said ASH President David A. Williams, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School. “When scientists aren’t funded, they spend more time applying for alternative grant funding than on scientific research and discovery, and some must reduce the size or close their laboratories completely. This environment endangers not only existing programs, but also the next generation of scientists who are growing disheartened with the field and abandoning research careers for other paths.”

Research projects supported by ASH’s latest bridge grants encompass a wide range of basic, clinical, and translational hematology research. Funded projects include exploring the role of a protein in malaria formation, the molecular genetics of a congenital bone marrow disease, and a treatment for infant leukemia.

Bergmeier said he will use the grant to investigate the mechanisms that control the adhesiveness of circulating blood platelets. A better understanding of these processes is relevant for our understanding of platelet activity associated with certain diseases and the antithrombotic activity of drugs that affect platelet signaling.

“This ASH Bridge Grant will help our lab tremendously, as it will bridge a gap in our NIH funding and allow us to continue this clinically very relevant line of research” Bergmeier said. “Our long-term goal is to improve the treatment for patients with cardiovascular disease. The development of improved therapies, however, depends on continuous support for basic science projects, mostly provided by the NIH. Unfortunately, these grants are harder and harder to obtain.”

Williams said, “The revolution we are experiencing in new treatments for many blood diseases and blood cancers has been made possible by the funding of research over the past several decades. While ASH is proud to help sustain important hematology research that ultimately benefits patients during this significant downturn in federal support, there is no substitute for an NIH grant.

“We urge lawmakers to work together and arrive at a bipartisan solution that replaces sequestration with a balanced approach to deficit reduction and allows necessary funding increases for NIH. Such funding is critical for continuing America’s pre-eminence in biomedical research, stimulating employment in high-tech jobs and – most importantly – improving and extending the lives of our patients.”

Read more about Bergmeier’s work.

Visit the ASA website to view the complete list of ASH Bridge Grant recipients.

To make a donation, or take action in support of federal funding for biomedical research, visit here.

The American Society of Hematology (www.hematology.org) is the world’s largest professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems by promoting research, clinical care, education, training, and advocacy in hematology. The official journal of ASH is Blood, the most cited peer-reviewed publication in the field.

UNC researchers find two biomarkers linked to severe heart disease

The finding published in PLoS One suggests that elevated oxidized LDL cholesterol and fructosamine – a measure of glycated proteins in blood sugar – are signposts for the development of severe coronary disease, especially in females.
UNC researchers find two biomarkers linked to severe heart disease click to enlarge Left: moderate heart disease with limited arterial blockages in the heart of a pig. Right: severe disease with several near-total blockages. The two biomarkers were greatly elevated only in severe disease.

Media contact: Mark Derewicz, mark.derewicz@unchealth.unc.edu, 919-923-0959 

July 6, 2015

CHAPEL HILL, NC – Insulin resistance affects tens of millions of Americans and is a big risk factor for heart disease. Yet, some people with the condition never develop heart disease, while some experience moderate coronary blockages. Others, though, get severe atherosclerosis – multiple blockages and deterioration of coronary arteries characterized by thick, hard, plaque-ridden arterial walls. Researchers at the UNC School of Medicine created a first-of-its-kind animal model to pinpoint two biomarkers that are elevated in the most severe form of coronary disease.

The study, published today in the journal PLoS One, suggests two new targets – oxidized LDL cholesterol and glycated proteins (i.e., fructosamine or hemoglobin A1c) – that researchers can further investigate and perhaps target through medications to help people with insulin resistance avoid the worst kind of heart disease.

“If these correlations were also found in insulin resistant humans, then we would want to do everything we could to treat them because they would be at a very high risk of developing severe cardiovascular disease,” said Timothy Nichols, MD, professor of medicine and pathology and first author of the PLoS One paper.

Interestingly, Nichols and his colleagues did not set out to pinpoint the two key biomarkers. They wanted to create an insulin resistant animal model that mimicked human heart disease. They chose pigs, which are metabolically similar to humans and have hearts very much like human hearts. By feeding the animals a diet high in fat and salt over the course of a year, all the pigs became insulin resistant. That is, their bodies produced a lot of insulin but their cells did not respond to the hormone as well as normal. All the pigs also developed coronary and aortic atherosclerosis. But only about half of the pigs developed the most severe form of the disease.

When the researchers checked the pigs for high levels of insulin resistance, they found no correlation with the most severe atherosclerosis. This was a surprising and unexpected finding.

David Clemmons, MD, the Sarah Graham Kenan Professor of Medicine, professor of biochemistry and biophysics, and senior author of the PLoS One paper, knew that the scientific literature suggested a correlation between atherosclerosis and glycated proteins – proteins bonded with sugars in blood.

Clemmons and colleagues tested the pigs for high levels of fructosamine and oxidized LDL cholesterol, which are surrogates for high levels of glycated proteins. Sure enough, all the pigs with severe heart disease had elevated levels of fructosamine and oxidized LDL.

“Also, this correlation was more common in females,” Clemmons said. Fourteen of the 20 pigs that developed severe atherosclerosis were females. Fourteen of the 17 pigs that did not develop severe atherosclerosis were male. “This surprised me, so I looked in the literature for anything similar.”

Clemmons found a study from Finland published in 2005 showing that elevated glycated protein levels were strongly associated with advanced heart disease and increased mortality in women but not in men.

“The underlying causes of this correlation are unknown,” Clemmons said. “But now we have a unique animal model that very much mimics what we see in humans. Our model is a good predictor of diet-induced atherosclerosis in females.”

A next step could be to study the affected heart tissue to find abnormal biochemical reactions in the cellular pathways involved in glycated proteins and severe coronary disease.  This could lead to potential new treatment approaches or tailored dietary interventions.

Clemmons added, “We could also study what’s different about these female pigs that make them much more susceptible to severe heart disease, if they have higher levels of glycated proteins.”

The National Institutes of Health and the North Carolina Biotechnology Center funded this research.

Timothy Nichols, MD is a physician at the UNC Heart and Vascular Center and director of the Francis Owen Blood Research Laboratory. David Clemmons, MD, is a member of the UNC Diabetes Care Center.

UNC Receives $15M AHRQ Award to Advance Heart Health in NC Primary Care

UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project is one of seven grantees awarded as part of the AHRQ initiative, EvidenceNOW – Advancing Heart Health in Primary Care.
UNC Receives $15M AHRQ Award to Advance Heart Health in NC Primary Care click to enlarge Dr. Sam Cykert

Chapel Hill NC (May 26, 2015) – The University of North Carolina at Chapel Hill and a cooperative team of health care and quality improvement experts were recently awarded a $15M federal grant from the Agency for Healthcare Research and Quality (AHRQ) to help primary care practices use the latest evidence to improve the heart health of millions of Americans. UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project is one of seven grantees awarded as part of the AHRQ initiative, EvidenceNOW – Advancing Heart Health in Primary Care, which supports the broad U.S. Department of Health and Human Services (HHS) effort for Better Care, Smarter Spending, and Healthier People, and is aligned with the Departments’ Million Hearts® national initiative to prevent heart attacks and strokes.

