Summer - the Association of Physician Assistants in Cardiovascular
Transcription
Summer - the Association of Physician Assistants in Cardiovascular
Cardiovision™ official journal of the apacvs SUMMER 2013 highlights in this issue www.apacvs.org APACVS Joins PA Community in Speaking Against AMA HOD Resolution House of Delegates Report 33rd Annual APACVS Winter Educational Meeting Cardiac Surgical Advanced Life Support: The New Paradigm? CVT PAs on Medical Mission to Dominican Republic Michael Nowak Organizes PA Medical Missions to Guatemala Drug Shortages association of physician assistants in cardiovascular surgery The handoff. Be confident what you’re passing along is of the highest quality. Your vessel harvest is done, but the impact of the conduit quality on cardiac bypass outcomes is just beginning. NEW The new VirtuoSaph® Plus Endoscopic Vessel Harvesting System helps deliver a conduit you can have confidence in every time. • Simple, one-step coagulate-and-cut mechanism delivers low targeted energy at the tunnel wall away from the main conduit Harvesting a new standard of care. • Advanced spot cautery provides direct cauterization in the tunnel • Longer effective dissector length with V-Glide PTFE surface • Open system and ergonomic design just like the original VirtuoSaph system There’s an ongoing need to improve conduit quality. The VirtuoSaph Plus EVH system is the answer. See the VirtuoSaph® Plus Endoscopic Vessel Harvesting System in action. Visit www.terumo-cvs.com/vsplus to find out more. To watch on your smartphone, scan this code. Terumo Cardiovascular Systems Corporation Ann Arbor, Michigan, USA 800 521 2818 l Terumo Corporation Tokyo, Japan 81 3 3374 8111 Terumo Europe N.V. Leuven, Belgium 32 16 38 12 11 l Terumo Europe N.V. Cardiovascular Division Eschborn, Germany 49 6196 8023 Terumo Latin America Corporation Miami, Florida USA 305 477 4822 Terumo® and VirtuoSaph® are registered trademarks of Terumo Corporation. ©2013 Terumo Cardiovascular Systems Corporation 841242 Mission & Content Editor-in Chief Doug Condit, PA-C Contents From the President’s Desk........................................... 4 APACVS Joins PA Community in Speaking Against AMA HOD Resolution..... 5 33rd Annual APACVS Winter Educational Meeting.................................. 5 House of Delegates Report . ................................... 6 Cardiac Surgical Advanced Life Support: The New Paradigm?......... 7 Doug Condit Named Winner of the 2013 PA Distinguished Service Award Presented by Montefiore Medical Center Staff and Alumni Association.......................... 9 CVT PAs on Medical Mission to Dominican Republic................................ 12 Michael Nowak Organizes PA Medical Missions to Guatemala . ....................... 13 submissions due oct. 31, 2013 for the susan lusty excellence in publication writing award................. 16 Drug Shortages.............. 17 membership application........................ 19 The mission of CardioVISION™ is to provide a means of communicating pertinent information among practitioners of the specialty and among related professionals in the medical field and industry. CardioVISION is a peer-reviewed quarterly journal that includes articles on practice issues, credentialing issues, educational opportunities, and more. CardioVISION also includes classified job ads and industry advertisements. Advertisements If you are interested in submitting an advertisement or job ad, please contact Jill Tucker at [email protected] for deadlines, rates and specifications. Original Articles If you are interesting in submitting an article for consideration of publication, please contact Editor Doug Condit, PA-C, at [email protected]. Reproducing Material Single photocopies of single articles may be allowed for personal use as permitted by national copyright laws. Written permission from the APACVS is required for all other uses. Please contact the APACVS office for queries, permission and/or payment of associated fees. APACVS Membership CardioVISION is a member benefit of the Association of Physician Assistants in CardioVascular Surgery. Visit our website (www.apacvs.org) or contact the APACVS office for more information. APACVS Board of Directors Officers: President: David E. Lizotte, Jr., PA-C, MPAS, FAPACVS Vice President: Steven M. Gottesfeld, PA-C Secretary: Doug Long, PA-C, FAPACVS Treasurer: David J. Bunnell, MSHS, PA-C Past President: Jonathan Sobel, PA-C, FAPACVS Board Members: Member-at-Large: S. Scott Balderson, PA-C Member-at-Large: Chuck Cuttic, PA-C, FAPACVS Member-at-Large: James F. Gillen, PA-C, FAPACVS Member-at-Large: Andrea McNiel, PA-C, FAPACVS Member-at-Large: Edward A. Ranzenbach, PA-C, MPAS, FAPACVS, DFAAPA, CAQ-CVTS APACVS Office Executive Director: Nancy Short, CMP 7044 S. 13th St., Oak Creek, WI 53154 Phone: 414.908.4952 x135 • Fax: 414.768.8001 www.apacvs.org Cardiovision Cardiovision Cardiovision 3 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 froM the From the President’s Deskdesk president’s It is with great pride that I assume the role of president for us to to the be professional to welcome ofyour the APACVS andassociation I extend aiswarm marginalized advocate for you. I am glad to report new members of the Executive Committee and Atby groups with that the APACVS continues to work Large-Members of the Board. We have assembled voices for you every day. the most talented and dedicated group of louder volunteers I and have ever had the pleasure of working with to formal continue Surveying the landscape ahead, supporting the important work of the APACVS. political action I see we are well positioned as Recently I opened my e-mail inbox David E. Lizotte, Jr., This change in leadership, both planned and orderly, Jr., committees. a profession to thrive in the to find this unsolicited thought PA-C, MPAS, FAPACVS FAPACVS represents stability in an Association that We has must seen atmosphere of the for the week staring up from my significant change insignificant the last year. Much of this change stems from the Boards’ review communicate changes to healthcare brought screen. A well-intentioned soul of the APACVS mission, and itson desire towhat continue our to grow and expand our ability to by the Affordable Care Act and the sent this quote, and despite my educate our peers as well as members of the surgical team. already know. teams and patients reality of physician shortages in all usual inclination to not open these We were faced with a classic life/ businessWe decision at the Winter CME meeting are competent, capable, skilled, specialties. We are well positioned particular messages, I opened in San Diego last January: grow or risk stagnation. In short order, we chose and knowledgeable clinicians who growth, because we continue to build strong this one. The result was that it and in doing so began a journey to reviewpractice every element of the Association and medicine in physician-led relationships with physicians helped me realize that the issues, develop comprehensive strategicasplans to ensure the realization of this new teams. Advocacy and outreach willvision. partners, not competitors. We areand mapped a future for the organization that was countless e-mails, and phone calls The Board looked boldly forward be the vehicle to accomplish this wellinnovative positionedand because weWe continue surrounding the American Medical both daring. recognized that this paradigm shift would