Eric Devaney, MD, FACS, Chief, Pediatric Cardiothoracic Surgery, and Martin Bocks, MD, FACC, Director of Pediatric Interventional Cardiology, consult on a patient in the UH Rainbow Babies & Children’s Hospital Cardiac Catheterization Suite.
It’s been almost two years since University Hospitals (UH) Rainbow Babies & Children’s Hospital in Cleveland partnered with Nationwide Children’s Hospital in Columbus to form the Congenital Heart Collaborative (CHC). Established in 2015, the innovative collaboration provides the complete continuum of care from the fetus to the senior citizen. It gives patients and their families direct access to one of the most extensive and experienced heart teams, skilled in the delivery of quality clinical services, novel therapies and a seamless continuum of care.
“Really, our goal is to never have a patient from Northern Ohio — from Toledo to Youngstown — have to leave the area to find experienced cardiac care,” says Christopher Snyder, MD, Division Chief, Pediatric Cardiology, UH Rainbow Babies & Children’s Hospital. “Congenital heart disease requires a lifetime of specialized care. And that’s what the Collaborative offers.”
The CHC is co-directed by Timothy Feltes, MD, FACC, Division Chief, Cardiology, at Nationwide Children’s Hospital, and Mark Galantowicz, MD, FACS, Division Chief, Cardiothoracic Surgery at Nationwide. The two are also Co-Directors of the Heart Center at Nationwide Children’s Hospital, currently ranked ninth in the nation by U.S. News & World Report (USN&WR) for pediatric heart and heart surgery care, and Professors at Ohio State University College of Medicine. Rounding out the Collaborative’s leadership team are Eric Devaney, MD, Chief, Pediatric Cardiothoracic Surgery at UH Rainbow, Alexandre Rotta, MD, Division Chief, Pediatric Critical Care at Rainbow, and Dr. Snyder. All three are Professors at Case Western Reserve University School of Medicine.
One Program, Two Campuses
The Collaborative’s physician team combines the expertise of more than 20 pediatric cardiologists, surgeons and anesthesiologists from both UH Rainbow’s and Nationwide Children’s Heart Centers. It also includes neonatal intensivists from UH Rainbow’s NICU, currently ranked fourth in the nation by USN&WR; maternal fetal medicine specialists from UH MacDonald Women’s Hospital; and adult cardiologists and surgeons from UH Harrington Heart & Vascular Institute.
Rainbow’s NICU has a 96 percent survival rate — one of the best in the U.S., according to Dr. Snyder. “And, the maternal fetal medicine specialists from UH MacDonald Women’s Hospital are also nationally recognized,” he says. “They provide prenatal diagnosis, fetal intervention, and a seamless transition from fetal to neonatal care.”
Currently, the CHC has nine pediatric cardiology and cardiothoracic surgery consultation locations in northern Ohio — in Cleveland, Parma, Concord Township, Medina, Mayfield Heights, Mentor, Solon, Westlake and Youngstown. Pediatric cardiothoracic surgery is performed at UH Rainbow.
“The common misconception about the collaborative is that we’re sending most of our patients to Nationwide,” Dr. Devaney explains. “That’s really not the case. It’s one program on two campuses.” The CHC leverages the expertise at both institutions to optimize the care for each individual patient and improve outcomes.
Monica Mielcarek, RDCS, AE, PE, Pediatric Cardiac Sonographer, UH Rainbow Babies & Children’s Hospital, conducts a fetal echocardiogram as James Strainic, MD, Director, Fetal Heart Program, and Tiffanie McCourt, RN, MSN, CPNP, AC-PC, Fetal Heart Program Coordinator, look on.
Combined Recruiting Efforts
The leadership team also combines forces to recruit the very best physicians. Dr. Devaney, who joined UH Rainbow and the CHC in 2016, is a prime example. Born, raised and educated through his undergraduate school years in Virginia, Dr. Devaney worked as a research chemist at the National Institutes of Health (NIH) Institute of Child Health and Human Development from 1984 to 1986. Determined to be a surgeon, he obtained his MD degree from the UCLA School of Medicine followed by an internship and 10 years of residency and fellowship training — first at the University of California San Francisco (UCSF) and then at the University of Michigan in Ann Arbor — in Surgery, Thoracic Surgery and Pediatric Cardiovascular Surgery.
“Dr. Devaney’s training at University of Michigan was under Ed Bove, one of the greatest pediatric heart surgeons of all time,” says Dr. Snyder. “We (Rainbow and Nationwide) recruited Dr. Devaney from USCD’s Rady Children’s Hospital in San Diego where he founded and directed their cardiac transplantation program.”
In addition to his role as Chief of Pediatric Cardiothoracic Surgery, Dr. Devaney is involved in research, as well — mainly with two goals in mind. One is to better understand the molecular biology of heart failure with a focus on trying to improve cardiac function through use of novel molecular inotropes. The other is to develop technology that utilizes induced pluripotent stem (iPS) cells for diagnostic purposes and for tissue engineering.