“The goal of the EvidenceNOW initiative is to give primary care practices the support they need to help patients live healthier and longer,” said HHS Secretary Sylvia M. Burwell. “By targeting smaller practices, we have a unique opportunity to reduce cardiovascular risk factors for hundreds of thousands of patients, and learn what kind of support results in better patient outcomes.”

Heart disease is the leading cause of death for men and women in the United States. In North Carolina, the latest data show an annual cardiovascular death rate of 263 per 100,000, explaining almost one-third of deaths in the state, more than any other cause. To successfully prevent heart attacks it is critical that health care professionals work with patients to adopt the ABCS of cardiovascular prevention: Aspirin use by high risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation. New evidence is continually evolving about how to best deliver the ABCS. The goal of this initiative is to ensure that primary care practices have the evidence they need and use it to help patients live healthier and longer.

As part of the EvidenceNOW- Advancing Heart Health in Primary Care, Heart Health Now! is composed of public and private partnerships and multidisciplinary teams of experts that will recruit and engage 250-300 small, independent primary care practices and provide quality improvement services typically not available to them because of their size. These services include onsite practice facilitation and coaching, expert consultation, shared learning collaboratives, and electronic health record support.

“I’ve cared for many people throughout my career who suffered the debilitating effects of a heart attack or stroke way too early,” said Sam Cykert, MD, professor of medicine, Division of General Internal Medicine and director of the Program on Health and Clinical Infomatics at UNC-Chapel Hill. “Because of the lack of sophisticated information systems and processes that could quickly identify risk and prioritize new evidence for care, many of these folks missed opportunities that could have prevented the paralysis, shortness of breath and death that often resulted from premature disease. By partnering with North Carolina practices to build in the needed supports, we have the potential to prevent thousands of heart attacks, strokes, and deaths within a few short years.”

Heart Health Now! is based at the Cecil B. Sheps Center for Health Services Research in partnership with the NC Area Health Education Center (AHEC) Program’s Practice Support Services, the UNC School of Medicine, Community Care of North Carolina (CCNC) and its family of Informatics Services . AHEC and CCNC have already built a standard of success in these areas. To learn more, visit

While Heart Health Now! will conduct an internal evaluation, AHRQ also awarded a grant to the Oregon Health and Science University (OHSU) to conduct an independent national evaluation of the overall EvidenceNOW initiative. The team will study the impact of the EvidenceNOW interventions on practice improvement and the delivery of cardiovascular care. In addition, the evaluation team will study which practice supports and quality improvement strategies are most effective in improving the implementation of new evidence.

UNC’s grant will run for three years and the evaluation grant for four years. Together, these grants represent one of the largest research investments to date by AHRQ. For more information about AHRQ’s EvidenceNOW initiative, including details on each of the grantees and cooperatives, visit: http://www.ahrq.gov/evidencenow.html. To read the full summary of UNC’s project, go to: http://www.shepscenter.unc.edu/project/heart-health-now-advancing-heart-health-in-nc-primary-care/

EvidenceNOW supports AHRQ’s overall mission to ensure that evidence is understood and used. Funding for this initiative comes from the Patient-Centered Outcomes Research Trust Fund created by the Affordable Care Act and supports AHRQ’s mandate to disseminate and implement patient-centered outcomes research findings so that new findings are integrated into the delivery of health care.

For more information about Million Hearts, visit http://millionhearts.hhs.gov/index.html.



Media Contact: Sonya Sutton, Sheps Center Communications Specialist. 919-962-4714; ssutton@unc.edu 

High mortality associated with STEMI heart attacks that occur in hospitalized patients

A new study by UNC researchers confirms their surprising earlier finding: Patients who suffer a STEMI heart attack while while in the hospital for something else are more likely to die than patients who have the same type of heart attack outside the hospital.
Dr. George A. “Rick” Stouffer

Media contact:  Tom Hughes, 984-974-1151,

Sunday, November 16, 2014

In 2013, University of North Carolina School of Medicine researchers published a study with a surprising finding:  Patients who suffered an ST elevation myocardial infarction (STEMI) heart attack while in the hospital for something else are more likely to die than patients who had the same type of heart attack outside the hospital.

Today the UNC researchers published a new study, based on data from more than 62,000 patients treated at hundreds of hospitals in California, which confirms their earlier finding.

“This study is the largest ever performed on patients who have a heart attack while they are in the hospital for a non-heart related condition,” said George A. “Rick” Stouffer, MD, chief of cardiology at UNC and senior author of the study, published today (November 16, 2014) by the Journal of the American Medical Association.

In the new study, Stouffer and his co-authors analyzed data from the California State Inpatient Database, which included 62,021 STEMI patients treated in 303 California hospitals from 2008 to 2011. Of these patients, 3,068 (4.9 percent) suffered a STEMI while hospitalized for conditions that were not heart-related. A STEMI occurs when an artery in the heart is suddenly and completely blocked. This type of heart attack is considered to be more serious and life-threatening than a non-STEMI heart attack, in which a coronary artery is severely narrowed but is not completely blocked.

The new study found that patients who developed STEMI while hospitalized were more likely to be older and female, and less likely to be treated with measures that are routinely used for patients who suffer a STEMI outside the hospital, such as cardiac catheterization or angioplasty. In addition, the hospitalized patients were three times more likely to die than those who were not in the hospital when their STEMI started.

“There are several reasons why the mortality rate is so high in patients who have a STEMI while in the hospital," Stouffer said. "The patients are older and have more co-morbidities such as lung or kidney disease than do patients who have a STEMI outside of the hospital. But our study shows that the use of percutaneous coronary intervention was associated with a lower mortality rate, even in the highest risk patients. This finding, along with our earlier observation that recognition of STEMI in hospitalized patients is often delayed, suggests two areas in which the care of these patients can be improved."

First author of the study is Prashant Kaul, MD, assistant professor of cardiology in the UNC School of Medicine. Co-authors are Jerome J. Federspiel, PhD; Xuming Dai, MD; Sally C. Stearns, PhD; Sidney C. Smith Jr., MD; Michael Yeung, MD; Hadi Beyhagi, MD; and Lei Zhou, MD.

All of the authors are UNC faculty with appointments in the School of Medicine, the McAllister Heart Institute, the UNC Gillings School of Global Public Health and the Sheps Center for Health Services.