require a goal. to grow a strong professional Association (AMA) House of change in our management company’s services, and as we pursued these discussions, I have made itcompany a priority fordecided our that continues to long-term keep Delegates resolution that would weassociation received the news that our management had to resign Board toonce continue to work with as a primary focus. Winston Our significantly restrict PA practice now toadvocacy pursue other opportunities. Churchill said that “Life can either be accepted changed.are If itpositioning is not accepted, key it must be changed. If itways cannot associations to find to be changed, nursingorcolleagues made perfect sense to me. Despite then it must be accepted.” The resignationcollaborate of the onlysomanagement company that that we can quickly their profession as competitors the language in the committee any us on theIBoard ever clearly unchangeable we aaccepted it meet the call and speak –with toof physicians. believehas that thisknown was report that was supportive of PA and began a journey to find new management that was enlightening, to say the least. clear voice when threats to the is a mistake and contribute this practice, the resolution proposed After dozens as of ahours of reviewing a thousand pages ofMy proposals profession are mounted. hope from philosophy motivation behindmore than to restrict our practice as PAs in 28 association management companies, the Board unanimously selected Technical is that you will continue to support the recent concerning AMA cardiothoracic surgery by limiting Enterprises, Inc. (TEI), a management company with 24 employees and over 30 years our association and serve as our resolution. our ability to perform invasive of experience in association management, to take us to the next level as an association. advocates to non-members whom skills. I had achieved a clarity that PAsiswere unfortunately bundled in we are heading. None of this could have been That exactly the direction in which you know and encourage them was impossible as the APACVS with nursing thesupport authorsand of this possible withoutbythe dedication of our interim management company, to support the the onlychallenge association Board and I worked with a host of O’Neill Communications. The staff at O’Neill accepted of supporting us policy. Because of our relationships truly represents the interest associations and delegates to amend through our transition and we will foreverthat be in their debt. with the AATS, STS, NCCPA and of cardiac, thoracic and vascular or defeat what I believe was a badly AAPA, were of rapidly to seek to significantly increase membership by With the we support TEI, able we will surgical physician assistants. worded but possibly well-intentioned mobilize support communicate both improving theand value of membership to PAs practicing in Cardiothoracic (CT) policy. As you will read later in the take a few moments to We will objections delegates Surgery and to by AMA opening up new means of Please membership in the Association. journal, the concerns of the PA expand our educational offerings, moving participate many of these to APACVS the web and making more in the census. discussing the proposed policy. We community were heard and the usewere of social media. Our website will receive a long overdue overhaul – all in house by We can then collect the data a voice among many, yet we portion of the resolution that caused TEI at no additional cost as part of our management fee. All of this and more will be necessary to understand who we are were heard. a concern for our membership was achieved at a cost savings to the Association. as a profession and continue to serve An obstacle looming on the horizon removed. This resulted in the AMA your needs.membership has approved Bythat an overwhelming majority vote, the Association was highlighted at the AAPA not creating policy that is hostile to the creation of an Associate Member category during this last election. This Best Regards, House of Delegates is the word PA practice. This was a significant will permit non-PA members of the surgical team to join the APACVS, thereby supervision. By virtue of being victory for PAs and the patients they increasing David E.inLizotte, Jr., PA-C, MPAS, our ability to promote the PA practice the specialty of Cardiovascular supervised by physicians, instead of serve. It helps to remind us about and Thoracic Surgery. FAPACVS collaborating with them, we have the importance of our relationships President, APACVS continued on next page allowed ourselves to be defined in a with the physician community. dependent matter that makes it easy One of the primary missions of “Expecting the world to treat you fairly because you are a good person is a little like expecting the bull not to attack you because you are a vegetarian.” - Dennis Wholey Cardiovision Cardiovision Ca Cardiovision Cardiovision Cardiovision 4 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org APACVS Joins PA Community in Speaking Against AMA HOD Resolution By David J. Bunnell, MSHS, PA-C The agenda of the 2013 American Medical Association House of Delegates (AMA HOD) included a resolution that caused a great deal of concern in the PA community. The resolution attempted to define surgery very broadly and included a statement that advocated for “direct and/or personal supervision” for nonphysicians performing invasive skills. It also sought to limit non-physician involvement in pain management practices as well. Even though the committee report commented on their support of PA practice in physician-led teams, the implications of the resolution was concerning for the future of PA practice. House of Delegates decisions are important because they indicate the direction that this influential medical association may take in their lobbying efforts. The American Academy of Physician Assistants (AAPA) appealed to the APACVS and other PA associations to engage with delegates and associations that had a vote on this issue. There was also a great deal of grass-roots efforts to speak against this resolution, including a petition that quickly gathered 7,500 electronic signatures. Your association expressed concern to the American Association for Thoracic Surgery and the Society of Thoracic Surgeons about how this resolution would affect the care that we currently provide to patients with cardiovascular and thoracic diseases. The AMA HOD heard testimony both pro and con to this resolution. The debate resulted in the complete removal of all language pertaining to surgery in the resolution. The reference committee acknowledged the PA community in their report. “Your reference committee heard the concerns raised, including those related to the practice of Physician Assistants in Physician-led health care teams…” 33rd Annual APACVS Winter Educational Meeting January 23-26, 2014 Orlando, Florida 13 Reasons to Attend: 1. Expert keynote speakers share their wisdom and tips 2. Earn CMEs 3. Network with your peers 4. Registration includes: Conference Materials, Breakfasts, Breaks with Snacks/Coffee, Lunch and Learns 5. The highly respected Endoscopic Vein Harvesting Panel of Experts moderated by Anthony Furnary, MD 6. The in-demand, hands-on Thoracoscopic Surgical First Assistance Course 7. The must-attend, hands-on Cardiac Surgical Unit Advanced LifeSupport (CSU-ALS) Course 8. Caribe Royale hotel property consists of 53 tropical acres