Posts from the ‘advanced expert care’ category

The Heart of the Matter: Brigham Team Delivers Precious Outcome

Jasmine Taylor with her son, Jaydan

When doctors told Jasmine Taylor, 30, five years ago that pregnancy would be a life-threatening condition due to her poor health, including a complex heart defect she’s had since birth, it didn’t come as a surprise to her. It was something Taylor had heard from her care providers since adolescence. Still, as she and her husband, Damon, dreamed of starting a family, that didn’t make the news any less heart-wrenching.

Today, however, her heart overflows with love. Seemingly against all odds—and thanks to the support of Taylor’s passionate and collaborative multidisciplinary care team at the Brigham and Boston Children’s Hospital (BCH)—the Stoughton couple welcomed their son, Jaydan, to the world in July.

“When I heard him cry for the first time in the delivery room, I thought, ‘I want to protect and love him forever,’” Taylor said.

Getting to that point was a long and difficult road, one that Taylor said she doesn’t take for granted. She was born with a severe form of tetralogy of Fallot, a cardiovascular disorder that restricts the passage of blood to the lungs. By the time she was a teenager, Taylor had undergone three open-heart surgeries—the first one performed when she was just eight months old.

Upon reaching her 20s, her health continued to decline. She became overweight, diabetic and struggled with high cholesterol. On top of that, she wasn’t keeping up with the long list of medications she had been prescribed to treat these issues; at 23, she had a stroke. The frightening event was a wakeup call, Taylor said.

She began taking her medications dutifully. She adopted a healthier diet and intensive exercise regimen, leading her to drop 100 pounds in one year and safely come off most of her medications. Taylor said she did it all with one aspiration in mind: getting healthy enough to become a mother.

“There was a chance—a hope—that I could become a parent, so I was very determined to make it happen,” Taylor said.

‘We’re Going to Do This’

Even with the dramatic improvements to her health, Taylor’s weak heart would make pregnancy challenging. Among the many changes women undergo while pregnant is a significant increase in blood volume—sometimes almost doubling to nourish a fetus—which puts more stress on the heart to pump blood through the body.

“I told Jasmine, ‘It’s going to be hard work,’” recalled obstetrician Katherine Economy, MD, co-director of the Brigham’s Pregnancy and Cardiovascular Disease Program. “She just looked and me and said confidently, ‘None of this is a problem for me. My goal is to have a baby,’ and I said, ‘That is my goal now for you, too. We’re going to do this.’”

Economy is just one member of the large interdisciplinary care team that worked together over the past two years to achieve a safe pregnancy and childbirth for Taylor and baby Jaydan. But just as important as the advanced, comprehensive care they delivered was Taylor’s fierce commitment to staying healthy and starting a family, her providers emphasized.

“It takes more than a village of expert care, compulsiveness, outreach, detail, innovation, coordination and attention to quality outcomes at every step,” said cardiologist Michael Landzberg, MD, senior staff member, founder and immediate-past director of the Boston Adult Congenital Heart and Pulmonary (BACH) Program, a joint effort of the Brigham and BCH that cares for adults born with heart conditions. “That said, without identifying and utilizing her unique strengths, Jasmine could never have accomplished what she has near-miraculously done. She remains a hero to each and every one of us.”

Close Collaboration

After facing fertility challenges unrelated to her heart condition, Taylor was referred to the Brigham’s Center for Infertility and Reproductive Surgery, where she underwent two rounds of in-vitro fertilization (IVF) at the center’s Weymouth clinic. Even at this stage, her complex health needs influenced how her fertility care was planned, said reproductive endocrinologist Janis Fox, MD.

“There were definitely unique considerations in performing IVF on someone with her history,” Fox said. “I very much wanted to avoid rare but known complications such as ovarian hyperstimulation, and I absolutely wanted to avoid a multiple pregnancy, as we all felt that would be an unnecessary challenge for her heart.”

Throughout her pregnancy, Taylor’s providers were in near-constant communication and, via the Pregnancy and Cardiovascular Disease Program, met monthly to discuss her progress and anticipate possible complications. The team also involves experts from other disciplines—including anesthesiology, cardiac surgery, neonatology and nursing—to ensure they are fully prepared, said cardiologist Anne Marie Valente, MD, co-director of the program.

“We coordinated and developed a written care plan so that at any point, no matter who was on call, each of us would know exactly the potentials and treatment plan,” Valente said.

As a patient, Taylor said her providers’ extraordinary commitment, support and compassion have been remarkable: “These are priceless people in my life. They are like my extended family.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

B-PREP Program Aims to Stop Breast Cancer in Its Tracks

Bprep

From left: Mil Pierce reviews information about a clinical trial with Shivam Dua at the Comprehensive Breast Health Center.

As far as she can tell, Mil Pierce, 55, of Belmont has done everything right in terms of leading a healthy lifestyle. She never smoked. She goes to the gym twice a week and walks her dog nearly every day. She doesn’t drink alcohol in excess. And she’s eliminated red meat from her diet.

Pierce has made these choices with the knowledge that she has a strong family history of breast cancer. The disease has affected her mother, maternal grandmother and a maternal great aunt, among many other relatives.

Yet after Pierce underwent genetic testing to see if she had an inherited mutation in the BRCA1 or BRCA2 genes – an alteration that greatly increases a woman’s risk of breast cancer – the lab results showed she didn’t have the harmful mutation.

That’s why Pierce was stunned to learn two years ago, following a biopsy, that there were precancerous cells in her breast tissue. If left untreated, the abnormal cells could develop into breast cancer.

“When I got that diagnosis, it hit me like a brick. I thought, wow, there’s something else going on,” she said. “Genetically speaking, there’s no explanation for it.”

Today, Pierce is hopeful not only for her own continued health but also that of her two teenage daughters, thanks to the care, resources and guidance she’s receiving through the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

Launched about two years ago and led by Tari King, MD, chief of Breast Surgery at DF/BWCC, the B-PREP Program develops a comprehensive, customized risk profile for every patient and a personalized plan aimed at reducing the likelihood of developing breast cancer. Upon entering the program, patients complete a survey that asks not only about their medical history but also a wide range of lifestyle factors that experts believe can contribute to breast cancer risk, including diet, physical activity, sleep, weight changes, whether they work a night shift and more.

“Assessing individual risk for breast cancer is complicated,” King said. “Breast cancer is not just one disease; it is a family of diseases, and the risk factors that can lead to the development of different types of breast cancer also vary.”

King emphasized that the program is open to all patients, including – and perhaps especially – those who don’t know their breast cancer risk.

“Many women think that if breast cancer is not in their family that they don’t have to worry about it, and that is not true. In fact, most women who come in with their first diagnosis of breast cancer don’t have a family history,” King said. “Our doors are open to anyone who wants to learn about their risk.”

Novel Trials

Another big misconception the B-PREP Program is working to dispel is that people at increased risk are at the mercy of their biology, King said. Based on what B-PREP’s multidisciplinary team learns from an assessment, each patient receives personalized recommendations and is connected to relevant resources, such as a referral to the Brigham’s Program for Weight Management or information about clinical trials currently enrolling patients.

One such novel trial is looking at how exercise affects breast cancer risk in women who have dense breast tissue and do not currently engage in regular exercise. Led by Jennifer Ligibel, MD, a medical oncologist specializing in breast cancer at DF/BWCC, the study pairs participants with a personal trainer for 12 weeks. Researchers will collect a breast tissue sample from participants before and after they complete the exercise program.

“We know that women who exercise more have a lower risk of developing breast cancer, but we don’t know why. We also know that denser breast tissue – that is, tissue containing more glandular elements to it and less fatty tissue – is linked to a higher risk, and, again, we don’t know why,” Ligibel said. “In a previous study we conducted looking at women who already had breast cancer, we saw that exercise actually changed the immune system within the cancer. Now, we’re looking at whether those same types of changes from exercise can be seen before a tumor has even emerged.”