Popular cancer drug target implicated in cardiovascular defects

Research led by UNC’s Kathleen Caron, PhD, shows that halting the protein CXCR7 leads to over activation of adrenomedullin, a hormone needed at proper levels for normal cardiovascular development

Media Contact: Mark Derewicz, 919-923-0959, mark.derewicz@unchealth.unc.edu

September 8, 2014

Kathleen Caron
Kathleen M. Caron, PhD, Department of Cell Physiology and Physiology
CHAPEL HILL – UNC School of Medicine researchers have discovered an unlikely relationship between CXCR7 – a protein implicated in tumor growth and metastasis – and adrenomedullin – a hormone involved in cardiovascular health. Deleting CXCR7 allows adrenomedullin to run rampant, triggering the development of an enlarged heart and the overgrowth of the lymphatic vessels that traffic immune cells and fluids throughout the body.

The study, published September 8 in the journal Developmental Cell, reveals that CXCR7 binds to the ligand adrenomedullin. The UNC research suggests that this relationship is important because CXCR7 has become a popular candidate for cancer-drug developers. The UNC paper also provides a novel and unexpected role for CXCR7 in lymphatic vessels, which are largely understudied, but play critical roles in inflammation, edema, and tumor metastasis.

“Our results suggest that inhibiting CXCR7 with a drug is also likely to influence the adrenomedullin peptide and may unexpectedly and negatively affect lymphatic vessels,” said senior study author Kathleen M. Caron, PhD, professor and chair of the department of cell biology and physiology. “Lymphatic vessels can function as highway conduits for the spread of cancer cells through the body, so being aware of how a potential drug might influence the function of these vessels is critically important.” 

Most receptor proteins act like molecular mailboxes that sit on the surface of the cell; they take in signaling molecules from nearby tissues and then transmit their messages into the cell, where specific commands are carried out, such as helping fight an infection or spurring tumor growth.

CXCR7 is different. It’s part of a rare class of proteins known as decoy receptors, which look like typical molecular mailboxes on the surface, but rather than transmitting messages, they chew them up like a trash compactor would. These decoy receptors destroy any excess signaling molecules in order to keep biological processes like inflammation and tissue development in check.

In 2007, several groups of biologists around the world began to knock out the CXCR7 gene in mice to try to understand its function. Because the CXCR7 gene is “turned on” in lymphocytes – a type of white blood cell – researchers expected the mice to have defects in their B and T cells, which would result in an underperforming immune system. Instead, the researchers discovered that the mutant mice had severe heart and valve defects and died shortly after birth.

KCaron-heartsCaron had previously seen the same defects in mouse models that contained three times the normal amount of the protein adrenomedullin. She began to contemplate the possible relationship between CXCR7 and adrenomedullin. Caron remembered literature from the 1990’s that had suggested a link between the two. Back then, CXCR7 was going by another name – RDC1 – so it wasn’t surprising to Caron that other researchers might not have made the same connection.

“One of the fun things about being in a field for a long time is you carry this historical literature with you,” said Caron, a member of the UNC Lineberger Comprehensive Cancer Center and the UNC McAllister Heart Institute. “I remembered that RDC1 was once thought to be an adrenomedullin receptor, and so we put together the pieces from that paper and the more recent findings to address a new and unexpected hypothesis.”

Caron asked Klara Klein, a graduate student in her laboratory, to help prove the connection once and for all. First, Klein performed a biochemistry experiment to show that the CXCR7 decoy receptor would bind and destroy the adrenomedullin peptide. Klein took cultured cells, made sure that they expressed the CXCR7 receptor, and then added adrenomedullin. She took out samples of the media at different times, measured the amount of adrenomedullin, and then calculated how much of the peptide was left. Klein found that the adrenomedullin was gradually depleted over time. In contrast, when she added the peptide to cells that didn’t express the CXCR7 receptor, the levels of adrenomedullin remained the same.

Klein then obtained a litter of CXCR7 mutant mice and confirmed that they did in fact have enlarged hearts. She also discovered that the mice had an overgrowth of lymphatic vessels. This made sense, if excessive adrenomedullin was implicated.

“The fact that these two types of mice had nearly identical effects suggested that adrenomedullin may be more than just another signal-triggering molecule,” Caron said. “It may be the CXCR7 receptor’s number one binding target.” Klein and Caron thought that if the main role of CXCR7 was to control the amount of adrenomedullin, then they should be able to reverse cardiovascular defects by reducing the amount of adrenomedullin. To do so, they mated the CXCR7 knockout mice with mice that had half the normal amounts of adrenomedullin. Caron’s team found that mice progeny had normal-sized hearts, and the lymphatic vessels of the mice were not overgrown.

“When you get rid of the CXCR7 receptor, you’re essentially getting rid of the brake that slows down adrenomedullin’s effects,” Caron said. “If they don’t have the brake, but at the same time you lay off the gas, then you normalize the size of the heart and lymphatic vasculature.”

Caron, who has had a long-term interest in the role of adrenomedullin in pregnancy, now wants to see how CXCR7 controls the dosing of this hormone in the placenta. She previously showed that adrenomedullin is responsible for recruiting the mother’s immune cells that infiltrate the placenta. Because dysregulation of the immune system during pregnancy underlies the majority of pregnancy complications – such as preeclampsia, preterm birth, and spontaneous abortion – understanding the role of the receptor in charge of tempering that innate immune response could lead to her lab’s next big breakthrough.

This research was supported by the American Heart Association and the National Institutes of Health.

Other UNC co-authors of the Developmental Cell paper include Natalie Karpinich, PhD; Scott Espenshied; Helen Willcockson; William Dunworth, PhD; Samantha Hoopes, PhD; Erich Kushner, PhD; and Victoria Bautch, PhD.

The UNC Center for Heart & Vascular Care implants UNC’s first ‘under-the-skin’ cardiac defibrillator

The subcutaneous implantable cardioverter defibrillator minimizes risks during implantation and reduces the risk of infection.

Chapel Hill, N.C. – July 31, 2014 – A newly developed ‘under-the-skin’ cardiac defibrillator was recently implanted in a patient from Creedmoor, N.C., by UNC electrophysiologist Jennifer Schwartz, MD, assistant professor and clinician in the UNC Center for Heart & Vascular Care. It is the first time the procedure has been performed at UNC Health Care.

The subcutaneous implantable cardioverter defibrillator (S-ICD) from Boston Scientific® is designed to detect an abnormal heart rhythm with thin, insulated wires, known as ‘leads’, that are placed under the skin, not inside the heart chambers, as is found with traditional implantable cardioverter defibrillators (ICDs). The S-ICD mimics an external defibrillator by providing an electric shock when a dangerous heart rhythm is detected.

Read the full story... 


In the Gazette: Inspiring heart health in the ‘stroke belt’

Alice Ammerman, PhD, a professor of nutrition in public health and director of Carolina’s Center for Health Promotion and Disease Prevention, reached out to county health officials along with her colleagues and built a project that helps encourage healthy living in Lenoir County.
In the Gazette: Inspiring heart health in the ‘stroke belt’ click to enlarge Alice Ammerman, PhD

Lenoir County is tucked into the eastern part of the state, about 75 miles east of Raleigh, with a population of around 57,000. If you’re headed to the coast, you’re likely to pass through.

