NY Cardiothoracic Group, PLLC Westchester Medical Center Valhalla, NY 10595 914 493-8793 Open Letter Reviewing 2006 Results May, 2007 The New York Cardiothoracic Group (NYCTG) - Drs. Steven Lansman, David Spielvogel, Ramin Malekan and Paul Saunders - would like to take this opportunity to review some of our 2006 results and mention some of the exciting areas we are developing in cardiothoracic surgery at Westchester Medical Center. Drs. Lansman and Spielvogel founded NYCTG in 2005, when Dr. Lansman was recruited to become Chief of Cardiothoracic Surgery at Westchester Medical Center in 2005. It has been a busy, productive 2 years. Our group's volume has steadily expanded, increasing 60% last year, from 400 cases in 2005 to 640 cases in 2006, while excellent outcomes have been achieved; operative mortality for all cardiac cases was 1.7% in 2005 and 0.9% in 2006. (Note: Reported data is for hospital mortality and excludes patients brought to the OR in cardiogenic shock). Coronary bypass grafting (CABG) remains a large part of our practice, comprising 57% of major cases. The age range, acuity, spectrum of severity and co-morbidities in this group represent tertiary referral patients, yet 98.4% of patients received at least one arterial graft, 69.4% received multiple arterial grafts and 17.1% had "all arterial grafting." In 2006, our coronary bypass mortality was 0.6%. Valve and CABG/Valve and Multiple Valve procedures, often including arrhythmia procedures and aneurysm surgery, made up most of the remaining cases. For 123 cases in 2006, Valve - CABG/Valve mortality was 0.9%. In addition, there are a number of subspecialty areas that we are developing. The Aortic Aneurysm Program, directed by Dr. David Spielvogel, is one of our major interests (See www.AorticSurgery.org). To date, we have performed 78 aneurysm procedures, including valve-sparing root replacements; Bentall, arch, and thoracoabdominal aneurysm repairs; non-invasive "endograft stent" procedures and re-operative procedures with 1 (1.3%) mortality. Dr. Spielvogel has lectured at national and international meetings on his widely adopted method of aortic arch replacement, the trifurcated graft technique (below). For preoperative and postoperative aneurysm patients, we inaugurated an Aortic Aneurysm Follow-up Program that includes a nurse practitioner and a custom-developed database to implement surveillance protocols for these patients. Also, Westchester Medical Center is co-hosting Aortic Symposium 2008. This meeting, which has been organized by Dr. Lansman for the past 20 years, is generally attended by over 1000 cardiac surgeons and, since it has become internationally recognized as the major forum for this field, will be held under the auspices of The American Association for Thoracic Surgery (see CME Meetings at www.AATS.org). Mitral valve repair is also a major interest. Our standard approach is to repair rather than replace the mitral valve, which we are now performing via a minimally invasive approach. In 2006, we successfully repaired 95% of mitral valves that we intended to repair preoperatively; the operative mortality for mitral valve repairs was 0%. Cardiac Transplant and Ventricular Assist Devices (VAD) represent another major area we are developing. To date, we have performed 4 heart transplants, all successful, and have implanted 16 assist devices, as "bridge-to-transplant" and "bridge-to-recovery." We have a number of assist devices available, including the ABIOMED Ventricle, the JARVIK 2000 rotary device and the HeartMate and NOVACOR implantable, pulsatile devices. Our first VAD patient, a law professor who developed shock following a large MI, was successfully supported with a right ventricular assist device, then weaned and discharged. We appreciate the confidence that the community has expressed by choosing NYCTG for their cardiac surgery and will endeavor to continue providing this level of care. Yours truly, Steven L. Lansman, MD, PhD Professor of Surgery, New York Medical College Chief, Section of Cardiothoracic Surgery Westchester Medical Center David Spielvogel, MD Associate Professor, New York College of Medicine Program Director, Cardiothoracic Transplantation Ramin Malekan, MD Assistant Professor, New York College of Medicine Paul C. Saunders, MD Assistant Professor, New York College of Medicine Phone: 914-493-8793 FAX: 914-493-1610