designed for fun and relaxation 9. Spacious one-bedroom suites with generous amenities and spa services available if desired 10. The Venetian Room, an awardwinning restaurant, is on the hotel property, along with other eateries and 24-hour room service 11. Shuttles to Walt Disney World theme parks, Orlando Premium Outlets, and Lake Buena Vista Factory Stores 12. Exhibits area offers chances to learn about new tools, technology and services 13. Lunch and Learns provide opportunities to learn about best practices while you dine Save the date! Check out www.Apacvs.Org soon for details. Make time to learn new techniques and re-energize yourself at this spectacular must-attend APACVS winter event! The APACVS has put together a roster of nationally known speakers in cardiac, vascular, and thoracic surgery to lecture on trends in the industry and share their wisdom on best practices. Caribe Royale Hotel In addition, there will be ample handson opportunities to learn cuttingedge techniques. Don’t forget that the exhibitors make this meeting possible, so be sure to make some time to visit with them and learn about their tools and services. As always, we are interested in hearing your feedback so we can serve you better. Do not hesitate to share your thoughts about this event with the APACVS Board. Cardiovision Cardiovision Cardiovision 5 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 House of Delegates Report by David J. Bunnell, MSHS, PA-C The American Academy of Physician Assistants (AAPA) held their annual conference this year in Washington, D.C. It was reasonably well attended with almost 6,000 Physician Assistants gathering to learn, network, and reconnect with colleagues. The annual Memorial Day weekend event also called for the reconvening of the House of Delegates (HOD) where representatives from each state and specialty meet to have the ongoing conversation about who we are and who we want to be. It takes the form of resolutions, debate, and voting. I had the privilege of serving as your Chief Delegate with President David Lizotte, PA-C, serving as the Alternate Delegate. It is notable that PA leaders who are not delegates often visit the house proceedings to catch up with colleagues and keep their finger on the pulse of our profession. Past President and Past Chief Delegate Dana Gray, PA-C; Past President John Byrnes, PA-C; Fellow Member and JAAPA Editorial Board Member Steve Wilson, PA-C; as well as Past President and current AAPA Board of Directors Member Michael Doll, PAC, all attended the proceedings. Steve Wilson, PA-C, also served on the House Nominating Committee and had a central role in the event as the members voted for their future leaders. The hot topic this year was the change in the AAPA volunteer structure. The AAPA Board of Directors decided to change the long-standing volunteer committee structure from that of longserving members to that of short-term, goal-directed committees. This idea had come from the census of PAs that told them that this was the manner in which many PAs were interested in engaging with the academy. However, this change was upsetting to volunteers who had served in the previous committee structure. As a result, there were several resolutions introduced with the aim of restoring the previous committee structure. The house members overwhelmingly voted in support of the previous committee structure. They also voted to request that the AAPA BOD place the new committee structure decision on hold until a conversation could occur between house leaders and the AAPA Board of Directors. The result of this passionate debate and voting was that the AAPA Board of Directors agreed to put their decision on hold so that they could meet with the HOD leaders to discuss a mutually agreeable solution. Another topic of interest to specialty associations is that of representation. State associations have proportional representation based on their membership. Specialty associations are given one seat in the house. The Orthopedic and Dermatology associations entered a resolution that would increase our representation to two votes. I had the opportunity to speak in favor of this resolution because I feel that the house rules leave specialty PAs under-represented in important votes. The testimony against the resolution suggested that we all live in states and are represented by those bodies as well. There was testimony that suggested that the number of votes is not important. However, delegates from the states were not in favor of my suggestion that they reduce their representation to that of one vote. This is not the first time that this sort of resolution has been proposed. It had been defeated in the past and unfortunately was defeated again. I feel that proportional representation is an equitable way to distribute influence. However, it is notable that arguments that make sense for APACVS members also make sense for that of other specialties as well. As a result, the specialties are closer than ever and often support each other with shared goals. The Association of Surgical PAs introduced a controversial resolution in favor of gun control. They argued that clinicians must speak on the epidemic of mass killings in our country because of the devastating effects on patients, families, and communities. There was enthusiastic debate both for and against this resolution. There was also debate as to whether it was the place of PAs to speak on these issues at all. In the end, the resolution was referred to a committee for further discussion and return to the house floor in the future for consideration. So, much as the conversation in the country, the PA community does not have an agreedupon solution or policy. However, also like the country as a whole, the conversation continues. This is a short representation of the meetings that occurred over three days. I believe that this was a consequential session of the House of Delegates. The conversation about how the AAPA engages with PAs, how specialty PAs are represented in the House, and how PAs should engage with society will have echoes far into the future. I consider it a great privilege to serve as your voice in these conversations. Thank you for allowing me to serve. Cardiovision Cardiovision Cardiovision 6 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org Cardiac Surgical Advanced Life Support: The New Paradigm? By Steven M. Gottesfeld, PA-C Post-cardiac surgery cardiogenic shock with post-operative arrhythmia and cardiac arrest are associated with significant mortality and morbidity in the immediate post-operative setting. This is especially acute in institutions that do not employ cardiac surgically trained house staff, as ICU staff may not be adequately trained to quickly identify potentially correctable conditions which, uncorrected, may lead to cardiac instability and potentially arrest and death. “Studies of survival after postcardiac surgery cardiac arrest are few, but there appears to be a considerable survival advantage associated with early aggressive resuscitation with emergent resternotomy and open cardiac massage, when indicated. This finding, which was published by J.H. Mackey, et al., Six-Year Prospective Audit of Chest Reopening After Cardiac Arrest. J. H. Mackay, S. J. Powell, J. Osgathorp, and C. J. Rozario, revealed an overall survival to discharge was 20/79 (25%). Favorable determinants of outcome were: arrest on intensive care unit (ICU), arrest