“We welcome everybody with open arms,” said Laura Lee Sylvester, the president of the Kinston-Lenoir County Chamber of Commerce. “That’s what makes us stand out – we really take care of each other, no matter who you are or where you live.”

The tight-knit community is also facing a health crisis. Located in what is recognized as the “stroke belt,” its residents experience significantly higher rates of cardiovascular disease, stroke and obesity rates compared to other parts of the state and nation.

Alice Ammerman, a professor of nutrition in public health and director of Carolina’s Center for Health Promotion and Disease Prevention (HPDP), took notice. She and her colleagues reached out to county health officials to learn more about the county’s specific needs and the initiatives already in place, and for nearly five years now, this community has been the focus of Heart Healthy Lenoir.

Read full article

Patient's heart story is one of celebrations and setbacks

Seventeen-year-old cardiac patient, Courtney, has celebrated many victories and felt the sting of setbacks on her journey to receiving a new heart. In 2013, Courtney was placed with a ventricular assist device (VAD) at N.C. Children's Hospital, but the celebration was temporary. Now, Courtney's family looks ahead to the next challenge: a heart transplant.

, 17, is like most teenagers. She likes to spend time with her friends. She enjoys playing the piano. She loves her 1-year-old rat terrier puppy. She hopes to get into her dream college and start life as an independent young adult.

But Courtney also deals with health concerns most teenagers never think about—not least of which is a question important to her immediate future: when am I going to get my heart transplant?

A lifetime journey

Courtney was born at a community hospital in Tarboro, N.C. in 1996. A few days after her parents, Debi and Scott, took her home from the hospital, they noticed her breathing was loud and that she had difficulty eating and breathing at the same time.

“We took her to the pediatrician, and they sent her to Pitt Memorial Hospital in Greenville,” says Debi. “They heard some murmurs in her heart and at that point, the pulmonologist at Pitt referred her to the pediatric pulmonology and cardiology team at UNC. It wasn’t a big emergency at that point. There was no NICU or PICU. It was just a watch her and wait kind of thing.”

Courtney was diagnosed with an atrial septal defect, a congenital heart defect that's commonly called “a hole in the heart.” The pediatric cardiology team at UNC repaired it in May 1997, but in January of 1998, Courtney went into heart failure.

“The doctors in the PICU back then just did everything in their power with medicines and treatments to keep Courtney’s heart going without having to transplant,” says Debi. “And because of the doctors and the therapies and, of course, prayer, her heart regained function.”

In the years since, Courtney has been a frequent visitor to N.C. Children’s Hospital, visiting pulmonologists, cardiologists, audiologists, neurosurgeons and neurologists, endocrinologist, orthopaedists, geneticists and even dentists. But it wasn't until the summer of 2013 that her condition became more serious once again.

In June, Courtney was admitted for surgery to replace the mitral valve in her heart. Cardiothoracic surgeon, Michael Mill, MD, didn’t have to perform a full replacement, however, and was instead able to fix her existing mitral valve.

“We went home,” says Debi. “Courtney started applying for jobs. She got her driver’s license. She turned 17. We thought she was on her way to having a bright future.”

As summer wore on, however, Courtney wasn't feeling quite herself.

“Sometime in August, she started getting really tired again,” says Debi. “We went to her doctor here [in Nashville, N.C.], and they sent us to Chapel Hill. Lo and behold, she was in heart failure.”

Courtney was admitted to pediatric intensive care, her family devastated as they watched her condition deteriorate by the day. Desperate to save her life, Courtney's medical team at UNC tried something they don't often attempt with pediatric patients: they implanted a left ventricular assist device (LVAD).

Usually a treatment reserved for adults, the LVAD, a pump that keeps Courtney's left ventricle functioning, is a temporary solution until Courtney can get a heart transplant. Adults can live with LVADs for up to two years.

“It was a big moment for everyone,” remembers Debi of the successful surgical procedure. “It was a big moment for us as parents, because she survived as a result of this pump. We were all celebrating, but I was more focused on celebrating the fact that they had saved my child.”

Courtney's doctors were impressed with the bravery she showed in the face of such a serious a situation.

“The evening of her surgery, she woke up calmly, her breathing tube in place, and asked for a pen and paper,” remembers Courtney's cardiothoracic surgeon, Jennifer Nelson, MD. “On that paper, the first thing she wrote was, 'Thank you. Courtney'. I still have a picture of that note. Every time I look at it, I am blown away by her bravery.”

“It made me cry. It made her mom cry. It was awesome," adds Courtney's crical care doctor, Benny Joyner, MD.

“Within a week, she was sitting up, attempting to eat, and within a month, she was walking."

Courtney’s LVAD is connected to her at all times. It hooks up to a controller that functions using batteries or an electrical outlet. Courtney puts the machine in a backpack that she takes with her everywhere she goes.

“Showers are difficult. Getting from point A to point B is more difficult,” says Debi. “But at the same, we’re so thankful. I’m just so glad she had an option.”

“It’s hard going through all of this,” says Courtney. “I’m missing a lot in my personal life. I could have done more extracurricular activities if it wasn’t for this health stuff. I wish I could spend more time with my friends.”

But, says Debi, even though it’s hard for Courtney, the family maintains a positive outlook on her medical challenges.

“We could have a poor-me attitude or sulk about it,” says Debi. “But Courtney’s been dealing with something all the time, for the past 17 years."

“Courtney is no ordinary young lady,” adds Dr. Joyner. “Her journey has been a difficult one, with time spent in and out of the hospital for a variety of ailments. But all the while she's maintained a stellar school record and a love for math.”

“Courtney is one of the most gracious, kind-hearted, 'glass-half-full' patients I have ever cared for,” adds Dr. Nelson. “It was incredibly inspirational to see Courtney improve after receiving her VAD. Watching her get up to walk after weeks of struggling just to turn in bed was a great moment for our whole team. Before long, her mother showed us videos of Courtney dancing along with Dance, Dance Revolution in the hospital. It was hard to hold back tears.”

The road ahead

Unfortunately, Courtney’s heart journey, which began at UNC almost two decades ago, won’t end with her transplant at N.C. Children's Hospital. The family’s insurance company won’t cover the transplant in-network at UNC. It comes as a hard pill to swallow for the family.

“Our relationships at N.C. Children’s are priceless,” says Debi. “We know the campus with our eyes closed. We’re so comfortable her medical team. We trust them. They’ve known Courtney for 17 years, and they would do anything to keep her alive.”

“I have a great bond with my nurses” adds Courtney. “I’m Facebook friends with a lot of them, and we have great relationships with each other.”

Debi especially appreciates how the Children's Hospital staff treats the whole patient, rather than just the diagnosis.