Pierce learned about her eligibility for the study from her B-PREP providers and became one of the first patients to enroll. She appreciates how comprehensive the B-PREP Program is, including the opportunities to participate in clinical trials that explore wellness-based approaches to prevention.

“This breast density and exercise study was music to my ears,” she said. “I’m really excited about being on the cutting edge of research, especially since there’s a mystery here.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

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AERD Center Aims to Clear the Air on an Underdiagnosed Disease

From left: Alice Maxfield speaks with David Doyle during a recent follow-up appointment.

For David Doyle, 54, taking in the flavors and aromas of food is more than his passion – as co-owner of several restaurants in Jamaica Plain, it’s also his livelihood. So when what seemed like unusually intense seasonal allergies caused his senses of smell and taste to diminish three years ago, Doyle grew concerned.

First experiencing severe nasal and chest congestion, he tried several over-the-counter allergy medications. Nothing worked – in fact, his symptoms worsened. Within a few months, Doyle not only felt miserable physically, but he was also devastated to find he could no longer smell or taste anything.

“I didn’t really want to eat because there was no joy in it,” Doyle said. “On a professional level, it was also really hard to work with these great chefs who would ask, ‘David, can you taste this?’ and all I could comment on was the texture.”

Hoping his symptoms would eventually subside, he continued taking allergy medications and pain relievers, even though their effects were minimal. It wasn’t until after suffering a frightening medical event that Doyle would learn the very medications he was taking to feel better were actually making him sick.

Doyle was on vacation with his family in Spain when he realized something was gravely wrong with his health. Suffering from a bad headache and congestion, he took some ibuprofen, a treatment he had used before without incident. This time, however, he began experiencing serious respiratory distress within a few hours and was rushed to a local hospital.

“My lungs were filled with fluid. I felt like I was suffocating,” Doyle said. “I had no idea what had prompted that reaction, but I was starting to suspect something had changed inside me.”

After returning home, he was referred by his primary care provider to Tanya Laidlaw, MD, director of Translational Research in Allergy in the Division of Rheumatology, Immunology and Allergy, who diagnosed him with aspirin-exacerbated respiratory disease (AERD). Triggered by a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, AERD is a chronic condition that includes severe asthma and recurrent, fast-growing nasal polyps.

Also known as Samter’s Triad, the disease often strikes otherwise healthy adults and progresses rapidly. Its cause is unknown, and effective treatments are elusive.

“This is a disease that is really not well-known and is underdiagnosed,” said Laidlaw, who also serves as director of the Brigham’s AERD Center. “It requires a multidisciplinary approach, particularly between ear, nose and throat surgeons and allergists – specialists who don’t ordinarily talk to each other about patients with these symptoms. Without that communication, an ENT surgeon is unlikely to ask about an aspirin allergy, and an allergist doesn’t typically look for nasal polyps.”

Founded five years ago, the Brigham’s AERD Center brings together allergists, ENT surgeons and researchers to explore new treatments and improve the lives of patients with AERD. The center’s clinicians diagnose and treat hundreds of patients per year, and its investigators manage an international research registry of more than 1,000 people with AERD. Combined with its robust clinical trials program, these efforts make the Brigham’s AERD Center the largest clinical and research center for the disease worldwide.

“We have an incredibly collaborative relationship between bench scientists and those of us who see this disease in patients,” Laidlaw said. “We are all in constant communication. Every patient with an aspirin allergy seen by an ENT surgeon is likely referred to us. That proves education can solve the diagnosis gap. However, there is still an enormous need for broader awareness and research funding.”

Tasting Success

Upon returning home and beginning treatment at the Brigham, Doyle enrolled in a clinical trial at the AERD Center to initiate high-dose aspirin treatment, which involves administering increasing doses of aspirin to patients and closely monitoring them for the next several hours.

After starting this daily therapy and seeing only marginal improvement, Doyle underwent two surgeries to remove nasal polyps under the care of Alice Maxfield, MD, an ENT surgeon in the Department of Otolaryngology. A third procedure adjusted the blood flow in his nose to reduce inflammation. Within days of the last surgery, Doyle said he felt dramatically better.

Today, Doyle estimates he’s recovered about 90 percent of his senses of taste and smell, and his respiratory symptoms are largely under control. Although it was a long road, Doyle said he is deeply grateful for the expert, compassionate care he has received at the Brigham.

“I feel like my experience mirrors many others with AERD. It’s really frightening to develop symptoms that don’t make sense to you, so it was a huge relief just to know what was happening,” he said. “My hope is more clinical trials will shed light on not only the causes of this disease but also treatments for it.”

Shortly after recovering from his final surgery, Doyle and his family returned to Europe to vacation in Italy. It was on this trip that he realized his senses started to return. The first food he remembers tasting? Truffles.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

‘An Amazing Gift’: Patient Receives Rare, Lifesaving Heart-Lung Transplant

Camille Frede (right), pictured with her mother, Nancy, is the first BWH patient to undergo a heart-lung transplant in more than 20 years.

When Camille Frede, 28, saw Antonio Coppolino III, MD, MSc, then a fellow in the Division of Thoracic Surgery, enter her patient room at the Shapiro Cardiovascular Center earlier this year, her heart skipped a beat as she recalled their last conversation several weeks prior.

“The next time I see you will be when we get ‘the call,’” Coppolino, now an associate surgeon in the division, had told Frede and her family at the time. “The call” would be the care team’s notification that a matched donor heart and lungs were available for transplantation. Frede received her transplant in March following two months of hospitalization at the Brigham. The 10-hour surgery was completed by a multidisciplinary team comprising nearly 60 staff members. 

The rare, complex surgery – which requires the donor heart and lungs to be transplanted simultaneously – was the first performed at the Brigham in more than two decades. 

For Frede, the transplant cured pulmonary hypertension, a life-threatening condition she had lived with since age 4. It causes high blood pressure in the arteries of the lungs and severe breathing problems. The condition worsens over time, progressively restricting the flow of oxygenated blood and potentially leading to heart failure. After trying numerous therapies over the years, Frede and her family grew worried as her health continued to decline.

“We would go on family bike rides, and I would be blue,” Frede said. “We were always waiting for another tragedy to happen.”

In February, she began receiving inpatient care at BWH. Within a month, she was treated with high-flow oxygen and extracorporeal membrane oxygenation (ECMO), a machine that pumps blood and oxygen for a patient when their own heart and lungs can no longer do so adequately. The therapy sustained Frede while she waited for suitable donor organs to become available. 

Patients whose pulmonary hypertension worsens to the point of requiring organ transplant normally undergo a lung transplant only, explained Hari Mallidi, MD, FRCSC, section chief of Transplant and Advanced Lung Diseases in the Division of Thoracic Surgery. 

But Frede also was born with an atrial septal defect, often referred to as “a hole in the heart,” which drove the need for both a donor heart and lungs, Mallidi said. 

“Even though her heart function was OK, we couldn’t technically make all the connections in the right places without changing everything,” he said. 

‘A Whole New Chapter’

Now six months post-transplant, Frede says every day she feels stronger and that a world of possibilities has opened up. She is hiking, biking, doing yoga and, for the first time in her life, running. 

“Every time I’m doing one of those things, I pray and think of my donor and their family. Without them, none of this would have been possible,” Frede said. “It’s been an amazing gift.” 

Aaron Waxman, MD, PhD, director of the Brigham’s Pulmonary Vascular Disease Program, who has treated Frede for the past 10 years, is thrilled to see her progress. 

“It’s a whole new chapter of her life,” Waxman said. “My expectation is she’s going to have a completely new, healthy life.”