within 24 hours of surgery, and reopening within 10 minutes of arrest. Fourteen of 29 (48%) patients opened within 10 minutes of arrest survived to discharge compared to six of 50 (12%) patients where time to reopening was more than 10 minutes (P=<0.001). Seven of 22 patients (32%) patients where emergency bypass was utilized survived to discharge. This study strongly confirms the benefit of chest reopening after cardiac arrest in the cardiac surgical ICU. Patients who arrest within 24 hours of surgery and in whom reopening is instituted within 10 minutes are particularly likely to benefit.” Basic cardiac life support (BLS), advanced life support (ACLS), and advanced trauma life support (ATLS) courses have been developed to enable members of the medical/surgical team to quickly recognize life-threatening conditions, adopt recognizable roles, and treat these specific disorders in a rehearsed and ordered way. Adoption of these courses by the major medical/surgical institutions has been credited with decreasing the morbidity and mortality associated with these disease entities. It is widely accepted that patients who have undergone complex cardiac surgical procedures are “unique” as it relates to the hemodynamic and physiologic changes which occur postcardiotomy. It is also becoming increasingly obvious that the current required training (BLS, ACLS, etc.) does not adequately prepare the entire post-operative surgical team to treat these life-threatening conditions. Studies of survival after post-cardiac surgery cardiac arrest are few, but there appears to be a considerable survival advantage associated with early aggressive resuscitation with emergent resternotomy and open cardiac massage, when indicated. This situation was quite obvious in countries such as England, in which nurses practice at a level inferior to U.S. nurses, physician house staff is Cardiovision Cardiovision Cardiovision 7 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 limited, and there are few cardiac surgical trained physician extenders such as Physician Assistants. This prompted Dr. Joel Dunning and colleagues to develop an intensive three-day Cardiac Surgery Advanced Life Support Course (CALS) that utilized both intensive didactic and simulation training to review and practice the skills necessary to identify critically ill patients, the proper use and ordering of arterial blood gases, electrocardiograms, radiography, intra-aortic balloon pump (IABP), airway emergencies, temporary cardiac pacing, sterile technique, emergency sternotomies, cardiac massage, and internal defibrillation. Intensive training in the recognition and early intervention in scenarios unique to cardiac surgery was confirmed with the publication of The Cardiac Surgery Advanced Life Support Course (CALS): Delivering Significant Improvements in Emergency Cardiothoracic Care (by J. Dunning, J. Nandi, S. Ariffin, J. Jerstice, D. Danitsch, and A. Levine). “Twenty-four candidates participated in the course. Critically ill patients were simulated using intubated mannequins, with lines and drains in situ, and a laptop with an intensive care unit monitor simulation program.” Upon completion of the three-day course the time to successful definitive treatment was significantly faster post-course for the critically ill patient scenarios: (565 secs [SD 27 secs] pre-course, compared with 303 secs [SD 24 secs] post-course; p < 0.0005). In addition, the times taken to achieve a wide range of predetermined objectives, including airway check, assessing breathing, circulation assessment, treating with oxygen, appropriate treatment of the circulation, and requesting blood gases, chest radiographs, and electrocardiograms, were also significantly faster in the post-course scenarios. Times to successful chest reopening and internal cardiac massage were also significantly improved in cardiac arrest patients: (451 secs [SD 39 secs] pre-course and 228 secs [SD 17 secs] post-course; p = 0.011. Based on this and other information, the CALS course was ratified by the European Association of Cardiothoracic Surgery and the European Resuscitation Council and is now being widely distributed through the European cardiothoracic surgical community. Publication of these successful results of the CALS course developed interest across the Atlantic. In addition, the CALS course is now being evaluated by the Society of Thoracic Surgeons and is currently being offered by the Nurses Training Institute (NTI) for Advanced Practice Nurses and their ICU colleagues. After extensive review, the course has been shortened to an eight-hour intense training regimen which includes didactic and simulation training described earlier. The APACVS Committee of Continuing Medical Education and the Board of Directors have reviewed this course and feel that it presents an excellent learning opportunity for PAs who practice Cardiovascular, Thoracic, and Critical Care Medicine. The committee has become an early advocate for this training course and feels that it will eventually become accepted and required to practice in Cardiothoracic settings. The committee was proud to offer its first courses during the Summer 2013 Critical Care Meeting this July and will offer it for the 2014 Winter Meeting in Orlando. Feedback Welcome The APACVS CME Committee and the Board of Directors would like to hear your opinions on this matter. Also, if you would like to become involved in this training course or you would consider volunteering your time to serve on the committee, please feel free to contact [email protected]. REFERENCES 1. 2. 3. Mackay, J. H., Powell, S. J., Osgathorp, J., & Rozario, C. J. Six-year prospective audit of chest reopening after cardiac arrest. Papworth Hospital, Cambridge CB3 8RE, UK. European Journal of Cardio-Thoracic Surgery (impact factor: 2.55). 2002 September; 22(3): 421-5. pp. 421-5. Dunning J., Nandi, J., Ariffin, S., Jerstice, J., Danitsch, D., & Levine, A. The Cardiac Surgery Advanced Life Support Course (CALS): Delivering significant improvements in emergency cardiothoracic care. Ann Thorac Surg. 2006 May; 81(5): 1767-72. Cardiovision Cardiovision Cardiovision 8 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org Doug Condit Named Winner of the 2013 PA Distinguished Service Award Presented by Montefiore Medical Center Staff and Alumni Association The following is based on a speech presented by Robert Sammartano, PA-C; Immediate Past President of the AASPA and Program Director of the Montefiore Postgraduate PA Residency in Surgery. APACVS sends a heartfelt congratulations to Doug on this achievement! Good evening. It is a true honor and distinct pleasure to be here tonight. I have to admit: It was a lot less stressful when I stood here two years ago and shared the first PA Distinguished Service Award with Warren Weinstein. It is incumbent upon me that in the few minutes allotted, I summarize the 41-year surgical PA career of Doug Condit. Therefore, in keeping with tradition, I welcome you all to the Bi-Annual Ancient Bald PA Award night. Doug Condit carries on the tradition with style. Doug arrived at Montefiore just after the Earth had cooled and Pangea was breaking up into continents. In truth, Doug came here to be one of the Fab Four of the Monte Surgical PA World. Montefiore started the world’s first postgraduate training in surgery for PAs in 1971. Doug, Clara Vanderbilt (seated somewhere in this room), Mike Sheran, and