Courtney and her family prepare for the next step in her heart journey: a transplant.“It’s so wonderful what they do to engage their patients,” says Debi. “There are so many things Courtney has to look forward to instead of just dreading all the tests and blood draws. It makes a big difference, they treat her on a personal level—and they take care of the family. We're important to them, too.”

“They made sure we knew where to get food, and they made sure to take care of her brother and us. Even if it’s just bringing us an extra cup of ice cream that they have in the freezer, they always took care of us.”

As Courtney faces a heart transplant at a different hospital, her mom feels sure that, despite leaving the comfort of N.C. Children’s Hospital, the staff at the new hospital will grow to love Courtney, too.

“The transplant process is moving along,” says Debi. “It’s not an emergency. Courtney could live with the LVAD for up to two years, but we know Courtney is ready to put this whole thing behind her.”

And even with the transplant, Courtney's heart journey won't be over.

“We know that a transplant isn’t a fix-all. It has to be cared for with medicine, procedures, tests,” says Debi. “We’ve been educated pretty well about it. But we have no choice. It will give her another 15 years or more to reach her goals. We know that a new heart doesn’t last forever, but we'll get to that when we get there. Right now, we want her quality of life to be the very best possible.”

In the meantime, as Courtney waits for her new heart, she looks forward to the future it will provide.

“I just want to be able to finish high school and go to college,” says Courtney. “I want to become a teacher at the deaf school. I love sign language—I taught myself using YouTube and books.”

As they reflect on Courtney’s heart journey to-date, the family is filled with gratitude.

“We thank everyone at the hospital for everything they’ve done,” says Debi. “Courtney wouldn't be alive without that heart working for her.”

Meet Dr. Timothy Hoffman, chief of pediatric cardiology

For Dr. Timothy Hoffman, there is nothing more important than community and the teamwork needed to provide optimal patient- and family-centered care.
Meet Dr. Timothy Hoffman, chief of pediatric cardiology click to enlarge Dr. Timothy Hoffman joined UNC Children's as chief of pediatric cardiology in March 2015.

It’s obvious that community and collegiality is important to Timothy Hoffman, MD. In conversation, it’s a concept that comes up often when he talks about his work at UNC Children’s and elsewhere.

“What’s impressed me most about the Division of Pediatric Cardiology is that this group is a family, and they have welcomed me and my wife, Pam (Pamela Ro, MD), with open arms.”

Dr. Hoffman is a recent addition to the division—joining UNC as chief of pediatric cardiology this past March—but he is outspoken about the quality program he found upon his arrival.

“I have been impressed with the level of care and the commitment to family-centered care,” reflects Hoffman. “It’s always been important to me that the family of a patient be involved as an integral member of the care team.”

Hoffman’s devotion to family and community was cemented in his own early days in Pennsylvania.

“I grew up in Pittsburgh in a blue collar family. We’re the sort of folks who all live within five miles of each other, but I’m the one who has done a bit of traveling,” he says with a laugh. “In fact, I went to Allegheny College which is 90 miles north of Pittsburgh and then to West Virginia University, which is 90 miles south, so I stayed close to home and family.”

After completing medical school at WVU, Dr. Hoffman remained at WVU for his residency and became chief resident. Although he would go to Children’s Hospital of Philadelphia for his fellowship training and first faculty job—and then on to Nationwide Children’s Hospital, where he spent 13 years and helped establish a heart transplant program—his affinity for his WVU “family” is apparent in his words and reflections.

“I got interested in pediatric cardiology while at WVU, primarily through the mentors I had there,” says Dr. Hoffman. “I was fascinated by the great level of care that had to be taken for these patients and how complex their cases could be. I learned that cardiology also gave you the ability to practice general pediatrics and all aspects of patient care.”

Dr. Hoffman specifically mentions Larry Rhodes, MD, now chair of pediatrics at WVU, as a man “who loves the care of children, especially those with heart disease.” Rhodes was in his time mentored by William Neal, MD, who also helped Dr. Hoffman chose his specialty.

“We talk about the role of mentors quite a bit,” reflects Dr. Hoffman. “They created quite a legacy at WVU and helped do great things in pediatric cardiology. Their legacy of care influences me. I’d like to do the same thing and build on the great foundation already here.”

Now at UNC, Dr. Hoffman is particularly interested in multi-level care.

“Pediatric cardiology is a discipline that involves so many other areas—cardiothoracic surgery, anesthesia, critical care, neonatology, oncology, just to name a few,” he says. “Because the services are so interlinked in how they care for these patients, I’d like to work toward collaborative services across departments and divisions and keep raising the bar on how we care for patients in North Carolina.”

“My vision is that in five years we will have expanded our regional and national footprint and enhanced the delivery of subspecialty services for the region,” he continues. “We also have a goal to be collaborating nationally and have faculty participate in multi-center initiatives to advance the field of cardiology.”

Dr. Hoffman is optimistic about these goals.

“Absolutely, we have been supported by hospital leadership, and the members of the division are on board. We’re a family, and we have the support we need to grow. This is an established division with energetic individuals providing the best care. From this strong foundation we will grow. Our goal is to enhance the overall service line, not only for the hospital but for the region and state.”

But no matter how much the division may grow, it all comes back to patient- and family-centered care.

“In this field, there are tremendous successes and also tragic challenges,” says Dr. Hoffman. “Every patient I’ve come in contact with has some impact on me in some way. It’s always been the joy of my job to talk to the families, getting to know them.”

“It makes you feel that you are special in their lives,” he continues, “And vice-versa. That’s the most heart-warming part of this job.”

With every beat of his heart

When 14-year-old Sam presented with a heart arrhythmia never before documented in the medical journals, pediatric electrophysiologist, Dr. Sunita Ferns, found herself facing the most challenging case of her career.

Fourteen-year-old, Sam, always knew he was a bit different from his peers.

"I always had shorter breath than the other kids; I always couldn't run as fast as the other kids," explains Sam. "I just couldn't keep up no matter what."

Dr. Sunita Ferns

His mother, Susan, just chalked it up to Sam being a bigger kid, even in middle school when he started experiencing periodic episodes that included headaches and nausea accompanied by shakes and chills.

"In retrospect, with what we know now, it all makes sense," says Susan. "But at the time, I wondered if he wasn't just trying to get out of school."

Everything changed during a visit to Sam's pediatrician's office in the family's hometown of Wilmington, N.C. An astute nurse practitioner examining Sam for a suspected case of bronchitis noticed pulsing in his neck and discovered Sam's heart rate was nearly twice as fast as it should be. These turned out to be important clues to a set of problems Sam had endured for years.

Sam was referred to James Loehr, MD, at UNC Children's cardiology practice in Wilmington. Testing revealed that Sam had supraventricular tachycardia (SVT), a condition that arises from improper electrical activity in the heart which presents as a rapid heart beat. Dr. Loehr referred Sam to Sunita Ferns, MD, MRCPCH, assistant professor of pediatric cardiology, who directs invasive electrophysiology program at N.C. Children's Hospital.

