25 Years of No. 1 in Heart Care
U.S. News & World Report recently released its 2019-20 Best Hospitals rankings, with Cleveland Clinic surpassing all other hospitals in heart care for an unprecedented 25 years in a row. No other hospital has ranked higher in this specialty since 1995.
“We are truly humbled to be honored as the nation’s best hospital for heart care for the 25th consecutive year,” says Lars Svensson, MD, PhD, Chair of Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute. “This would not be possible without the trust of our patients, devotion of our caregivers and generosity of our donors.”
Cleveland Clinic performs more cardiac surgeries than any other U.S. hospital and has the best outcomes, while frequently serving patients with more complex medical needs. Since the 1940s, when Arda Green, MD, and Irvine Page, MD, led research projects that isolated serotonin and linked high blood pressure to heart disease, Cleveland Clinic’s cardiovascular innovations have spanned decades:
- 1956 — Donald Effler, MD, and Laurence Groves, MD, performed the world’s first successful stopped-heart surgery in clinical practice
- 1958 — F. Mason Sones Jr., MD, developed selective coronary angiography
- 1958-65 — Irvine Page, MD, and Helen Brown, PhD, were key investigators in a landmark study that helped establish the association between dietary cholesterol and heart disease
- 1967 — René Favaloro, MD, pioneered coronary bypass surgery
- 1971 — Dr. Favaloro and Floyd Loop, MD, developed a new standard of care for bypass surgery, using the mammary artery
- 1980 — Toby Cosgrove, MD, who now holds 30 patents, invented new devices for heart valve repair
- 2003 — Steven Nissen, MD, directed the REVERSAL trial, the first study to show that high doses of statins could halt the progression of coronary artery disease
- 2011-ongoing — Stanley Hazen, MD, PhD, linked gut bacteria to high cholesterol, heart failure and chronic kidney disease
Innovation is an integral part of Cleveland Clinic’s culture. “We will continue to strive to make patients feel at ease when entrusting their care to us, while also remaining dedicated to the advancement of research in cardiovascular medicine,” Dr. Svensson says. “This is a reflection of our devoted team of physicians, nurses, mid-level providers and support staff who care for our patients.”
How Your Support Helps
Cleveland Clinic has been providing, re-imagining and reshaping healthcare for almost 100 years. Because we’re a nonprofit healthcare institution, we’re grateful for the philanthropic funding that directly impacts the research, patient care and education initiatives that have helped make us one of U.S. News & World Report’s top-ranked hospitals in the nation. Thank you for your support.
Living the Life He Wants – and Giving Back
Alex May felt like a fish out of water. At home in Arkansas two years ago on a harrowing autumn night, he slumped against his kitchen island, desperately gasping for air. His neighbor, a surgeon, suspected acute heart failure and rushed him to the local hospital.
A doctor there was candid. “Plan A is: We could operate on you here,” he said. “But you’d be better off going someplace where they have more experience with your specific valve condition.”
“OK,” Alex said. “What’s plan B?”
He can laugh about it now – and does.
“I want to make sure I can live life right where I want to,” says Alex, 55.
“Plan B” turned out to be a pair of successful mitral valve repair surgeries at Cleveland Clinic, where future cardiovascular patients will soon benefit from advancements in robot-assisted surgery, thanks to generous supporters such as Alex and his wife, Sara. During a recent follow-up appointment, Alex received a clean bill of health.
Racing in a Real-Life Cannonball Run…and a Telltale Murmur
The mitral valve consists of two leaflets, or leaflike flaps, that regulate the flow of oxygen-rich blood from the lungs through the left side of the heart, from the atrium to the ventricle. Loose leaflets can result in regurgitation – i.e., a leak – which lets blood flow backwards in the heart. This may lead to shortness of breath, palpitations, fatigue and more serious complications, including decreased heart function.
Alex was first diagnosed with a mitral valve leak a decade ago, after he and Sara moved with their two sons from the East Coast to Arkansas for new professional opportunities. Alex is Vice President and General Counsel at Walmart; Sara, now retired, was Executive Vice President of Corporate Affairs at Tyson Foods.
Outside their successful careers, the couple enjoyed traveling, skiing, riding motorcycles and scuba diving. Alex raced cars, too. He competed three times in One Lap of America, a cross-country rally whose roots inspired the 1981 film Cannonball Run.