Gary Phelps were the experimental subjects of Drs. Marvin Gleidman, Richard Rosen and Scott Boley (the only surviving member of the Trinity). Doug and colleagues served as surgical interns for what felt like an eternity. After graduation they became the first Service–Based PAs at Montefiore: Clara in general surgery; Mike in pediatric surgery; Doug, who continues to this day in Cardiothoracic Surgery; and Gary, who moved to Isreal. The route Doug took to get to Monte is notable. Not surprisingly, Doug was an Eagle Scout. His CV states he was educated in Colorado—Glenwood Springs High School and Colorado State University in Fort Collins, Colorado. That same CV also does NOT state his birth date. So I am not sure if “Eagle Scout” means he was a member of the Boy Scouts of America or that’s just a nickname the cavalry gave him as he trekked East across the Great Plains in the late 1890s. He left CSU in 1966. For many of us in this room, that period of time recalls a troubled time for the U.S. Doug, in the tradition of his service to all, joined the U.S. Navy and went to serve with the USMC in Vietnam. In June of 1966, he entered as a seaman recruit (E-1) and was honorably discharged as a Hospitalman First Class (E-6) four years later in 1970. Doug’s military career set the tone for his PA life. His contributions to Montefiore and the PA profession over years are being honored tonight. He received several citations for his military service: National Defense Medal, Vietnamese Service Medal (with combat insignia and four Doug Condit (left) pictured with Mary Alice O’Dowd (middle), MD, President of the Montefiore Medical Center Staff and Alumni Association and PA Robert Sammartano (right), who gave an introduction. bronze stars), Combat Action Ribbon, Good Conduct Medal, Navy Unit Commendation, Vietnamese Cross of Gallantry, and Vietnam Campaign Medal. When Doug left the Navy, a new allied health profession was rising in the south; Dr. Eugene Stead at Duke started the first undergraduate training program for physician assistants, which is where Clara graduated. As with many young men with military corpsman or medic experience, this new profession gave them training and an opportunity to continue to serve in a medical/ surgical path. Cardiovision Cardiovision Cardiovision 9 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 Doug Condit (top row, center) poses with five CVT PA colleagues (all active APACVS members) and the first and current PA Directors of the Montefiore PA Surgical Residency. Doug went farther south to the University of Alabama at Birmingham PA Program and centered on surgical practice. He graduated in 1972 and headed straight north to Monte. Many of you know or have benefited directly from Doug’s contributions here as a surgical PA in cardiothoracic surgery over his 40+ years at Montefiore. I have his CV here and it has weight physically and shows him to be a caring PA; educator; author; committee member; leader in local, state and national PA issues; and a role model for all PAs who have become surgical PAs. Few may know how he is responsible for shaping surgical PA practice enjoyed here at Monte and across the country. The following is a shortened list of the many organizations that recognize his outstanding contributions to surgical PA practice. • Senior Physician Assistant in Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York, January 1, 1984. • Fifth recipient of the American Association of Surgeon Assistants John W. Kirklin, MD Award for Professional Excellence, San Francisco, California, October 8, 1990. • Who's Who in Science and Engineering, Premier Edition: 1992-1993; 1994-1995; 19961997. • New York State Conspicuous Service Cross, August 30, 1996. • Recipient of Civilian Physician Assistant of the Year, American Academy of Physician Assistants Veterans Caucus, May 26, 1997. • Recipient of Physician Assistant of the Year, New York State Society of Physician Assistants, April 8, 2000. • Distinguished Fellow, American Academy of Physician Assistants August, 2010. Doug Condit (left), with Clara Vanderbilt (center) and Robert Sammartano (right) at the banquet. All three are recipients of the AASPA-APACVS Kirklin Award for Surgical Excellence. Not shown is Kirklin award winner and Montefiore alumnus John Lee, who was too busy performing cardiac surgery in Hawaii to participate in the festivities. That same CV lists his authorship of 233 publications, 121 presentations at meetings (local, state and national), and membership on 37 various committees, boards of directors, and editorial staffs. It also states he served as adjunct faculty to the Touro Manhattan and CUNY Harlem PA programs. He is a diehard and true Yankees Fan. Doug’s impact on the PA profession is substantial. The honors he has earned do not chronicle the zeal and determination he exerted to effect recognition for all PAs in surgery through the years and across the country. In closing, your patients, physician colleagues, co-workers, and surgical PAs here, across the country, and future PAs and I extend our gratitude to you, Doug, for your example, leadership, and continued service. Be sure to update the CV with tonight’s award! Cardiovision Cardiovision Cardiovision 10 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org ® MAQUET is a registered trademark of MAQUET GmbH • Copyright MAQUET Medical Systems USA or its affiliates. CAUTION: Federal (US) law restricts this device to sale by or on the order of a physician. Refer to Instructions for Use for current indications, warnings, contraindications, and precautions. 15 YEARS. 11 GENERATIONS. ONE TRUSTED NAME IN EVH. The numbers don’t lie: MAQUET VASOVIEW is the clear market leader with 1.5 million endoscopic vessel harvesting (EVH) procedures performed to date. Complete family of VASOVIEW products, including bipolar and direct current devices—all indicated for use in the saphenous vein and radial artery Wealth of data demonstrating sustainable, reproducible, long-term patient outcomes for up to 4 years1-5 The only EVH system to offer virtually zero thermal spread on the concave side of the jaws, eliminating risk of injury to the surrounding tissue6,7 In-line instrumentation and 0° scopes, which allow ergonomic surgical control to improve harvesting technique www.maquetusa.com References: 1. Ouzounian M et al. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting. Ann Thorac Surg. 2010;89:403–408. 2. Ad N et al. The impact of endoscopic vein harvesting on outcome of first time coronary artery bypass grafting surgery. J Cardiovasc Surg. 2011;52:739–748. 3. Dacey LJ et al. For the Northern New England Cardiovascular Disease Study Group. Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting. Circulation. 2011;123:147–153. 4. Grant SW et al. What is the impact of endoscopic vein harvesting on clinical outcomes following coronary artery bypass graft surgery? Heart. 2012;98:60–64.5. Williams JB et al. Association between endoscopic versus open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012;308:475–484. 6. Lombardi P, Lau L. Measurement of Thermal Spread from Use of VASOVIEW HEMOPRO: Study Demonstrates Minimal Thermal Injury to Endothelium. White Paper. MAQUET Cardiovascular. 