Dr. Ferns hugs Sam's mother, Susan, while his grandmother looks on following surgery. Click to enlarge.
Dr. Ferns knows this to be a very serious condition.

"This is like running a marathon for your entire life through the day and night," Dr. Ferns explains, "and with time the heart function begins to take a toll, and you develop heart failure."

Dr. Ferns also realized Sam's was a very unusual case. The problem was occurring right on top of the tissue that normally controls the electrical impulses of the heart.

"It's in an extremely unusual location,"adds Dr. Ferns. "They are usually in a location that's far away from the normal conduction system, so they can be taken care of easily."

Resolving the arrhythmia without damaging Sam's normal conductive tissue would be tricky, if it was possible at all. With no effective pharmaceutical options, Dr. Ferns faced a dilemma: attempt to surgically address the arrhythmia by burning the wayward synapses, which could likely leave Sam in need of a pacemaker, or to leave the condition alone, which would ultimately be fatal.

Sam goes for the basket following his surgery.
Complicating the decision was the fact that, despite an extensive search, the pediatric cardiology team couldn't find a single case like Sam's anywhere in the medical literature. Dr. Ferns and her team would be in completely uncharted territory with a surgical intervention, but complete heart failure some years from now was not an option.

Sam had his surgery at UNC Hospitals on Dec. 12, 2014. Using state-of-the-art equipment that measures heart tissue down to the tenth of a millimeter, Dr. Ferns and her team went to work on Sam's arrhythmia in a procedure that Dr. Ferns describes as "touch and go."

"I knew there was such a high risk of heart block, I was trying my best not to go off path," recalls Dr. Ferns.

She felt the case was a success, but only time would tell if the tissue was permanently destroyed or if it would regenerate and cause recurrent SVT. A post-operative visit with Dr. Loehr four weeks later confirmed what everyone hoped: Sam's surgery was a success.

Mom, Susan, beams when she talks of how much stamina Sam has now that his heart function is normal. For his 15th birthday in January, she got him a basketball hoop and enjoys watching Sam and his friends play pickup games out in the cul de sac in front of their house.

Sam, too, has noticed a big difference in how he feels. He is no longer missing school and is considering following in Dr. Ferns footsteps by one day pursuing a career in cardiology.

"Dr. Ferns is my hero," says Sam with a big smile. "She saved my life!"


While infant daughter, Taylor, was hospitalized for nearly two months after open heart surgery, mom, Tori, had to return home to Greensboro to work and care for her other children, but caregivers at N.C. Children's Hospital kept her part of her daughter's care across the miles.

Heartwarming: Nurses keep Greensboro mom connected to her baby from afar

Taylor was born with breathing problems so severe she was airlifted from her hometown hospital in Greensboro, N.C., to N.C. Children's Hospital in Chapel Hill, N.C.

Taylor had surgery that same day and open-heart surgery less than a week later. She then spent nearly two months at the Children's Hospital—first in the pediatric intensive care unit (PICU) and then the cardiac intermediate care center (CICC) on 5 Children's—recovering from her surgeries.

Her mother, Tori, could not stay in Chapel Hill with her newborn daughter but had to return home to work and care for her other children. Yet, thanks to the nurses at the Children's Hospital, she felt a part of Taylor's care and recovery, even when she could not be at her baby's bedside.

"They told me everything; I did not have to ask," says Tori. "They called and kept me informed every day, and that means a lot when you cannot be with your baby 24 hours a day. They would even call me in the middle of the night if they needed to."

Tori adds she also appreciates the level of care Taylor received.

"The nurses were wonderful," says Tori. "They took great care of her. UNC is a great hospital. They take very good care of their patients."

Today 11-months-old Taylor is a thriving girl who enjoys trying to keep up with her older brother and sister. Her most recent ultrasound in July, according to Tori, was excellent, and her cardiologist, Dr. Scott Buck, was able to decrease her medication.

"The cardiologist said it looks perfect, even better than the last ultrasound, which was also really good," reports Tori. "In fact, everything is going great with Taylor. She had a rough time there for a while, but everyone did an excellent job, and it's really easing up now."

Easing up health wise, perhaps, but Taylor is really giving her mom the runaround these days.

"She just started crawling this past weekend," laughs Tori. "She's was a little bit behind development-wise, which was expected because of all the time spent in the hospital, but she's just taking off."

Taylor doesn't have to travel far for follow-up care. She is able to see N.C. Children's Hospital cardiologists at their office in Greensboro.

"It is really nice to be able to see her UNC doctors so close to home," says Tori.

And the news keeps getting better. Tori reports Taylor's next follow-up visit is in October, during which Dr. Buck hopes to take her off of one of her medications, leaving her with just one.

More about Taylor

Hometown: Greensboro, NC; Guilford County — about 100 miles roundtrip
Diagnosis: Congenital heart defect; transposition of the great arteries
Primary pediatric specialties: Cardiology; cardiothoracic surgery; anesthesiology
Other pediatric specialties seen: Critical care medicine; general pediatrics; occupational therapy; speech therapy for feeding
Frequency of visits: Every three months at UNC's pediatric cardiology satellite clinic in Greensboro.
Favorite caregivers: Melissa Illig, PICU nurse, plus Casey, Kathy, Terri, and Lindy, also PICU nurses
Sara Dietz, speech therapist
Everyone in pediatric cardiology and cardiothoracic surgery, including surgical nurse practitioner, Karla Brown, and Dr. Michael Mill
Favorite thing about N.C. Children's Hospital: "They kept me inform of everything that was going on with her. I had to leave the hospital at night, but if anything was going on, even if it was 1:30 in the morning, they would call." ~ Taylor's mom, Tori

Cardiology care at N.C. Children's Hospital

The pediatric cardiology group practices through the N.C. Children's Heart Center centered at North Carolina Children's Hospital. It is the largest children's heart program in the state, offering innovative treatment to more than half of the state's pediatric heart patients.

The division's extramural clinical program is comprised of regional outreach clinics in several North Carolina cities, including outpatient clinics in Burlington, Cary, Fayetteville, Fort Bragg, Greensboro, Raleigh, Rutherfordton and Wilmington. Learn more about pediatric cardiology at UNC.

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The heart of the matter

Alj and his mom, Tina, have but one wish this holiday season: a new heart for Alj. Mother and son currently occupy a room on 5 Children’s, a dedicated team of medical experts keeping him stable until a donor heart becomes available for transplant. This is their story.
The heart of the matter click to enlarge Then and now: Tina recreates an image captured by the Daily Tar Heel during Alj's initial PICU stay 13 years ago.