Frede, who recently obtained her bachelor’s in nursing, is now evaluating advanced training programs to fulfill her dream of becoming a nurse practitioner to help others – a goal inspired by her mother, Nancy, who is also a nurse. In addition, Frede hopes to dedicate her time to raising awareness about pulmonary hypertension and the importance of organ donation.

While the past year was challenging for Frede and her family, they said the remarkable, compassionate care they received at BWH helped them weather the stress and uncertainty. In ways big and small, their Brigham care team lifted their spirits and provided a supportive environment for healing. 

Throughout her life, including during her hospitalization, Frede sought to remain as active as possible. While she was on ECMO, care team members helped her obtain a stationary bike for her hospital room and played YouTube videos of scenic routes while she pedaled. In the months following discharge, Frede completed several bike rides around New England with Waxman and her exercise physiologist, Julie Tracy, of the Division of Pulmonary and Critical Care Medicine. 

Nancy recalled the moment she and several Shapiro nurses shed tears of joy as they watched Frede listen to her own heartbeat with a stethoscope for the first time post-transplant. She said the experience marked the first of many wonderful moments to come.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

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BWH Receives First NICU Installed MRI System in the U.S.

Work crews lower the NICU’s MRI into the Connors Center.

Arriving by crane through a roof hatch in the Mary Horrigan Connors Center for Women and Newborns on Sept. 8, a new MRI system specifically designed for safe imaging of newborns will provide high-quality scans directly in the Brigham’s Neonatal Intensive Care Unit (NICU). The system, approved by the U.S. Food and Drug Administration last year, is the first NICU-dedicated MRI in the country.

“The installation of the state-of-the-art, neonatal MRI system will greatly enhance the research capabilities of BWH and elevate and expand neurocritical care for our littlest patients,” said Terrie Inder, MBCHB, chair of the Department of Pediatric Newborn Medicine. “Locating this technology within the NICU will reduce time and patient risk associated with transporting newborns to a traditional MRI and allow MRI access from the first hours of life through the challenging, sometimes life-threatening, time within the NICU.”

Babies undergoing scans will be in a temperature-controlled, self-contained incubator bed that minimizes the patient’s movement while allowing for better control of the environment and continuous monitoring of vital signs. Information gained from the MRI can inform a care team and family as to whether brain injury has occurred and, in the future, guide which treatments may assist in preventing disability.

The self-shielded, permanently magnetic system has been specifically designed for the NICU, an area that would be typically size- and risk-prohibitive for an MRI. The system is also quieter than traditional whole-body scanners to ensure the safety and comfort of infants undergoing scans.

Manufactured by Aspect Imaging, the system, known as EMBRACE, initially will be used for research purposes.

“This new MRI system, designed with a single use – scanning of the newborn – will enhance the care we provide for our NICU patients. This empowering technology will complement our existing fleet of MRI scanners and improve efficiency by offering imaging to our tiniest patients within the controlled confines of the NICU,” said Srinivasan Mukundan Jr., PhD, MD, medical director of Magnetic Resonance Imaging in the Department of Radiology.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

Heart & Vascular Center First in Region to Perform 1,000 TAVRs

Staff in the Brigham’s transcatheter aortic valve replacement (TAVR) program celebrate their recent milestone.

Less than a decade after performing the first transcatheter aortic valve replacement (TAVR) at the Brigham, a multidisciplinary team in the BWH Heart & Vascular Center recently became the first in New England to have completed 1,000 TAVR procedures.

Now with the largest program of its kind in the region – based on annual volume and total TAVRs performed – the Brigham’s TAVR team recently held a staff celebration in honor of its 1,000th case, which it achieved earlier this year. The program is now rapidly approaching 1,200 procedures.

“This milestone makes me realize that I am part of a progressive and talented group of individuals who have developed one of the country’s best TAVR programs,” said cardiac surgeon Marc Pelletier, MD, and the program’s surgical director. “The number 1,000 gives us pause to realize the amount of work needed to get here and how many patients and families have been helped by this groundbreaking technology.”

A minimally invasive surgical procedure performed in the Cardiac Catheterization Lab, TAVR is used to treat patients with a heart condition called aortic valve stenosis. Among these patients, blood is unable to flow freely from one of the heart’s valves to the body’s main artery, the aorta. Some patients with this condition can avoid open-heart surgery with the use of TAVR, which uses advanced imaging to help specialists guide a catheter into the heart – through a small incision in the leg, groin or chest – and insert a replacement aortic valve.

TAVR can be done without general anesthesia, and patients experience a quicker recovery than they would from a traditional open-heart valve replacement. The entire procedure takes about 90 minutes, and patients are often home within a day or two.

The Brigham performed its first TAVR in 2009 as part of a landmark, multi-institutional series of clinical trials known as the PARTNER trials. Following approval by the U.S. Food and Drug Administration, the procedure moved into clinical service at BWH in 2011.

Maximizing access to this lifesaving treatment is a major focus for the team, noted interventional cardiologist Pinak Shah, MD, who serves as the program’s medical director. The program now runs three clinics per week for patient evaluation, and TAVRs are typically done within two to three weeks of the patient’s first appointment.

“We can do this because of our ability to perform TAVR procedures five days per week, which is unusual in this field,” Shah said. “This is a testament to the dedication of everyone involved in the process – from clinic scheduling to radiology to procedure scheduling and catheterization laboratory staff.”

Pivotal to the BWH TAVR team’s success has been its focus on multidisciplinary collaboration, said cardiac surgeon Tsuyoshi Kaneko, MD.

“I am really proud of how much we’ve grown, but more than that, it’s the phenomenal teamwork,” Kaneko said. “To perform this procedure, it’s not just cardiac surgeons. It’s not just interventional cardiologists. We have an incredible team that includes anesthesiologists, nurses, non-interventional cardiologists, physician assistants, radiologists, fellows and many more. Everyone has contributed so much to the growth of this program.”

Pelletier and Shah agreed, noting that the team’s comprehensive approach and combined expertise enable them to assess referrals quickly and support faster, smoother recoveries for patients.

“It is a tremendous honor to be a part of this milestone and program, which is the ultimate example of cross-disciplinary collaboration,” Shah said. “It is very satisfying to work with such talented colleagues who have a common goal of building a successful program and providing great care for our patients.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

Innovative Video-Assisted Surgery Leads to Faster Recovery, Less Pain

From left: Wallis Urmenyhazi and Scott Swanson

Wallis Urmenyhazi, PhD, was speaking with her primary care physician by phone after a recent chest X-ray when he said four words that would change her life: “You have a lesion.” 

“I didn’t know what he meant by lesion, but he told me to see a thoracic surgeon,” says Urmenyhazi, a retired professor of French literature, who had seen her physician for a persistent cough.

After meeting with a thoracic surgeon in her home state of Pennsylvania, Urmenyhazi learned that her lesion was a thymoma, a rare disease in which a tumor grows within the thymus gland, a butterfly-shaped organ that sits in front of the heart and makes immune cells. There are only 1.5 cases of thymoma for every million people each year in the United States.   

The most common treatment is to remove the tumor with surgery. Accessing a thymoma can be challenging, however. The thymus sits behind the sternum, between the lungs, and is surrounded by sensitive blood vessels. A traditional surgery opens the chest by making a large incision in the breastplate.   

Urmenyhazi had misgivings. It was a major operation with a long recovery process. Her tumor had been caught early; her only symptom was a cough. Through online research, she learned that some surgical procedures approached thymomas through small incisions and used less-invasive techniques aided by video or robotic technology.  

“I asked my surgeon at the time if he would perform a minimally invasive procedure, but he didn’t have that expertise. He recommended the more complex traditional operation, which had no guarantee of success,” she said.    