“We’re trying to develop vascular patches with growth potential that can be used clinically. We’re still in the bench phase for this. It’s all a translational focus of research with the ultimate goal of carrying it from the bench to the bedside,” he says.
Another new recruit, Martin Bocks, MD, joined UH Rainbow in 2016 as Director of Pediatric Interventional Cardiology. A Michigan native, Dr. Bocks completed his medical doctorate from Wayne State University in Michigan, followed by an internship and residency in Internal Medicine-Pediatrics and fellowships in Pediatric Cardiology and Pediatric Interventional Cardiac Catheterization — all at University of Michigan. Afterwards, he remained on staff there for eight years as a pediatric interventional cardiologist and an adult congenital cardiologist.
“Dr. John Cheatham, a well-known interventional cardiologist from Nationwide, helped us recruit Dr. Bocks. It was a true team effort between the two hospitals,” says Dr. Snyder.
In fact, one of the reasons Dr. Bocks accepted the position at UH was because of the opportunity to work and collaborate with Dr. Cheatham and the other interventionalists at Nationwide. “I was well aware of Dr. Cheatham’s accomplishments and the innovative approach he has brought to pediatric interventional cardiology — so a major reason that I took the Rainbow cath lab director position was to allow me the chance to have colleagues and mentors here and at Nationwide through the Collaborative,” he explains. “So it was a good opportunity for me to grow and take on a leadership role in a really new, interesting, innovative care model.”
It also offered the opportunity to continue his research in pediatric medical device development and testing, which is currently funded by nearly $4 million in NIH grants over the next 4 years. Bioresorbable stents for cardiac applications is just one of those research projects.
Sarah Plummer, MD, Pediatric Cardiologist, with Chad Eckert, RN, CCRN, Clinical Nurse Manager of the UH Rainbow Babies & Children’s Hospital Cardiac Step-Down Unit, check on a young post-surgery patient.
Like their CHC colleagues, Dr. Bocks and Dr. Devaney are board-certified in their respective specialty and subspecialty areas. In addition, Dr. Devaney is certified by The American Board of Thoracic Surgery in Congenital Cardiac Surgery; Dr. Bocks, in Adult Congenital Heart Disease (ACHD) — a certification recently established by The American Board of Internal Medicine, in a first-time partnership with the American Board of Pediatrics.
“Although many ACHD patients have heart anatomy that is better understood by pediatric cardiologists, they can also develop acquired diseases, both cardiac and non-cardiac, that require the additional knowledge possessed by adult cardiologists or other sub-specialists,” says Dr. Bocks, who is one of the first 200 physicians to be certified in ACHD. “We need to meet their adult needs in a setting — like UH Harrington Heart and Vascular Institute — that makes them feel comfortable, while also combining necessary resources and staff from both the pediatric and adult worlds in an effective and convenient way.”
To that end, Dr. Bocks and Dr. Devaney, along with Dr. Marco Costa, UH Harrington Heart and Vascular Institute President and Director of its Interventional Cardiovascular Center, and Dr. Curt Daniels, Director of the Columbus Ohio Adult Congenital Heart Disease (COACH) and Pulmonary Hypertension Program at The Heart Center at Nationwide Children’s Hospital, are building a comprehensive program for ACHD at University Hospitals.
According to Dr. Devaney, this is a good example of how the Collaborative leverages expertise across both campuses. “The team also has joint clinical conferences twice a week to discuss all congenital heart patients undergoing any form of surgical or interventional therapy. We discuss in detail every case, so we have the combined resources, expertise and brain power of two large institutions. And that’s a huge plus,” he says.
The Collaborative also has the combined strength of a number of quality improvement projects and the use of quality metrics. Having greater numbers across both campuses allows the CHC to have better statistical power to make decisions to determine best therapies and improve outcomes.
“Are we doing a good enough job in delivering high quality care, because that’s really our main focus,” says Dr. Snyder. “We want to provide the best quality care for congenital heart disease in our area. And we have an institutional commitment to provide the personnel and the infrastructure that’s necessary to provide that.”
He points to the five-bed pediatric cardiac step-down unit that the CHC at Rainbow has outgrown. Construction is underway to add another five beds. Plans for the addition of two state-of-the-art hybrid intervention suites — a single-plane and a bi-plane — have also been approved. Each will serve as a fully functional catheter lab, electrophysiology lab, and operating room.
By mid-2018, according to Dr. Snyder, Rainbow plans to expand from its current cardiac intensive care unit and add more step-down unit beds to accommodate more patients. The staff will also grow in kind. “All of the future plans for the CHC fall in line with the program’s first and foremost goal: exceptional patient care and clinical quality,” he says.
“I see this Collaborative has the potential to make Rainbow, as well as Nationwide, the pre-eminent congenital heart programs in the state of Ohio and leaders on the national scene,” adds Dr. Devaney. “So I’m very excited to be part of that and to contribute to that effort.”
For more information about the Congenital Heart Collaborative, visit UHDoctor.org. For Pediatric and Adult Congenital Heart Disease Referrals, including patient transfers, admissions and appointments, call 216-844-3528.