The young man in room 5C24 is sitting upright in his hospital bed playing a video game, the picture of health. Somewhat slight in stature for a 13-year-old, Alj (pronounced “Al Jay”) Jeffries has radiant cocoa skin and warm, dark chocolate brown eyes. When asked a question, he is quick to offer a polite, soft-spoken response in a voice that is perhaps deeper than you might have expected. And almost always, he’ll flash that shy smile. It’s a smile that will steal your heart. And therein lies the irony.

To look at him, you’d never guess Alj is losing his 13-year battle against heart disease. His only hope of long-term survival: a heart transplant.

“He’s kept me calm through this whole storm,” says his mother, Tina Turner, a constant presence by his side, steadfast in her faith that the life-saving miracle for which they’ve been waiting will come in time.

Tina has held on to that faith since the very beginning of their medical journey, when at a mere 4 months of age, her bubbly baby boy became lethargic, his usual coos and giggles replaced by odd grunting sounds.

Alj’s grandmother was the first to raise the alarm. Something is seriously wrong with the baby, she thought, and took him to UNC Hospitals’ emergency department. An X-ray revealed Alj’s enlarged heart, so constrained in his tiny chest cavity, it was barely squeezing.

The official diagnosis was dilated cardiomyopathy, a disease in which the heart muscle becomes weak and enlarged, making it difficult to pump blood through the body. Although the exact cause is unknown, Alj’s family suspects his condition was genetically inherited. His half-sister, Carissa, 15 years older than Alj, also had heart disease and would later succumb to it at age 19, years after a heart transplant of her own.

Four-month-old Alj was admitted to the pediatric intensive care unit (PICU), the family told he likely wouldn’t make it through the night.

“We cried and cried and just held each other,” remembers Tina of their first stay in the PICU; there would be more in the years to come. “But then, something deep in my heart, it told me, no, he’s here for a reason. I gotta stay strong for him. I gotta stay positive for him.”

Tina has stayed strong and positive ever since—through that first PICU stay that spanned four months, through other hospitalizations they’ve had at N.C. Children’s Hospital, through innumerable outpatient appointments with Alj’s cardiologists and other specialists. Talking to Alj, it’s clear a mother’s faith and strength is contagious.

“I’m here for a reason and trying my best to stay strong for my mom and my brother and my dad,” says Alj. “Even though my heart is sick on the inside, I’m so strong on the outside.”

Alj with Dr. Buck
Alj with this pediatric cardiologist, Dr. Scott Buck. (Click to enlarge.)
Through the expert care provided by his UNC Children’s cardiology team, Alj has stayed as strong as he could for as long as he could. He’s received regular care and followed his doctors’ advice to the letter. That means Alj avoids strenuous physical activity, which includes fun things that kids his age regularly enjoy and take for granted—playing sports, riding a bike, or running. Despite the precautions taken, cardiomyopathy is a progressive disease, often leading to life-threatening heart beat irregularities, heart valve problems, blood clots, and even heart failure. 

In Alj’s case, his heart has taken him about as far as it can. He needs a heart transplant, and he needs it soon.

According to his pediatric cardiologist, Scott Buck, MD, an associate professor of pediatrics in the UNC School of Medicine, there are currently about 300 children waiting for a heart nationwide.

“It is inherently unpredictable,” says Dr. Buck of finding a suitable heart for Alj. “The wait can be days but most often it is weeks and even months—and each year about 50 kids succumb to illness [before receiving a transplant] due to lack of donor availability.”

The United Network for Organ Sharing (UNOS) oversees organ transplantation in the United States and is in charge of fairly determining who receives donated organs. Organs are assigned based on how sick a person is and how quickly he or she needs a new organ. Alj is classified as status 1A, the level of most critical need, but organs assignments also are based on best match for the organ donated. The organ has to be the right size for the person's body, for example, and the donor must have same blood type as the recipient.

“Alj’s heart function is severely impaired, which puts him at the highest status on the transplant list,” explains Dr. Buck. “But the good news is that, although he’s very sick, longevity after transplant is extraordinarily high, so we expect a great outlook for Alj after transplant.”

Dr. Buck encourages families to discuss and make decisions about organ donation before an unexpected life event puts them in the position of having to decide. In North Carolina, registering as an organ donor can be done simply through the Department of Motor Vehicles or via organizations like Donate Life North Carolina.

Alj with Mom
Says mom, Tina: I wish I could take his old heart and preserve it, because that heart is so precious, beautiful, warm, loving, and kind. (Click to enlarge.)
Knowing another person must die for her son to live has been difficult for Tina.

“I personally don’t want another’s loved one to pass away—I absolutely hate that part of it—but if a family would somehow find it in their heart to give us that gift . . .” Tina’s eyes well with tears as her words trail off. She pauses a few seconds before she finishes her thought. “Word just can’t describe the gratitude I would feel.”

Until a donor heart is found, Alj will likely remain at the Children’s Hospital, a continuous infusion of medication to help maintain regular heart contraction, medical experts closely monitoring him. After a lifetime battling an ever-worsening heart condition, Alj feels comfortable and at ease in the hospital—but Tina prays for so much more for her son.

“I just want a life for him, for him to be renewed, for him to enjoy all of the things he’s had to miss out on,” she says. “After 13 years, it’s time for him to start living.”

Editor’s note: Tina is a nursing technician on 5 East at N.C. Memorial Hospital. UNC Health Care employees wishing to donate hours to her may do so through human resources. The family has also set up a “Team Alj” Facebook page for those interested in following their journey or offering words of encouragement.

This Story in the News

Governors Club Provides a New Source of Support for Children’s Health

UNC Children’s First-Ever Endowed Chair from a Residential Community
Governors Club Provides a New Source of Support for Children’s Health click to enlarge Dr. Timothy Hoffman

For Immediate Release: November 1, 2016
For Information Contact: (919)491-5541

Chapel Hill, NC: This year’s Big Ten – ACC Charity Golf Challenge at Governors Club has special significance as the event celebrates the announcement of the Governors Club Distinguished Professorship in Pediatric Cardiology.

The announcement reflects ten years of effort and leadership from Dr. Fred Bowman, a member of Governors Club and a retired pediatric cardiac surgeon. While Dr. Bowman is an alumnus of the UNC School of Medicine, his UNC ties actually date back to his birth on Franklin Street in Chapel Hill. “What we do should have a purpose,” said Dr. Bowman. “This is just our way of giving back.”

Dr. Bowman enlisted the support of Lowell Hoffman, the organizer of the Governors Club Big Ten – ACC Charity Golf Challenge. Participants of the event include alumni from Big Ten and ACC schools, who have a friendly competition to raise money for local charities. Since 2009, the event’s ACC alumni participants have supported the Chair in Pediatric Cardiology. They have raised over half a million dollars.

“This Chair is both a ‘thank you’ and an emblem of recognition for the mission and leadership of the men and women at UNC Children’s,” Mr. Hoffman said.