Despite her reservations, Urmenyhazi scheduled the operation – but canceled a day later. She searched online for a surgeon with experience in minimally invasive techniques for thymoma, ultimately finding Scott Swanson, MD, director of Minimally Invasive Thoracic Surgery in BWH’s Lung Center. 

A member of the surgical team for Dana-Farber/Brigham and Women’s Cancer Center, Swanson is an expert in video-assisted thoracic surgery (VATS) and teaches the technique around the world.

“After meeting Wallis, I recommended VATS, a minimally invasive procedure where we insert a tiny camera and instruments into small incisions in the chest. This allows us to access the thymus without opening the chest. Compared with traditional approaches, patients can expect less pain and a quicker recovery,” Swanson said.  

The procedure was performed without complications. After the surgery, Urmenyhazi had no pain. It was almost as if the surgery hadn’t happened, she said.   

VATS has been available for 25 years, but not enough surgeons are trained to do it, Swanson explained. That’s why he and members of the Division of Thoracic Surgery travel to hospitals across the globe to train surgeons in minimally invasive techniques and expand access to this lifesaving procedure.

Swanson applauded Urmenyhazi for being an advocate for her own care. “Sometimes, the patient needs to seek out the physicians who are trained to perform the most cutting-edge surgical techniques,” he said.   

Urmenyhazi meets yearly with Swanson for follow-up scans. “I will be forever grateful for Dr. Swanson,” she said.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

New Angiography Imaging System Comes to Hybrid OR

From left: Michael Belkin, Felicity Billings and Edwin Gravereaux, beside the ARTIS Pheno imaging system in BWH’s hybrid OR.

BWH surgeons and interventionalists working in the Michael J. Davidson, MD, Hybrid Operating Room are among the first clinicians in the Northeast to use the new ARTIS Pheno angiography imaging system.

The powerful, robotically controlled device delivers high-end imaging for patients undergoing certain cardiac, endovascular or thoracic surgeries or procedures.

The Brigham has a rich history of pioneering technologies and imaging tools in the hybrid operating room (OR) to deliver the most advanced care to patients. Some interventions that once took place over several days – historically in multiple operating rooms and diagnostic labs – can now be done over the course of one visit in the hybrid OR. BWH was the first hospital in the U.S. to use the ARTIS Zeego system, the Pheno’s predecessor, in the OR.

Known as “C-arms” for their C-shaped design, the Zeego and Pheno perform real-time X-ray imaging during angiograms and therapeutic procedures. Both are designed to rotate completely around a patient’s body, making it easier to diagnose a condition in the OR and, if necessary, immediately operate.

BWH clinicians are using these imaging systems to guide increasingly complex procedures, such as aortic valve replacements and transcatheter aortic valve replacements (TAVRs). These require high-quality, granular imaging – an area in which the Pheno offers several improvements, according to Michael Belkin, MD, chief of the Division of Vascular and Endovascular Surgery.

“The Pheno algorithms will allow us to better perform these procedures,” he said. By better, Belkin means faster imaging, less radiation exposure for patients and interventional surgeons, and higher-quality images. Resolution for two-dimensional imaging in Pheno is four times higher than in the older device.

Last month, BWH clinicians began enrolling patients in a clinical trial for transcatheter mitral valve replacement, a study the Pheno will support, said cardiac surgeon Tsuyoshi Kaneko, MD, of the Division of Cardiac Surgery.

“This trial requires a thoracotomy – a surgery to open the chest wall – which we will perform in the hybrid OR. It’s a perfect example of where the Pheno will be really useful,” Kaneko explained, as the newer system will provide better visibility and resolution with less contrast load.

Improving Quality and Safety

In addition to the new system’s advanced capabilities, parts of its design are expected to improve care quality and safety for patients in the hybrid OR, providers said. Pheno’s wider-space robotic C-arm moves more easily in and out of the patient field without interrupting the sterile surgical field. And as a more closed system compared to the Zeego, the Pheno is easier to keep sterile.

“The Zeego moves like an old-generation robot, whereas Pheno will be silky smooth when the arm moves and will make our procedures much, much easier,” Kaneko said.

The new device also enables clinicians to obtain images faster. “We want to see the image in a matter of seconds, especially when working on an urgent or complex case,” said Kaneko. This isn’t only a matter of convenience; it also concerns patient safety. Because the Pheno scans up to 15 percent faster than earlier systems, images are produced with less IV contrast – an added benefit, as contrast can tax the kidneys.

While the Pheno likely won’t be used for conventional open cardiac, thoracic or endovascular procedures, Belkin is enthused about the device’s potential benefits for patients for whom its use is appropriate.

“We are already doing hundreds of cases every year in the hybrid OR now,” Belkin said. “With this newest machine, we can deliver even better care to our patients.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

‘My Heart Is Full of Love’: Patient Grateful for Care, Compassion

From left: Ann Washington, Cindy Washington and Darien Clark

At age 25, Cindy Washington and her heart have been through a lot: two cardiac arrests, the installation of a pacemaker and, most recently, the implantation of a left ventricular assist device (LVAD). But the Roxbury native says there’s one thing that has kept her heart going through all the hard times: love.

“From the amazing care team at the Brigham to my fiancé, mom, siblings and friends, I am so grateful for all the support I receive from them every day,” Washington said. “If it weren’t for these people in my life, I don’t know where I’d be today. Because of them, my heart is full of love.”

In 2011, Washington was diagnosed with dilated cardiomyopathy, a type of heart failure due to an enlarged heart that has an impaired ability to pump blood. Despite having an implantable defibrillator placed in her chest in 2014, her heart grew weaker. In 2016, she needed to have an LVAD implanted. The LVAD, a mechanical pump that supports heart function and blood flow in patients with heart failure, is a “bridge to transplant” as Washington awaits a donor heart.

On Valentine’s Day, Washington came back to BWH with her mom, Ann Washington, and fiancé, Darien Clark, to visit with members of her care team and thank them for all they’ve done for her and her family.

Ann, who saved her daughter’s life twice by performing CPR on Washington when she suffered the cardiac arrests, said she’s forever grateful for the incredible, compassionate care provided at BWH.

“I know Cindy might not be here today if it wasn’t for the extraordinary team of experts at the Brigham that has never given up on my daughter,” said Ann, as she wiped tears from her eyes.

‘A Special Patient’

After Washington first became sick, she had to drop out of college because she was too weak to attend classes and keep up with the workload. She became depressed and isolated from family and friends. Today, her life looks a lot different. She feels great and is taking online courses, with hopes of one day becoming a health policy lawyer. Washington said she’s gotten through the tough times because of her support system, both at the Brigham and at home, and by maintaining a positive outlook.

“Heart disease hasn’t beaten me yet,” Washington said. “I’ve always told myself that I’ve never had a broken heart; it’s just been a little sick. My will is strong, and I refuse to let anything get me down.”

Michael Givertz, MD, medical director of BWH’s Heart Transplant and Mechanical Circulatory Support Program, is a member of Washington’s care team. He described Washington as a “very special patient” who, from a young age, has remained hopeful, joyful and positive.

“Cindy is a shining example of a patient who is living life as fully as she can,” Givertz said. “She’s independent, strong and determined. She’s a true pleasure to care for, and I feel fortunate that I’ve had the opportunity to get to know Cindy and her family.”

Knowing that returning to school was important to Washington, Givertz wrote her a letter of recommendation for a college scholarship.

Another person who has been instrumental in Washington’s life is her fiancé, who has stood by her side through everything. Clark said he wouldn’t have it any other way. Although it has been difficult to see his loved one hurting, he knew they’d get through it – together.

“Cindy is my world,” Clark said. “She’s my valentine today and every day. We’ve overcome so many obstacles together, and I will never leave her side.”