During a pre-race physical, a telltale murmur in Alex’s heart was detected. A cardiologist later confirmed the mitral leak. With regular check-ups to monitor his condition, Alex lived with the disease without incident until October 2017, when his visit to that Arkansas emergency room hastened a referral to Cleveland Clinic.
“Is there any other place I should go?” he asked the doctor back home.
“No,” the doctor said. “They’re the best in the world for this.”
“Is that where you would go?” Alex asked.
The doctor didn’t hesitate. “Absolutely,” he replied.
Repair vs. Replacement
Alex was kept stable until Cleveland Clinic’s Critical Care Transport team arrived. “Two nurses in jumpsuits came in, took over the room and took over me,” he recalls. “They said, ‘He’s our patient!’ They disconnected everything and hooked up their own equipment. . . . I was really impressed with them and their professionalism.”
Flown via a Cleveland Clinic jet to Cleveland, Alex was evaluated and scheduled for surgery with Per Wierup, MD, PhD, of Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute.
“I will fix you,” Dr. Wierup assured Alex, who was surprised when the cardiac surgeon proposed repairing the mitral valve. Alex previously had been led to believe that his only option was a valve replacement, which he feared would limit his active lifestyle.
At Cleveland Clinic, the vast majority of leaking mitral valves are repaired, not replaced. Most of these operations are performed minimally invasively or robotically.
“Generally speaking, when you compare mitral valve replacements and repairs, replacements have higher rates of infection and thromboembolic episodes –meaning strokes or blood clots – and decreased heart function,” Dr. Wierup says. “You also have a survival benefit if you repair the valve. We know that if you repair the valve, even with severe leakage, the long-term survival is as good as the background population. It makes a world of difference.”
As with most cases, Dr. Wierup was able to preserve the original leaflets of Alex’s mitral valve. Elongated chordae that could no longer position the leaflets to form a tight seal were replaced with resilient Gore-Tex sutures. The surgery also involved measures to cure atrial fibrillation (common among patients with mitral regurgitation), including a maze procedure.
Staying Active Following a Setback
Within six months of his first surgery, Alex felt “100 percent,” he says – good enough to start hitting the gym regularly. During an intense workout involving three sets of 10 behind-the-head pull-ups, he felt a pop in his chest. He dropped off the bar and found himself again gasping for air.
Reoperation is uncommon following successful mitral valve repair. But when a secondary area on Alex’s valve ruptured, it necessitated another surgery at Cleveland Clinic in December 2018, performed by Dr. Wierup. He repaired Alex’s tricuspid valve, which also had developed a leak, and reinforced Alex’s mitral valve with more sutures and a heavy-duty annuloplasty ring.
“This will give him more leeway . . . because I figured Mr. May is not going to stop working out,” Dr. Wierup says. “We encourage our patients to stay active.”
In fact, exercise is a cornerstone of managing almost every cardiac disease, according to Dermot Phelan, MD, PhD, FACC, Alex’s cardiologist at Cleveland Clinic. In addition to serving as Medical Director of the Sports Cardiology Center in the Miller Family Heart & Vascular Institute, Dr. Phelan is the team cardiologist for the Cleveland Cavaliers.
“We’re always counseling our patients on the importance of exercise, not only for their overall well-being but for their heart health,” Dr. Phelan says. “In certain cases, exercise may need to be prescribed in a very specific fashion, so as not to overdo it. But for all patients, a consultation about exercise is paramount for their long-term well-being.”
Paying It Forward for Robotic Operating Rooms
These days, Alex is back in the gym and back on his Harley-Davidson. “I feel really good,” he says. “I feel like I don’t have any restrictions on myself.”
In gratitude for the care he received, Alex and Sara made a $100,000 gift to Cleveland Clinic.
“It’s not tough giving back to the place that saved your life,” Alex says. “If we can help Cleveland Clinic help somebody else the way I was helped, it’s very powerful to us.”
Adds Sara: “Every time we’ve been here, we’ve met so many interesting people from all over the world. People come here from everywhere. It just reaffirms our respect for this organization and everything it does. . . . Every step of the way, Cleveland Clinic treats you like the concierge at a fine hotel.”