Dr. Timothy Hoffman, the Chief of Pediatric Cardiology at UNC Children’s, will assume the title of Governors Club Distinguished Professor. “I’m so grateful for the support of everyone at Governors Club,” Dr. Hoffman said. “This support couldn’t come at a better time, and will mean a great deal to the children we care for and their families.”

Funds from the Governors Club will be flexible, allowing Dr. Hoffman to identify priority efforts in research, clinical care, and teaching that need support. UNC Children’s will also provide updates on how funds are being used.

About Governors Club: Governors Club is a community of caring people who have found their way to Chapel Hill from across the country and around the world. It is a balance of younger people with families and of retired men and women who find ways to “give back” of their life experience and resources.

The Governors Club community includes some 900 families as well as a separately chartered country club with membership across and beyond the Triangle region. The Club offers a multitude of social and educational programs, dining, fitness and sports activities including 27 holes of Championship Jack Nicklaus golf.

About UNC Children’s: UNC Children's clinical home, N.C. Children's Hospital, is a major referral center for children with complex conditions and consistently recognized by U.S. News & World Report as one of "America's Best Children's Hospitals" on its annual list.

N.C. Children’s Hospital has 150 inpatient beds and a comprehensive children's outpatient center located in the same building, enabling your child to see multiple specialists in a single visit.

Our physicians work hand-in-hand with community hospitals and pediatricians all across the state, providing specialty care to more than 70,000 children from all 100 counties in North Carolina each year.

The greatest gift

Born with a congenital heart defect, Samiya was diagnosed with congestive heart failure at just 4 months old. Her only hope of survival: a heart transplant. But would it come in time?

A weary LaCria Hicks stood on the sidewalk just beyond the entrance of N.C. Children’s Hospital that unforgettable September night. Her daughter, Samiya, just two days past her first birthday, occupied a room in the pediatric intensive care unit (PICU) just a couple of floors up. Troubled by the baby’s worsening condition, LaCria had been unable to tear herself away from her daughter's bedside and missed the final shuttle to the Ronald McDonald House.

As guest services personnel secured alternative transport for her, the beleaguered mother reflected on an earlier conversation with one of the critical care physicians amidst the evening’s chaos.

“Be straight with me,” she had implored him just past midnight. They had been waiting for more than six months. Was there hope they would find a heart in time?

In a moment she will never forget, the doctor had taken her hand in his and, eyes locked on hers, said, “She is going to be a stubborn teenager.” And with that, she found renewed faith.

“The doctors haven’t lost hope, so I haven’t lost hope,” she thought to herself as she waited for transport. And then her mobile phone rang.

A heart defect

LaCria’s pregnancy had been considered high risk from the start given a previous history of gestational diabetes. She and husband, Chris, felt reassured by the extra monitoring until LaCria’s four-month ultrasound revealed some anomalies.

Samiya spent her first birthday in the PICU.
The couple was referred to the UNC Children’s Heart Center, where Blair Robinson, MD, did a fetal echocardiogram. He confirmed a narrowing of the baby’s aortic arch along with a hole in her heart.

“Dr. Robinson was great,” says LaCria. “He explained Samiya’s heart defects and the course of treatment. He said she would need three surgeries, the first at 5 days old and the next would be around 6 months, and then another when she was like 5 or 6.”

LaCria’s pregnancy became difficult. She developed gestational diabetes again and then pre-eclampsia, a complication of pregnancy whose hallmarks are high blood pressure and protein in the urine. The dangerous condition can compromise organ function and threaten both the mother and unborn baby’s health, delivery of the baby being the only cure. As such, Samiya was born a couple weeks shy of full term.  

“She spent a day in the NICU and then was transferred to the PICU in anticipation of her heart surgery, which went as anticipated,” recounts LaCria. “We stayed about three weeks post-op. She went home with a feeding tube, so we had some complex care issues, but things were going about how we expected.”

But by the time Samiya was 4 months old, LaCria became concerned by some frightening symptoms. Samiya was vomiting frequently, and she had bouts when her face would turn blue. Dr. Robinson did an echocardiogram, which revealed a terrifying development. Samiya was suffering from congestive heart failure.

“It horrifying. I went into panic mode. I didn’t really understand what it all meant,” says LaCria.

Samiya was admitted to the PICU. When surgical interventions didn’t improve her condition, her care team presented another option: a heart transplant.

“That was very hard and painful decision for us,” recalls LaCria. “I am a Christian woman. How can you pray for a heart? How can you pray for another person’s child to die? I had a hard time reconciling that, but there were no other options. Even on the transplant list, there weren’t any guarantees. Would she be strong enough? I finally surrendered. God, if it is your will, your will done.”

The ensuing months were difficult on the family. The family, LaCria, Chris, and Samiya’s two older siblings, Briana and Brandon, spent the summer at the Ronald McDonald House. When school started back up again, Chris spent his days in Chapel Hill at the hospital with Samiya, while LaCria went to work and ran back and forth with the older kids. She visited Samiya every day.

“It’s a complete waiting game,” LaCria remembers of those months waiting for a heart transplant. “We didn’t know when it was going to come, if it was going to come. At the beginning, it didn’t occur to me that she wasn’t going to make it that far. But then her condition began to deteriorate. Her oxygen levels were dropping for no reason. She had been through so much, so much suffering.”

The phone call

“The doctors haven’t lost hope, so I haven’t lost hope,” was the last thought to cross LaCria’s mind before her mobile phone rang that September night, just two days past Samiya’s first birthday.

A year after her transplant, Samiya returned to participate in the Radiothon.
“Mrs. Hicks?” said the man who identified himself as a member of the transplant team. “I just want you to know, we found a heart for Samiya.”

“I just busted out screaming,” recalls LaCria. “Tears and yelling and jumping around. He’s still talking, telling more, and I’m not hearing him.”

The transplant surgery took 10 hours. Michael Mill, MD, was Samiya’s transplant surgeon.

“Dr. Mill, I swear that man is heaven sent,” says LaCria. “I never felt so confident. He just told me this is the perfect time, this is meant to me—lots of positive affirmation that everything was going to be okay.”

“When we saw him again after the operation, you could tell everyone was tired, that they had given it their all,” remembers LaCria. “And Dr. Mill, he stayed afterwards and prayed with my mom.”

Samiya spent three months in the hospital following the transplant surgery and was discharged week before Christmas.

“It was beautiful, our own Christmas miracle,” says LaCria.

Now 4 years old, Samiya is a happy child, a natural comedienne who loves to play and dance, says her mom.

“She goes to playground and comes back with five friends,” beams LaCria. “She never met a stranger.”

“Maybe it has to do with all the time she spent in the hospital,” continues LaCria, “all the people who became part of our extended family. They mean the world to us—Dr. Robinson, Dr. Mill, Dr. [Cheri] Hanson and Dr. [Benny] Joyner in the PICU. And the nurses, I call them the ‘unspoken champions.’ Too many to count, they are our heroes. They’ve given us the greatest gift.”

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