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BWH Celebrates Achievement of Comprehensive Stroke Center Certification

From left: Ali Aziz-Sultan and Steven Feske

The Stroke and Cerebrovascular Diseases Center received advanced certification as a Comprehensive Stroke Center from The Joint Commission and the American Heart Association/American Stroke Association on Nov. 15. This highly selective designation – awarded to only a small fraction of institutions in the U.S. – recognizes hospitals that meet the standards to treat the most complex stroke patients.

“This certification reflects our ability to care for these patients from the moment they come into our ED until they are discharged from our specialized unit,” said Linda Bresette, DNP, NP-C, director of the Brigham Health Stroke Program. “Our highly trained, multidisciplinary staff worked together to showcase how our stroke patients receive advanced, individualized care that’s grounded in science and delivered with compassion.”

To become certified, BWH underwent a rigorous on-site review by Joint Commission experts who evaluated all aspects of complex stroke care. This includes the initial assessment, treatment protocols, advanced imaging, and state-of-the-art facilities for urgent intervention and intensive care. The certification reflects that BWH meets advanced standards of stroke care and has provided evidence of successful performance on more than 18 quality measures. All BWH clinicians demonstrated advanced education and competency.

“This certification recognizes our multidisciplinary team of specialists who deliver the best in stroke care. It acknowledges our advanced diagnostic and treatment capabilities, and allows us to provide the most comprehensive medical, interventional and surgical therapies,” said Steven Feske, MD, chief of the Division of Stroke and Cerebrovascular Diseases and medical director of BWH’s Comprehensive Stroke Center.

Stroke is the fifth-leading cause of death and a leading cause of adult disability in the U.S., according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

To improve outcomes for stroke patients, BWH provides pre-arrival evaluation and treatment planning, accelerating treatment for patients transferred to BWH for advanced stroke care. The center also offers remote physician consultations via telemedicine. Once at the Brigham, patients receive rapid assessment by expert clinicians who have access to neuro-interventional suites and a dedicated neuroscience intensive care unit. Additionally, BWH researchers investigate groundbreaking approaches to stroke management in several national clinical trials.

“Stroke is a life-threatening emergency, and the greatest chance for recovery from stroke occurs when treatment is started immediately after the onset of symptoms,” said Ali Aziz-Sultan, MD, Neurosurgical director of BWH’s Comprehensive Stroke Center. “Newer stroke therapies offered at BWH, such as endovascular treatments, can rapidly reestablish blood flow and restore patients’ health.”

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DF/BWCC to Offer Groundbreaking CAR-T Cancer Therapy

CAR T-cell therapy uses T cells (illustrated above) from a patient’s own immune system to attack cancer.

What if the key to a cure for cancer is already inside our own bodies?

Scientists at BWH and Dana-Farber Cancer Institute have asked that question over the past several years as they studied an immunotherapy – that is, a treatment that uses a person’s own immune system – for adult cancer patients.

Now, following a successful clinical trial and recent approval from the U.S. Food and Drug Administration (FDA), Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) is one of a few locations nationwide certified to offer the first chimeric antigen receptor (CAR) T-cell therapy for a form of non-Hodgkin lymphoma.

CAR T-cell therapy, like all forms of cancer immunotherapy, seeks to sharpen and strengthen the immune system’s inherent cancer-fighting powers. It involves giving patients modified versions of their own immune system’s T cells – white blood cells that help protect the body from disease.

“Treating patients with CAR T cells has been one of my most exciting professional experiences, and the FDA approval of this therapy offers hope and optimism to a subset of patients whose other treatments have failed them,” said Caron Jacobson, MD, medical director of the Immune Effector Cell Therapy program at DF/BWCC. “It is extremely rewarding to be able to offer a new therapy to patients who had virtually no other options just 12 to 24 months ago.”

Clinical Trial Demonstrates Safety, Effectiveness

The drug, known as Yescarta (axicabtagene ciloleucel), was developed by Kite Pharma and can be used to treat adults with refractory aggressive B-cell non-Hodgkin lymphoma.

Over the past couple of years, Jacobson and her team have been testing Yescarta in a clinical trial at DF/BWCC, the only facility in the northeast that was part of the trial.

The FDA ruling is based on the results of this nationwide trial, which showed the therapy to be safe and effective. Of the 101 patients who received Yescarta, 82 percent responded to the treatment, with 54 percent having a complete response to therapy. Thirty-six percent of patients remain in complete remission six months after treatment.

“This therapy requires just a one-time infusion for patients, and the results are evident within one month,” Jacobson said. “It is our goal as clinicians to help patients and improve their quality of life. Seeing these patients return to work, their families and their livelihoods so quickly is an important reminder of how far we have come. It is also inspiration for the work we still need to do.”

The initial clinical trials of CAR T-cell therapy have involved pediatric and adult patients with blood-based cancers such as leukemia, lymphoma and multiple myeloma. Based on the therapy’s success so far, CAR T-cell therapy trials are now opening for certain types of solid tumors as well.

“The successful development of CAR T-cells as a therapy for cancer is a testament to the progress we have made in understanding how our immune system is regulated and how cancer evades the immune system,” Jacobson said. “It is a perfect example of how basic science research can fuel clinical progress. Now we need to take what we can from the clinic back to the laboratory to make this therapy even better.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
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Room to Grow: Center for Child Development to Provide Post-NICU Care

From left: Carmina Erdei, Michalia Root, Lianne Woodward (seated), Pamela Dodrill, Jennifer Benjamin and Nicole DePalma

Critically ill newborns often spend the first several months of their lives in the Neonatal Intensive Care Unit (NICU) at BWH. After hospital discharge, these vulnerable patients remain at risk for ongoing complications, yet providers have no formal mechanism for continuing care or tracking the progress of patients and families during this formative period. A new center opening at the Brigham is poised to change all of that.

Located at 221 Longwood Ave. and scheduled to open in the coming weeks, the new Center for Child Development will provide a comprehensive, team-based approach to outpatient care of infants and children at risk for developmental delay and/or ongoing medical problems following NICU discharge.

The center encompasses three discrete, but intertwined, areas of focus: the Research Suite, led by Lianne Woodward, PhD, director of Research in the Department of Pediatric Newborn Medicine; the NICU Follow-up Program, run by Jennifer Benjamin, MD, attending neonatologist and infant follow-up specialist; and the Feeding Program, directed by Pamela Dodrill, PhD, NICU feeding therapist.

The new center at BWH will advance the department’s vision to provide long-term support for NICU patients and families by addressing clinical needs and filling gaps in research. The latter will allow Pediatric Newborn Medicine to track and analyze the short- and long-term outcomes of the care provided in the NICU and identify ways to improve care delivery in the future.

“Our responsibility as care providers for this fragile patient population is not only to provide the highest quality of medical and developmental care during their NICU hospitalization, but also to ensure that ongoing issues at the time of discharge are addressed for the long term,” Benjamin said. “We need to learn from our own patients, which will allow us to optimize the care we provide to future NICU babies and families.”

Holistic, Patient-Centered Care and Research

BWH neonatologists will identify which infants in the NICU will be best served at the center, with appointments in the Follow-up Program typically occurring every four to six months during the child’s first three years of life.

“We not only focus on the assessment and management of a child’s developmental progress at regularly scheduled intervals, but we also evaluate other areas of concern, including overall growth and nutrition, behavior management and social and family issues, such as parental well-being,” Benjamin said.

According to Dodrill, depending on an infant’s needs, there may be a clinical assessment to identify feeding issues, monitor related therapies, measure infant growth and recommend interventions to improve feeding and nutrition.

In addition to the care of infants and toddlers, the longer-term goal of the center is to create opportunities for wider family support, such as providing in-center access to a mental health specialist and/or social worker who can help families directly with any difficulties they may be experiencing.