07/08. LT7900184 7. Data on file, MAQUET Cardiovascular; 2008. • Uncompromising VASOVIEW EVHThe performance. Proven outcomes. MAQUET EVH partner of choice. The standard of care. CVT PAs on Medical Mission to Dominican Republic By Doug Condit, PA-C Sincere congratulations from APACVS to Michael Gardocki and Jason Lightbody! This spring, these two APACVS members spent a week as members of a medical mission to Santiago, Dominican Republic. Dr. Robert Pascotto, who is semiretired from his cardiac surgery practice in Fort Myers, Florida, created the medical mission to this hospital in 2002 and has assured that at least two and usually three “Heart to Heart” medical missions occur annually. Due to his diligence, the Jose Maria Cabral y Baez Hospital has made some significant strides toward building a consistent heart program. Currently, only the missions that he organizes perform heart surgeries at this hospital. This year, a multidisciplinary team of surgeons, Gardocki, Lightbody, critical care physicians, anesthesiologists, and nurses from Montefiore Medical Center spent a week performing much needed surgery at the hospital. have here in the states, especially in the face of a changing health care system. Many patients were required by the hospital to bring their own medications from an outside pharmacy and endotracheal tubes if they were having lung surgery. Every family we met was overwhelmingly grateful for our help. I look forward to going back next year and in the years to come.” His comments about returning are true, as this was his third trip on a medical mission to the Jose Maria Cabral y Baez Hospital. It should be mentioned that not only do volunteers donate their time, but they also pay for their personal transportation to the Dominican Republic. CVT PAs Michael Gardocki (left) and Jason Lightbody (right) in Santiago, Dominican Republic CVT PA Jason Lightbody (left) with a post-op patient in the ICU. Patients were moved out of the monitored ICU to a regular floor bed on POD #1 to make room for the operations performed that day. The team had the opportunity to work with medical students and residents to help them build surgical skills and confidence to utilize these skills in the Dominican Republic. The local physicians, residents, and medical students frequently took team members over to their houses for dinner. When describing his first experience on this team, Jason noted, “It was very rewarding to be able to go on a trip like this and give back to so many people and families that otherwise would never have gotten their needed surgeries. It really makes you appreciate all that we Many of the medical personnel who volunteered on this mission are shown with several of their patients. Cardiovision Cardiovision Cardiovision 12 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org Michael Nowak Organizes PA Medical Missions to Guatemala By Doug Condit, PA-C APACVS congratulates Michael Nowak on his successful missions to Guatemala and looks forward to learning more about his travels. This winter, Michael Nowak, MPAS, PA-C, FAPACVS, a Cardiac Surgery and Hospitalist PA at the Mayo Clinic in Rochester, MN, coordinated a Physician Assistant-centered medical mission to Guatemala with an Emergency Department PA and Physician, both from Pennsylvania, and 11 PA students from the Seton Hill PA program. From Jalapa, the team visited numerous rural villages, including some where the villagers had never before seen a Caucasian person. During their visit, they treated approximately 1,300 individuals. Members of the team had to literally bring all of their medical supplies into the country with them. They brought nearly 1,000 pounds of supplies, including medical instruments, diagnostic equipment, and medications. Their host family was an American family in Jalapa, a village approximately two hours East of Guatemala City. David and Julie Sutton and their family moved to Jalapa approximately 10 years ago. They currently are involved in various forms of ministry. They routinely host medical missions, as many local residents have no access to even rudimentary health care. From Jalapa, the team visited numerous rural villages, including some where the villagers had never before seen a Caucasian person. During their visit, they treated approximately 1,300 individuals. For this trip, Michael personally raised the money necessary to purchase medications used on the mission. To save on shipping costs, each member of the team carried suitcases with medical supplies. Michael notes that the trip was very inexpensive, only about $500 per person for the week (including transportation, sleep quarters, three square meals a day, and Setting up the mountain village clinic Michael Nowak with a child from the orphanage For this trip, Michael personally raised the money necessary to purchase medications used on the mission. To save on shipping costs, each member of the team carried suitcases with medical supplies. Cardiovision Cardiovision Cardiovision 13 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 translators) and each traveler’s airfare. He was able to also raise some additional funds that helped paid for some of the students’ costs. When asked if he would do it again, Michael commented: “Personally, I LOVED IT, and will be coordinating a weeklong trip each and every year back to the same place. My goal is to take about 10 PAs and/or PA students. I will be taking a team of 10 the week of November 3 this year and am already signing people up for next year. The personal rewards are incredible. Most of these people have never received any medical care and have never even had a Tylenol or vitamin. Most of the common health problems included intestinal worm infections, fungal skin infections, musculoskeletal complaints, infections, and complaints similar to what you would see here in a primary care office. We also brought a lot of vitamins, toothbrushes, toothpaste, crayons for the kids, and yes—even some chocolate for the kids.” Anyone interested in participating in a PA Medical Mission Trip to Jalapa, Guatemala is invited to contact Michael directly at [email protected]. Taking a break to play some soccer with the kids Reviewing cardiac examination with PA students Rapid Strep Analysis Decreased breath sounds, dullness to percussion and decreased tactile fremitus A line of approximately 100 people in the background “We also brought a lot of vitamins, toothbrushes, toothpaste, crayons for the kids, and yes—even some chocolate for the kids.” Patient, interpreter, and medical provider Team picture Michael Nowak with PA student and patients Cardiovision Cardiovision Cardiovision 14 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org There is a distinction between one qualified PA and another. It’s called a CAQ. You’ve become a leader in your field. You’ve honed your skills. You’ve gained knowledge and expertise. You’ve done everything to be an accomplished cardiovascular and thoracic surgery PA. The Certificate of Added Qualifications (CAQ) in Cardiovascular and Thoracic Surgery is your chance to prove it. The CAQ is offered by NCCPA—the only certifying organization for PAs in the U.S. Already trusted by health care employers, NCCPA helps you document your advanced qualifications. You already have what it takes. Visit www.nccpa.net/cvtscaq or call 678-417-8100, and start earning your CAQ in CVTS today. Then distinguish yourself from other PAs. submissions due oct. 31, 2013 for the susan lusty excellence in publication writing award The Association of Physician Assistants in Cardiovascular Surgery (APACVS) is excited to announce the Susan Lusty Excellence in Publication Writing Award. APACVS is looking for PAs who wish to share their scholarly knowledge, hands-on experience, and professional insight with fellow APACVS members through the published articles. This award honors Susan Lusty, RN, the only non-PA winner of the esteemed Kirklin Award. Susan, who was the founding editor of Surgical Physician Assistant and who passed away in 2003, encouraged surgical PAs to submit their written pieces and offered a professional forum for their publication. The APACVS is grateful to Susan for her inspiration to PAs and her passion to share the writings of others. To be eligible for this award, the following criteria must be met: 1. The awardee must be a member, in good standing, of the APACVS. 