The Mays’ gift will help fund two new robotic operating rooms in the Heart & Vascular Institute, where the J.B. Hunt Robotic Operating Suite is scheduled to open in 2020. Utilizing da Vinci surgical robot systems, surgeons will be able to perform a range of procedures – from repairing or replacing mitral and tricuspid valves to removing cardiac tumors – in the facility. This capital project is made possible by the generosity of donors such as the Mays.
Cleveland Clinic is “a special place,” Alex says. “We’re happy to support it.”
How You Can Help
We’re grateful for the support from our donors because it helps us save lives.
To help fund the robotic operating rooms and leading-edge research, make a gift to the Miller Family Heart & Vascular Institute (choose “Cardiovascular and Thoracic Surgery” from the drop-down menu).
‘We’ll Come to You’: School-Based Health Care Benefits Kids, Families
According to the National Center for Children in Poverty, 43% of Ohio’s children live in low-income households. Their families face many socioeconomic challenges, including access to medical care.
Cleveland Clinic Children’s School-Based Health Care program for grades K-12 is working to change that. The program was established in 2014 to provide care to children where they spend much of their time: at school.
“What I love about this program is that if you can’t come to us, we will come to you,” says Roopa Thakur, MD, FAAP, Medical Director of the School-Based Health Care clinics. “A lot of kids can’t come into the office because their parents can’t take off work or there are transportation issues.”
A Pediatrician’s Office on Wheels
Now serving six area school districts, the program provides health and wellness services in a mobile unit, which Dr. Thakur says is like a pediatrician’s office on wheels. Services include complete physical examinations that may be used for sports physicals, camp, college and work authorizations; comprehensive healthcare, including diagnosis and treatment of acute and chronic illness; immunizations; health screenings for vision, hearing and scoliosis; first aid and more.
The program also provides epinephrine auto-injector prescriptions and training for school personnel to administer epinephrine to students who have life-threatening allergic reactions.
Parents must enroll their children in the program and complete a pre-visit questionnaire so providers know a child’s medical history before the first visit. Providers call the parents after the visit to go over specifics, and an after-visit summary is sent home in an envelope with the child. Parents are always welcome to attend appointments.
A two-year grant from the Council for Economic Opportunities in Greater Cleveland has allowed the program to test for lead in preschoolers enrolled in Head Start. “Lead poisoning is a huge issue in Cleveland,” Dr. Thakur says. “We’ve made great strides recently with legislation passed by Cleveland City Council to make Cleveland lead-safe. During the 2018-2019 academic year, over 130 families received education and over 100 children were screened at five community Head Start events attended by our mobile unit.”
Although most students have health insurance through Medicaid, the School-Based Health Care program has financial counselors to help enroll families who are not yet covered. Children receive services regardless of their insurance status.
Population health is a hot topic for medical providers. Dr. Thakur defines it as the opportunity to address the need for high-quality preventive care to improve the short- and long-term health outcomes of an entire community. “I believe that our School-Based Health Care program is one of the most innovative ways to provide that high-quality care to patients who might not otherwise have a medical home,” she says.
Addressing Physical and Mental Health
“Part of what we’re trying to do is get creative about how to provide medical services where the patients are, instead of expecting them to come to us all the time,” Dr. Thakur says. “For example, our in-school clinic at Lakewood High School provides both medical and mental health services because anxiety and depression were identified as primary concerns within the school district.”
In January 2018, the program opened its first in-school clinic at Lakewood High School, offering medical care five days a week and mental health services four days a week. “When we form a partnership with a new school, we have them complete a needs assessment to be sure we’ll be providing services that they actually need – and to determine if we have the right resources for them,” Dr. Thakur says. “We’re finding more and more that mental health services are what’s needed. I wasn’t surprised by the nature of this need, but I was surprised by the magnitude.”
Mental health providers at Lakewood now include a psychologist, a psychiatrist and, through a recent grant from Three Arches Foundation, a patient navigator who helps coordinate mental health treatment with other organizations outside of the program. Dr. Thakur believes this is a step beyond what other school-based programs are doing and points to the popularity of these services. “Over half of the visits to the clinic are for mental health services,” she says.
Expanding in Urban Districts
The program is now poised to begin serving more schools, including the Cleveland Metropolitan School District, thanks to a $100,000 gift from Howard Hanna Real Estate Services and a $100,000 grant from the Department of Health and Human Services. The funds will be applied to the purchase of a new, $392,000 mobile unit, allowing the program to serve more students in the Cleveland area.