On the research side, Woodward said investigators will now be able to track the outcomes of NICU babies from discharge through early childhood. The initial areas of focus include the influence of early nutrition, maternal mental health factors and brain injury during the neonatal period on a child’s brain and behavioral development.

Specifically, Woodward said the suite offers opportunities for state-of-the-art evaluations of a child’s cognitive, language, behavior and motor development, in addition to family assessments.

In combination with the new neuroimaging research platform in the Brigham’s Building for Transformative Medicine, the opportunities to study the effects of pregnancy complications and early neonatal risk on children’s long-term brain and behavioral development is immense, Woodward said. “This will open up collaboration and partnership opportunities not only within the center but across the hospital and country, all of which will be key to our success.”

Woodward said she’s excited about what the new space will offer to patients, families and staff.

“A major focus in our design was to make this a very child- and family-friendly space,” Woodward said. “From the beginning, we had a vision to create a center that was developmentally supportive. Every decision was made with our patients and families in mind. We can’t wait until we can officially open our doors and begin offering these services.”

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Beginning a New Chapter: Army Vet Undergoes Novel Amputation

As a corporal in the U.S. Army, Purple Heart recipient Brandon Korona faced missions with bravery and honor. Four years after suffering a traumatic injury while serving in Afghanistan, he’s calling on those same values as the second patient to undergo an experimental amputation of his lower left leg to prepare it for a robotic prosthetic under development in collaboration with the Massachusetts Institute of Technology.

The procedure and robotic prosthetic, known collectively as the Ewing Amputation, are expected to remedy the chronic pain that Korona, 26, has struggled with as a result of his injuries. In addition, he hopes his experience will help pave the way for other wounded veterans.

The six-hour procedure was performed by Matthew J. Carty, MD, director of BWH’s Lower Extremity Transplant Program in the Division of Plastic Surgery, and Eric Bluman, MD, PhD, of the Department of Orthopaedic Surgery, at Brigham and Women’s Faulkner Hospital in April.

“Brandon was a great candidate for this procedure,” said Carty. “He’s young and motivated, and he served his country with bravery. We expect that this surgery and robotic prosthetic will give him a higher level of function and comfort than what is typically delivered with a standard below-the-knee amputation.”

If the procedure is successful, Korona’s brain will interact with the robotic prosthetic once it is in place, which is expected to occur within the year. This will enable him to perform complex actions and feel sensation, neither of which is possible with a traditional prosthetic.

The surgery connects the leg’s front and back muscles at the point of amputation. This preserves the link these opposing muscles normally have in a healthy leg. Sensors implanted in the muscles will send signals to the brain when the amputated leg moves. The goal is for the brain to power the robotic prosthetic.

‘The Right Decision’

In 2013, Korona, then 22, was injured in Afghanistan when the convoy he was riding in encountered a 250-pound improvised explosive device. His left leg and right ankle were severely injured.

In the months and years that followed, Korona underwent several surgeries and therapies to try to repair his injuries and relieve his chronic pain, but none were successful. A traditional amputation seemed like his last option – that is, until he was introduced to Carty, who told him about the Ewing Amputation. Carty had performed this pioneering procedure for the first time last July on patient Jim Ewing.

Korona and his wife, Chelsea, were overjoyed there was an option that could one day allow him to get back to doing things he loves, such as running and working out.

“We know this decision is the right decision now – for me, for us and for the rest of our lives,” Korona said.

The Gillian Reny Stepping Strong Center for Trauma Innovation at BWH is funding this research and Korona’s clinical care.

Looking Ahead

Since his surgery, Korona has been building his strength and engaging in physical rehabilitation at the Boston VA Healthcare System’s West Roxbury medical center. He’s also working toward a bachelor’s degree and plans to earn a master’s degree as well.

Korona has also been busy cheering on his favorite sports teams, including the Boston Celtics. During a playoff game last month, he was recognized during the team’s Heroes Among Us program, which honors people who have made an overwhelming impact on others.

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BWH Patient Gives Thanks for Lifesaving Surgery, Blood Transfusions

From left: Frannie Carr Toth and her son, Michael, reunite with obstetrician Daniela Carusi, who delivered Michael at BWH.

Following an ultrasound appointment 24 weeks into her second pregnancy, Frannie Carr Toth tried to process the information she just received: a diagnosis of placenta accreta, a rare but serious condition that occurs when the placenta embeds too deeply in the uterine wall. The complication carries a high risk of severe bleeding during delivery.

Carr Toth was closely monitored throughout the rest of her pregnancy by her obstetrician, Daniela Carusi, MD, MSc, of the Department of Obstetrics and Gynecology, and a multidisciplinary care team at the Brigham. However, the severity of the accreta – that is, how deeply embedded the placenta was – would not be known until the baby was born.

“It was really scary. I was worried about my life and my baby’s life,” Carr Toth said.

After experiencing several episodes of bleeding shortly before her scheduled caesarean section, she lost half of her body’s blood volume during delivery. But thanks to a lifesaving surgery, expert care and the well-stocked blood bank at BWH, Carr Toth and baby Michael are now healthy and at home with their loved ones.

Hoping to encourage more people to donate blood and platelets, Carr Toth shared their story during the Brigham’s third annual Accreta Awareness Blood Drive, hosted by the Kraft Family Blood Donor Center at Stoneman Centennial Park on April 7.

“I put so much of the credit on Dr. Carusi and the team’s shoulders, but also among the big heroes in this story are the nameless donors who took it upon themselves to give blood, and I wish I could personally thank them,” Carr Toth said.

Placenta accreta affects about one in 500 pregnancies in the U.S., and it is more likely to occur in women who have had a prior C-section or uterine surgery, said Carusi, who specializes in treating mothers with the condition. During childbirth, the placenta typically separates from the uterus. In patients with placenta accreta, there is a high risk of severe bleeding when the placenta cannot detach. A C-section is required to deliver the baby safely; even so, mothers can still experience life-threatening blood loss.

“Pregnancy and delivery, which is usually such a normal and exciting time, can be very dangerous for some women,” Carusi said. “Having providers who are trained to take care of this – and having blood banks that are ready to respond – are really essential to keeping mothers safe.”

Blood banks nationwide have faced a blood shortage since last May, said Malissa Lichtenwalter, supervisor for donor recruitment at the Kraft Center. Drives like the one held for accreta awareness and individual donations are vital to keeping BWH’s blood bank stocked, she said.

Carr Toth noted another reason she feels grateful to receive care at BWH. Although placenta accreta results in a hysterectomy for most women, Carr Toth’s C-section was performed using a novel technique called “hybrid surgery” that enables some patients, including her, to avoid a hysterectomy. In this collaborative procedure, interventional radiologists embolize – that is, temporarily block – blood flow to the uterus as soon as the baby is delivered.

“I knew that it might not work out, but I wanted to try,” Carr Toth said. “I put my trust in the team, and we emerged from this worst-case scenario with best-case outcomes.”

Carr Toth said her overall experience as a Brigham patient has reinforced that she and her family came to the safest, most compassionate place to receive care.

“I felt like I was given all the information I needed and empathetic, wonderful care,” she said. “When I needed to be admitted, everybody from triage to labor and delivery to the antepartum floor just made me feel so well taken care of.”

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Q&A: Introducing Brigham Health

bh_bwh_pms_293Brigham Health was unveiled earlier this week as the new name for the parent organization that includes Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physicians Organization. All three entities will retain their individual names and identities. Brigham Health replaces Brigham and Women’s Health Care (BWHC). 

Brigham Health President Betsy Nabel, MD, discusses with BWH Bulletin what this change means for us. 

Why did we change from BWHC to Brigham Health?

Nabel: Those who know the Brigham think of it as a top-tier New England hospital – a place to go for care when needed, especially complex procedures. But according to market research, many outside of New England assume we are solely a women’s hospital. And while we are certainly a leader in women’s health care, we want to be sure it’s clear that our excellence and expertise extend to so many other areas. Brigham Health reinforces that we are not just one point on a map, or even a single point of discovery.