2. The awardee must be a primary or secondary author of the manuscript. 3. The manuscript must be published in a peer-reviewed Index Medicus journal. 4. The manuscript must be relevant to the practice of cardiovascular and thoracic surgery or critical care. 5. The manuscript must be < 2 years old, to ensure that the paper is clinically relevant. 6. Adjudication of the award will be accomplished by a committee appointed by the President of the APACVS. 7. Members of the review committee, the Board of Directors, and the CME Committee are ineligible to receive the award. Submissions are due October 31, 2013! Manuscripts must be submitted electronically to the APACVS National Office by October 31st. This award will be given annually at the Winter Meeting in January of 2014. The manuscript will be introduced by the President at the end of the President’s address and will be the opening presentation at the meeting. Questions about the submission process should be sent to: Ed Ranzenbach, PA-C, MPAS, FAPACVS, [email protected], 414-908-4952 or 877-221-5651. The application can be downloaded by going to www.apacvs.org. Cardiovision Cardiovision Cardiovision 16 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org Drug Shortages By Edward A. Ranzenbach, PA-C, MPAS, FAPACVS, DFAAPA, CAQ-CVTS Member-at-Large, APACVS Board of Directors Is it just me, or are medications commonly used in cardiac surgery no longer available? We haven’t been able to get Papaverine, IV Furosemide, and numerous other agents for months. Recently, our hospital pharmacy announced that the only Calcium Chloride available was sealed in the crash carts. Over the weekend, I wanted to lower a patient’s serum potassium using Insulin and D50 but had to use an infusion of D10 instead. No D50? Really? Cardinal Health, which supplies numerous generic pharmaceutical agents, lists 65 agents currently on manufacturer backorder or short supply including such notables as: • Aminocaproic Acid • Gentamicin • Ondansetron • Atorvastatin • Isoniazid • Bumetanide • Lorazepam • • • • • • • • • • Atropine • Calcium Chloride Cathflo Activase Cefazolin D25% D50% Dopamine Epinephrine Fentanyl Furosemide • • • • • • • • Ketorolac Mannitol Marcaine Metoclopramide Midazolam Naloxone Nitro-Bid Nitroglycerine/ D5W Norepinephrine • • • • • • • • • • Pancuronium Pantoprazole Sodium Papaverine Sodium Potassium Phosphate Promethazine Propofol Sensorcaine Sodium Bicarbonate Hypertonic Saline Solu-Medrol How can we possibly perform complex cardiac surgery without the basic agents we use daily to keep our patients alive? The bigger question is: How is it possible that all of these common generic agents are in such short supply? The answer is pure economics. This became readily apparent to me a few weeks ago when the nightly news ran a story about a new cancer agent that can reduce some tumors, in some patients, by as much as 80% and can extend some patients’ lives for months to years. The cost of one of these agents was $14,000 per month. no longer the concern of Big Pharm. They have long ago gone the way of generic formulary and are manufactured by smaller pharmaceutical companies on tight margins. All it takes is one fly in the ointment (literally) and these manufacturers halt production while they scour the process. At a minimum, such issues can result in shutdown of the plant and resulting shortages. At maximum, such an issue can result in the demise of the manufacturer and loss of agents for months to years while a new manufacturer comes online. Problems In a six-month period in 2010, of 311 hospitals surveyed, 89% reported drug shortages that may have caused The agents we commonly use, although first-line for us, are Edward A. Ranzenbach, PA-C, MPAS, FAPACVS, DFAAPA, CAQ-CVTS In aout call six-month period in 2010, of 311 hospitals surveyed, 89% reported drug shortages that may have caused safety issues or errors in patient care, and 80% experienced shortages that caused delay or cancellation of patient care. Cardiovision Cardiovision Cardiovision 17 www.apacvs.org association of physician assistants in cardiovascular surgery Summer 2013 safety issues or errors in patient care, and 80% experienced shortages that caused delay or cancellation of patient care. In some cases, hospitals resorted to using dosages from single-dose vials on multiple patients to alleviate their shortage. When it comes to manufacturers simply not meeting the demand for a particular drug, the Food and Drug Administration (FDA) actually has limited authority in this area. The agency cannot require a company to manufacture a particular drug or even require that it be notified of shortages, planned or otherwise. Thus, it is possible for a manufacturer to commit its resources to drugs that have higher profit margins rather than those that may serve the highest patient population. Additionally, there is the problem of quality and how it affects the manufacturing process. When a drug is recalled by a manufacturer or the FDA determines a problem in the manufacturing process, this often results in a shutdown of the entire manufacturing process while the problem is corrected and the manufacturer undergoes rigorous inspection by the FDA before manufacturing may resume. Problems such as contaminants, biological or inorganic (such as glass or metal in vials), in one step of the manufacturing process can actually affect a number of drugs in the pipeline that depend on this process. Kweder and Dill report that in 2012, quality-related problems and capacity delays continued to account for the majority of drug shortages, especially those involving sterile-injectable drugs. From 2009 to 2012, six of the top 10 manufacturers of sterile-injectable drugs received warning letters from the FDA for serious violations in manufacturing standards. Four of those manufacturers closed factories or significantly reduced production on order to resolve these problems. Taking Action In October of 2011, President Obama signed Executive Order 13588 into law that required the government to take proactive measures to identify and prevent the shortage of prescription medications. Yet, we continue to have shortages of the basic medicines needed to perform management of cardiac surgery patients. I encourage you to all go to http://www.house.gov/ representatives/find/ and find your congress representative and senator. Make them aware of this ongoing crisis and encourage them to act. Join an APACVS Committee Help APACVS set goals and share your specific talents with the organization. To learn more info, visit www.apacvs.org. • Communications Committee • Continuing Medical Education • Corporate Relations • Elections Committee • Fellow Member Oversight