Dr. Thakur also is enthusiastic about the impact of technology on the program. “Looking ahead, we’re particularly excited about the possibility of implementing telemedicine services as part of the School-Based Health Care program. That way, if a patient needs care but is physically located somewhere other than where our mobile unit is parked, we may still be able to provide them services, including behavioral and mental health services.”
How You Can Help
As a nonprofit healthcare organization, Cleveland Clinic is grateful for your support of community programs like this, which make a tangible difference in the lives of children and their families.
Doubling Down on Rare Cancer Research
An innovative fundraising initiative is underway to funnel necessary resources toward curing an under-the-radar cancer.
Epithelioid hemangioendothelioma (EHE) is a rare vascular sarcoma. Like other cancers, EHE is caused by a genetic malfunction that encodes a unique cancer-causing protein. Brian Rubin, MD, PhD, of Cleveland Clinic and his colleagues are studying this protein to discover vulnerabilities that can be exploited therapeutically.
A double dose of support was awarded this month by the Margie and Robert E. Petersen Foundation. One million dollars will fund research into the identified protein’s connection to the disease, while a matching grant of $1 million will fund additional research and strengthen organizations around the world that advocate for continued research and efforts to cure EHE.
“This new fundraising initiative is a win-win, as we can support two efforts simultaneously,” says Dr. Rubin, Chair of the Robert J. Tomsich Pathology & Laboratory Medicine Institute at Cleveland Clinic and a member of the Cancer Biology Program of Cleveland Clinic’s Lerner Research Institute. “Support from people worldwide will go directly to our EHE research at Cleveland Clinic while also building the infrastructure of worldwide foundations that are raising awareness and additional funds for the research.”
Among those organizations are the EHE Foundation (U.S.), the EHE Rare Cancer Charity (U.K.) and the EHE Rare Cancer Foundation (Australia). Their collaboration with Cleveland Clinic drew the attention of the Petersen Foundation and sparked this innovative fundraising initiative.
EHE Won’t Hold Her Back
The ongoing work of Dr. Rubin and his team gives hope to patients such as Mariah George. She had never heard of EHE before she was diagnosed with the disease nearly three years ago. It presented itself in her liver.
“Dr. Rubin told me that most doctors would look at my scans and think that I’m extremely ill,” says Mariah, 33. “Naturally, I was concerned. But he went on to explain how this is a very different form of cancer, which reassured me.”
EHE is, in a word, unpredictable. Tumors can grow slowly over a span of decades or even lapse into spontaneous regression. Some patients experience only mild symptoms; others have no symptoms for years. That said, the cancer also has the potential to quickly become aggressive.
After reviewing her options with Dr. Rubin and her oncologist, Dale Shepard, MD, PhD, Mariah settled on a watch-and-wait approach, with routine scans to ensure that all is well. As a precautionary measure, she also has been listed for a liver transplant, should the need arise.
In the meantime, Mariah isn’t letting anything hold her back. After a career in corporate wellness, she went back to school last year to pursue an associate’s degree in surgical technology – which has her currently doing clinical rotations on Cleveland Clinic’s main campus. Last month, she rode for the third consecutive year in VeloSano’s “Bike to Cure” weekend to raise funds for cancer research at Cleveland Clinic.
“From day one, I’ve said that if I have to have cancer, I’m actually quite thankful that this is the form of cancer I got,” Mariah says. “Dr. Rubin is just a phone call or an email away, and I know that I’m in the best possible place I could be for care.”
Stepping Up to Find a Cure
Individuals around the globe have stepped up to meet the matching grant from the Petersen Foundation. Online communities of people with EHE as well as people with other rare cancers are supporting this effort because the research into a cure for EHE will build a groundbreaking repository of knowledge – and the findings may translate to other cancers.
“The matching funds are particularly vital because they’ll strengthen our worldwide collaborative research group as well as the EHE Foundation,” Dr. Rubin says. “We’re grateful for this gift from the Petersen Foundation, which solidifies our relationship with the EHE Foundation and provides much-needed funds for EHE research.”
How You Can Help
Gifts to support this collaborative research effort led by Dr. Rubin should be directed to the EHE Foundation. They will be matched dollar-for-dollar by the Petersen Foundation over the next three years, until the $1 million total is raised.