The new name eliminates some of the confusion we have found among those outside of New England. Talking about the services of BWH, BWFH and the BWPO as simply Brigham Health will enable us to more effectively reach people who are seeking health information, referrals and care.

How does this change fit into our strategy?

Nabel: This change is a vital component of our institutional strategy. For example, one of our strategic priorities is to improve health. In addition to providing highly specialized care in the hospital and ambulatory settings, we also must engage people around the world as we promote health and wellness and concentrate on preventing disease in populations.

Another example is twofold. By building national and international lines of business, we reinforce our financial strength and advance our work in business development – two areas essential to guaranteeing we continue delivering on our mission.

Why was the name Brigham Health selected?

Nabel: Brigham Health reflects our role as a leader in maintaining and restoring health around the world, encompassing all that we do in delivering care, advancing scientific discovery and educating the next generation of health care professionals. It broadly defines everything we do today and provides a new platform for amplifying our commitment to what everybody desires: health.

For more Brigham Health information and resources – including an FAQ, downloadable logos and presentation templates – visit BWHPikeNotes.org

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Reaching New Heights: Novel Surgery Gives Hope to Injured Climber

Jim Ewing is a trailblazer – in every sense of the word.

A devoted rock climber, Ewing, 52, of Maine, is listed in guidebooks as the man behind several “first ascents,” a climbing term referring to the first time a route is completed and mapped out. He recently charted new territory yet again – this time as the first patient to undergo an experimental surgical procedure to amputate his lower left leg and replace it with a robotic prosthetic.

Two years ago, while rock climbing with his family in the Cayman Islands, Ewing suffered a devastating fall that sent him plummeting 50 feet, resulting in numerous injuries. Although his initial wounds eventually healed, he was left with chronic pain in his foot and ankle. Every step was excruciating.

When it became clear that no further surgeries or therapies would make the pain stop, Ewing began doing his own research. None of the physicians he met with would consider amputation – until he met Matthew J. Carty, MD, director of BWH’s Lower Extremity Transplant Program in the Division of Plastic Surgery.

“Within just a few minutes of meeting Dr. Carty, I was deeply impressed by his bedside manner,” said Ewing, who shared his story during a Nov. 21 press conference alongside Carty, who led the surgical team that performed the amputation at BWFH in July. “He was incredibly thorough and compassionate in a way I hadn’t seen in most other surgeons. He was listening to me.”

Carty has collaborated with the Massachusetts Institute of Technology (MIT) Media Lab Center for Extreme Bionics to develop a pioneering approach to amputation that would allow a patient’s brain to interact with a robotic prosthetic, resulting in increased mobility and sensation. The project was the inaugural winner of the 2014 BWH Stepping Strong Innovator Award.

Tyler Clites, representing MIT, and Audrey Epstein Reny, whose family founded The Gillian Reny Stepping Strong Center for Trauma Innovation, also spoke at the press conference. The center funds the Innovator Award, as well as other clinical and research efforts to advance trauma care.

“Our family understands profoundly what it is like to have life as you know it change in an instant,” said Epstein Reny, whose daughter, Gillian, was injured in the 2013 Boston Marathon bombing. “When we heard Jim’s story, we desperately wanted to help him get back to enjoying his life’s passions, including climbing. We are so proud he is the first patient beneficiary of a Stepping Strong innovation. It’s almost beyond words to see our family’s vision turn into hope for Jim.”

While other areas of medicine have experienced extraordinary breakthroughs, amputations have not evolved in 2,000 years, Carty said. If successful, this new procedure – which has been named the Ewing Amputation – will represent a major innovation in the field.

“We believe Jim’s progress will allow us to reframe the way we think about limb loss,” Carty said. “Traditionally, amputation has often been seen as a failure – the surgical equivalent of throwing in the towel to the ravages of trauma, disease or bad luck. By reinventing the way amputations are performed, we hope to elevate them to the status of another form of limb salvage, one designed to restore as much function as possible.”

When the foot flexes under normal conditions, muscles on the front and back of the leg work in concert – one muscle stretches as the other contracts. These muscles communicate such movements to the brain, allowing us to walk, run and move in other ways without much thought. Traditional lower-limb amputations sever this connection.

The Ewing Amputation preserves these relationships via a pulley system to maintain the link between the muscles. As a result, sensors implanted in the muscles will send signals to the brain when the leg moves. The aim is for the brain to power the robotic prosthetic Ewing will use as part of a clinical trial. This new approach to amputation is expected to restore more natural movement, control and sensation to amputees.

Jim Ewing scales an indoor climbing wall after his amputation.

Jim Ewing scales an indoor climbing wall after his amputation.

Although Ewing is still early in his recovery, “he has demonstrated movement abilities and perceptions far beyond what we typically witness in patients with standard amputations,” Carty said. If successful, the same procedure could be applied to an amputation of an arm or hand, as well.

As for Ewing’s climbing career, he is scaling the walls of indoor climbing gyms with less pain and renewed confidence – even without a prosthetic – thanks to the first-of-its-kind procedure.

“Climbing is what I’ve been doing for most of my life, so I feel like I have my life back,” he said.

‘I Will Never Give Up’: Injured Marine Receives Double-Arm Transplant

While on a second tour of duty in Afghanistan in 2010, now-retired Marine Sgt. John Peck’s life changed in an instant when he stepped on an improvised explosive device (IED), triggering an explosion. He lost both of his legs and a large part of each arm. Later, he developed an infection, which required a further amputation of his left arm to save his life.

For two months after the blast, Peck remained at Walter Reed Army Medical Center in Washington, D.C. He has since undergone more than two dozen surgeries to address his injuries.

Ready to move forward, Peck, of Fredericksburg, Virginia, completed an evaluation at BWH in August 2014 to receive a double-arm transplant. Two years later, life was about to transform again—this time, for the better. He received a call this summer from Simon G. Talbot, MD, BWH director Upper Extremity Transplantation, with news that the bilateral arm transplant would take place at the Brigham.

“My life had been on a timeout for a while,” said Peck, now 31, a recipient of two Purple Hearts. “When I got the call, I broke down and cried. I quickly had to pull it together because I had to get to Boston. I was ready to face the challenges with patience and perseverance.”

At an Oct. 5 press conference in BWH’s Zinner Breakout Room, Peck joined Talbot and David Crandell, MD, medical director of the Amputee Program at Spaulding Rehabilitation Network, where Peck has been undergoing outpatient rehabilitation, to share his story with the world.

Peck recounted the moment he saw his new hands for the first time.

“It was pure love at first sight,” Peck said. “When I look down at my hands, they seem so natural. It was just a perfect match.”

In August, a multidisciplinary team—including 12 surgeons—worked nearly 14 hours to transplant the arms, one below the elbow and one above. Peck’s case was the fourth bilateral arm transplant performed at the Brigham.

Peck’s surgery went seamlessly, Talbot said. Although Peck experienced a brief episode of rejection about two weeks after surgery, which is common among transplant recipients, he’s now doing well and meeting all of his milestones, he added. Peck is expected to regain function and sensation in his new limbs over the next several months.

“While every patient is special to us, having the opportunity to care for a patient who has given so much in service to this country was especially meaningful to our team, particularly to those who have served,” Talbot said.

During the press conference, Alexandra Glazier, president and chief executive officer of the New England Organ Bank, thanked the donor family and talked about the life-changing benefits of organ donation.

“We are continually humbled and inspired by the willingness of donor families to give to others while they deal with the profound and sudden loss of a loved one,” Glazier said.