Committee • Finance Committee • Membership Committee Contact [email protected] today! Cardiovision Cardiovision Cardiovision 18 Summer 2013 association of physician assistants in cardiovascular surgery www.apacvs.org APPLICATION for MEMBERSHIP in the Association of Physician Assistants in CardioVasular Surgery Receive the many benefits of membership in the Association of Physician Assistants in CardioVascular Surgery (APACVS) EDUCATION PUBLICATIONS/RESOURCES PROMOTION OF THE CVT PA • • • • • • • APACVS presents two annual educational meetings, one focused on cardiac, vascular and thoracic surgery, one focused on cardiothoracic critical care. APACVS hosts several hands-on sessions including a Certificate of Completion in Invasive Skills Course, a Thoracoscopic Surgical First Assistant Course, a Cardiothoracic Surgery Advanced Life Support Course, Mechanical Assist Course, and many others planned for the coming years. APACVS co-sponsors the Allied Health Symposium and Critical Care Symposium at the annual AATS meeting. APACVS website provides a database for on-line case and procedure logging. APACVS is developing web-based modules that are eligible for CME and will satisfy the new self-assessment recertification requirements. • • • q Active q Student APACVS maintains professional liaison relationships with STS, AATS, AAPA, and AASPA and FACTS-Care. These liaisons have provided critical support for cardiac, vascular and thoracic PAs facing regional and national legislative or regulatory battles and support our mission of education of the cardiac, vascular and thoracic PA in all arenas. APACVS has a delegate in the AAPA House of Delegates, the legislative body of the AAPA. This representative has been vital in educating the non-CVT PA as to the critical role the CVT PA plays in contemporary medicine. APACVS has developed positive, collaborative relationships with other professional organizations, including the NCCPA. q Associate q Resident q Retired Name________________________________________________________________________________ Last First MI Prefix Suffix Mailing Address__________________________________________________________________________ Company Web URL __________________________________________________________________________ Address Address Line 2 __________________________________________________________________________ City State Zip Primary Phone_ _________________________________ Cell Phone_______________________________ Work Phone_ ___________________________________ E-mail_ ________________________________ Publish in Directory? q Yes q No Do you wish to receive e-mail updates from APACVS? q Yes q No APACVS Fellow Membership provides qualified members the opportunity to display a level of experience and excellence in practice through the use of the FAPACVS designation. (One must be an Active member before applying to become a Fellow.) • PROFESSIONAL LIAISON • Type of Membership The annual Practice & Compensation Profile provides data on the role of the CVT PA in contemporary practice and the compensation received. The Association’s magazine, CardioVISION™, is published quarterly and keeps readers informed of news and events affecting the cardiac, vascular and thoracic PA. • APACVS has developed and produced a CD-rom to help educate the medical community about what cardiac, vascular and thoracic PAs can do. APACVS exhibits at other CT Surgical meetings including the STS and EACTS meetings to promote the role of the cardiac, vascular and thoracic physician assistant to surgeons, to hospital and practice administrators, and to PAs in other arenas. APACVS MEmbership year The APACVS membership runs for one year and renews on the anniversary. Payment of dues must be included with application. q $165 Active Member Annual Dues q $100 Associate Member Annual Dues q $75 Resident Member Annual Dues q $25 Retired Member Annual Dues q $0 Student Member Annual Dues (4001.1) (4001.2) (4001.3) (4001.4) Payment Options q Check enclosed or in mail (payable to APACVS) q Visa q Mastercard q Discover q Am. Express Card Number_____________________________ Expiration Date_ ___________________________ PA Program_ ___________________________________ Graduation Date__________________________ Authorizing Signature_ _______________________ Degree_ ______________________________________ Credentials_____________________________ Today’s Date______________________________ Other Professional Certification________________________________________________________________ Name on Card_____________________________ AAPA Member q Yes q No Member Number_______________________________________________ E-mail_ ______________________________________________ AASPA Member q Yes q No Member Number_______________________________________________ NCCPA Certified* q Yes q No Certificate Number______________________________________________ An e-mailed receipt from authorize.net will be sent to the above e-mail address when a credit card is processed. *All non-student applications must include an NCCPA number in order to be processed. Check the committee(s) you’d be interested in serving q Continuing Medical Education q Elections q Fellow Member Oversight q Communications APACVS Member specialty (Check all that apply) q Cardiac q Facebook q Membership q Corporate Relations q Website q Thoracic q Vascular q I am a student The personal information provided will not be used for any purposes other than those stated upon this form unless you provide your consent. Should you have any questions concerning your personal information please call (414) 908-4952. APACVS endeavors at all times to treat your personal information in accordance with all applicable laws. Association of Physician Assistants in CardioVascular Surgery (APACVS) 7044 S. 13th St. Oak Creek, WI 53154 P: (414) 908-4952 F: (414) 768-8001 www.apacvs.org CAUTION: Federal (US) law restricts this device to sale by or on the order of a physician. Refer to Instructions for Use for current MAQUET is a registered trademark of MAQUET GmbH • Copyright MAQUET Medical Systems USA or its affiliates. • indications, warnings, contraindications, and precautions. THE DEBATE IS OVER: EVH IS SAFE, EFFECTIVE AND PROVEN Since 2009, five independent studies have reaffirmed that endoscopic vessel harvesting (EVH) is the proven and effective therapy for the 21st century.1-5 EVH does not compromise long-term revascularization outcomes1-5 View the data Equivalent survival and cardiac outcomes for EVH compared to open vein harvesting1-5 Post-saphenectomy wound complications show significant superiority for EVH1-3,5 Debate closed: EVH is the standard of care for coronary artery bypass graft surgery. References: 1. Ouzounian M et al. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting. Ann Thorac Surg. 2010 Feb;89(2):403-8. 2. Ad N et al. Endoscopic versus direct vision for saphenous vein graft harvesting in coronary artery bypass surgery. J Cardiovasc Surg (Torino). 2011 Oct;52(5):739-48. 3. Dacey LJ et al. Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting. Circulation. 2011 Jan 18;123(2):147-53. 4. Grant SW et al. What is the impact of endoscopic vein harvesting on clinical outcomes following coronary artery bypass graft surgery? Heart. 2012 Jan;98(1): 60-4. 5. Williams JB et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012 Aug 1;308(5):475-84. VASOVIEW EVH • Uncompromising performance • Proven outcomes. www.maquetusa.com