Two years ago, Jamil Borgi, MD, became the first chief of cardiothoracic surgery at Metairie, La.-based LCMC Health’s East Jefferson General Hospital. His appointment coincided with a partnership between LCMC Health and New Orleans-based Tulane University’s School of Medicine to provide advanced cardiovascular care to patients.
“From a cardiac surgery standpoint, I saw that many programs avoided highly complex cases and focused primarily on routine procedures,” Dr. Borgi told Becker’s. “That created an opportunity to build a program capable of managing advanced and complex cardiothoracic care.”
Dr. Borgi joined forces with Sasa Vukelic, MD, director of advanced heart failure and transplant cardiology at East Jefferson; both previously worked at Montefiore Health System before moving to Louisiana. They leaned on their experience there to build an “entire system around advanced cardiothoracic care, including heart failure, cardiogenic shock and mechanical circulatory support,” Dr. Vukelic said.
At the time, they said their region should have generated about 150 heart transplant cases per year, but hospitals across the state were not performing more than 25. They also realized that many patients with advanced heart failure were either not receiving appropriate care and many traveled to other states to receive advanced therapies.
“Patients can travel to another state for surgery, but they still need a nearby team to manage their care afterward,” Dr. Vukelic told Becker’s. “Without a local transplant center, patients may face enormous risks.”
Surrounding hospitals had avoided launching these programs due to resource-intensive requirements. Advanced cardiothoracic care requires collaboration across multiple surgeon and physician specialties, as well as financial coordinators, physical therapists and respiratory therapists.
“It truly takes a large team,” Dr. Borgi said. “You cannot simply open a transplant program without first building the necessary infrastructure and culture around complex cardiovascular care. The operating room teams, anesthesiologists, ICU staff and postoperative care teams all need to be prepared.”
When Dr. Borgi first joined East Jefferson Hospital, there were only two surgeons in the program. Now there are six across the system, in addition to several new cardiologists and heart failure specialists.
To date they have performed about 30 mechanical heart support procedures such as left ventricular assist devices, and completed 13 heart transplants. East Jefferson also operates one of only two comprehensive level 1 cardiogenic shock programs in the state, and one of the only programs serving the Gulf South region.
The program originally aimed to help patients who are within a two-hour drive of the hospital. But once services opened, they started seeing patients coming from four or more hours away. Their current region includes Louisiana, coastal Mississippi, coastal Alabama and parts of the Florida Panhandle.
“We’ve seen a large increase in referrals from across Louisiana and surrounding states,” Dr. Borgi said. “Our hospital is now becoming known as a center for advanced cardiovascular care.”
To meet the rising demand, East Jefferson Hospital has adopted a hub-and-spoke model with regional hospitals.
“Those hospitals can communicate with us for consultation and guidance, even when patients do not require transfer,” Dr. Vukelic said. “Our goal is not only to provide advanced care at our center but also to elevate cardiovascular care throughout the Gulf South.”
The future
The East Jefferson Hospital leaders have a few goals on the horizon.
- They plan to open a lung transplant program in the next year.
- They plan to expand surgical capabilities for other complex cardiothoracic procedures, including advanced aortic surgery, redo cardiac surgery and procedures for chronic thromboembolic pulmonary hypertension.
- They plan to keep performing more heart transplants each year.
- They are working to establish a cardiothoracic surgery fellowship program, a position with few training openings across the country despite a severe shortage of people in the specialty. They are also looking to open advanced heart failure fellowships.
- They are expanding monitoring programs and telehealth services so patients in rural communities have better access to care.
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