Peck is relearning how to perform basic tasks with his hands—picking things up, eating, brushing his teeth, getting in and out of a wheelchair and, perhaps most important to him, holding the hand of his fiancée, Jessica Paker.

His new arms serve another special purpose—he’s able to wear a memorial bracelet on his wrist that honors the memory of a friend killed in action.

“It means a lot to me that I can actually wear it now,” said Peck. “Military members wear these bracelets to celebrate the lives and successes of our fallen brothers. I’m just happy that I could finally put it on.”

Looking ahead, he would like to one day attend culinary school and audition to be a star on the Food Network channel—a dream of his since he was a child.

Peck commended his medical team for giving him a new chance at life.

“Their expertise is world class,” he said. “I am grateful to the entire team—including the surgeons, nurses, anesthesiologists, residents and specialists—who worked together to perform the surgery and provide my follow-up care.”

In addition, Peck gave special thanks to his anonymous donor and the donor’s family for making the transplant possible. Because of them, he’s been given a new chance at life.

“Every day when I look down at my new arms, I will drive on through the pain and I will never give up,” Peck said. “I will remember my donor’s selflessness and his gift until the day I die. I want the family to know that I appreciate their bravery and courage in making the decision to donate their loved one’s organs. I assure them that I will not let this gift go to waste.”

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BWH Vets Grateful to Give Back

Several members of retired U.S. Marine Sgt. John Peck’s surgical team are also military veterans. They shared their thoughts on caring for a brother-in-arms.

BRIGHAM AND WOMEN'S HOSPITAL PLASTIC SURGERY FOURTH DOUBLE HAND AND FOREARM TRANSPLANTArnold Alqueza, MD, Orthopaedic Surgery, U.S. Navy. “I completed my five years of active duty in the Navy as a submarine officer 17 years ago. It is an honor for me to be able to serve the veterans who laid it all on the line for our country every day when they served.  I hope John Peck finds joy and use from the gifts given to him by another gracious family.”

BRIGHAM AND WOMEN'S HOSPITAL PLASTIC SURGERY FOURTH DOUBLE HAND AND FOREARM TRANSPLANTPaul Burgart, CST, Operating Rooms, U.S. Army: “I was at Letterman General Hospital, Operating Room, Sixth U.S. Army, San Francisco, from 1971 to 1973, helping care for vets returning from Vietnam. Life feels full circle now, being able to be part of the team helping to take care of this next generation of vets, who have given so much in the service to their country. I feel honored to serve in this capacity.”

RELEASE DATE: 20160901, September 1, 2016, Boston, MA, USA; Brigham and Women's Hospital Plastic Surgery Transplantation Program, in coordination with the hospital's entire transplant team, and the New England Organ Bank, worked throughout an entire day to replace both forearms of USMC Sgt. John Peck (Ret.) in a bilateral mid-forearm transplant procedure, the fourth of it's kind for the Brigham and Women's Hospital in Boston MA. The hand and forearm transplant team, led by plastic surgeon Dr. Simon Talbot, MD, began the pair of surgical procedures shortly after 12 noon and the doubly transformed John Peck was transported to the tower ICU floor for recovery before 3 a.m. the following day. ( lightchaser photography © 2016 ) DATE EMBARGOED ARCHIVES OUT

George S.M. Dyer, MD, Orthopaedic Surgery, U.S. Air Force: “It was a particular honor to participate in the care of an injured Marine. Nearly 20 years ago, I finished seven years of active duty service to go to medical school. Then, after 9/11, I regretted that I was no longer on active duty to serve my country, but not yet fully trained as a surgeon. So I am especially grateful for this chance to use my new profession to give something back to a man like John Peck, who gave so much as part of his own service.”

AMIGO Suite Celebrates 5 Years of Improving Patient Care

From left: Sean Jackson, Clare Tempany, Angela Kanan and Alexandra Golby celebrate the AMIGO suite’s fifth anniversary.

From left: Sean Jackson, Clare Tempany, Angela Kanan and Alexandra Golby celebrate the AMIGO suite’s fifth anniversary.

In the five years since the Advanced Multimodality Image Guided Operating (AMIGO) suite opened at BWH, more than 1,200 procedures have been performed there—a figure Clare Tempany, MD, medical director of AMIGO, says wouldn’t have been possible without BWH’s commitment to expanding the boundaries of medicine.

“We’ve seen amazing results in many fields of medicine and surgery within AMIGO,” she said. “We’re honored so many people have supported the suite, and we hope they continue to do so for years to come.”

A joint endeavor between BWH and the National Institutes of Health, the AMIGO suite spans 5,700 square feet of operating and imaging technologies. Multidisciplinary teams of specialists—including radiologists, surgeons, anesthesiologists, nurses, technologists, engineers and researchers—use its equipment and novel design to efficiently and precisely guide treatment before, during and after a procedure, without the patient or clinical team having to leave the operating room.

It is the first operating suite in the world to house a complete array of advanced imaging equipment and interventional surgical systems, along with advanced navigational technologies for use during procedures, enabling less-invasive, more-effective therapies.

Clinicians have used the AMIGO suite to perform surgeries and procedures in several areas, including Neurosurgery, Interventional Radiology, Endocrine Surgery, Radiation Oncology and Surgical Oncology. Case volume in AMIGO has continued to rise, with about 296 cases performed in 2015 and 385 projected for 2016.

Neurosurgeon Alexandra Golby, MD, AMIGO co-director and director of Image-Guided Neurosurgery, recalls performing the first procedure in the suite in 2011. Looking back, she’s proud of how AMIGO’s scope has expanded.

“Even before AMIGO launched, we had a vision to make it a multispecialty and multi-organ suite,” Golby said. “In AMIGO, patients have access to state-of-the-art, first-in-human approaches, and everything we do is built on that as the guiding principle: Perform the best possible interventions for patients, which are really personalized to their needs.”

Golby said this includes patients who come to AMIGO with particularly complex cases that other treatments were unable to resolve.

During a recent event celebrating AMIGO’s five-year anniversary, Tina Kapur, PhD, co-director of AMIGO and executive director of Image-Guided Therapy in the Department of Radiology, who also provides research oversight in AMIGO, said she was happy that AMIGO continues to be a vibrant place for research. Over the last two years, several papers about research performed in the suite have been published in peer-reviewed journals.

“To know that we have performed more than 1,200 procedures has been amazing,” Kapur said. “We have been able to survive and thrive, and now our mission is to plan for the next 1,200 cases.”

AMIGO has played a pivotal role in pioneering discoveries, agreed Mehra Golshan, MD, distinguished chair in Surgical Oncology at BWH, who has tapped the center’s resources for a clinical trial studying women diagnosed with early-stage breast cancer.

“Groundbreaking research in AMIGO has translated to treatment-changing approaches for breast MRIs, which potentially affects tens of thousands of women who undergo breast-conserving therapy,” Golshan said. “In addition, AMIGO has been instrumental in BWH receiving its first grant from the Breast Cancer Research Foundation.”

Since AMIGO opened, about 900 interventional radiology cases have been performed there, including tumor ablations—minimally invasive destruction of cancer tissue—and MR-guided biopsies, which are performed when cancer is visible in MRI images but cannot be confirmed by traditional biopsies. More than 200 Neurosurgery procedures have been performed, including brain tumor resections and deep brain stimulations, which treat various disabling neurological symptoms.

Looking forward, Kapur hopes teams in AMIGO will be able to partner even more closely with technology companies to help develop and test new devices, software and imaging. “We’re a unique test bed to do that because we have an unusual mix, where researchers and clinicians work closely every day,” she said.

During the event, speakers acknowledged the late Ferenc A. Jolesz, MD, who was the driving force behind AMIGO.

“Ferenc was like a second father to me,” said Golby. “He was a true visionary. I hope we can do him proud as we take our work into the next five years of image-guided therapy.”

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