University Health System’s Heart and Vascular Institute: A One-stop Team Approach to Heart Care

Friday, March 30, 2018

Each year, the list of treatment options for patients with heart problems becomes longer and more sophisticated. Finding the right treatment means finding the right providers — a choice that also is becoming more complex.

Steven Bailey, MD, past Chief of the Briscoe Division of Cardiology at UT Health San Antonio; Edward Sako, MD, PhD, Division Chief of Adult Cardiac Surgery at UT Health; and Andrea Carpenter, MD, PhD, Professor of Surgery, UT Health

University Health System’s Heart and Vascular Institute, or HVI, is dedicated to making that choice a little easier, says John Calhoon, MD, Chair of Cardiothoracic Surgery at UT Health San Antonio and Medical Director of the Heart and Vascular Institute at University Hospital.

Cardiologists, surgeons and highly trained staff work together to find the best course of treatment, in keeping with the patient’s own goals and desires.

John Calhoon, MD

“We operate as a team,” Dr. Calhoon says. “Our surgeons are co-located with our cardiologists. Patients for cardiology and surgery are in the same unit. I think that proximity, that moment-to-moment, day-to-day discussion of cases — whether a cardiac case requires surgical or medical expertise — exists here at the HVI.”

“The biggest example of teamwork might be our valve clinic, where a patient with valve disease might see a cardiologist and a surgeon in the same setting at the same time,” says Edward Sako, MD, PhD, Division Chief of Adult Cardiac Surgery at UT Health. “Then we’ll have a conference to get consensus on the best option, including TAVR (transcatheter aortic valve replacement) or other percutaneous methods.”

Cardiologists with a wide range of specialties and research interests are critical to that team approach.

“You don’t go to a cardiologist these days,” Dr. Calhoon says. “You go to a heart team with a wide variety of expertise.” That includes specialists in rhythm disorders, arterial disease, heart tumors, valve disorders, rehabilitation and more.

The fact that the HVI is an academic program that trains other physicians is an advantage. Being a program that develops new and better treatments through research and innovation also is an advantage. The intravascular stent, developed in the 1980s by Julio Palmaz, MD, Ashbel Smith Professor of Radiology at UT Health, is considered one of the major medical advances of all time. It is but one chapter in the long and storied history of the heart program.

But those aren’t the only advantages, according to Dr. Calhoon.

“To be good at teaching, you make sure you’re staying abreast of the evidence,” Dr. Calhoon says. “But that’s just part of our mission. Our mission is to be as patient-friendly as anyone around, and our vision is to make decisions based on research or evidence. We make them with an eye toward value, and we make them as a team.”

Advanced Care

Shah-Hinan Ahmed, MD

Under the direction of Shah-Hinan Ahmed, MD, Clinical Chief of Cardiology at University Hospital and Associate Professor of Medicine at UT Health, and Steven Bailey, MD, past chief of the Division of Cardiology at UT Health, University Health System’s Heart and Vascular Institute has been quick to evaluate and adopt many advanced procedures such as TAVR. The technique allows a new aortic valve to be placed within a diseased valve while the patient’s heart is still beating.

While TAVR was initially approved for patients considered too sick or frail for traditional open-heart valve replacement surgery, its use has gradually expanded.

Anand Prasad, MD, is Director of the Cardiac Catheterization Laboratory at University Health System and Freeman Heart Association Endowed Professor in Cardiovascular Disease at UT Health. His clinical interests include helping patients with heart and kidney disease, including those with diabetes and chronic kidney disease needing coronary or peripheral angiograms. He is cofounder of the annual Cardio Renal Connections Meeting ( in San Antonio, which brings together clinicians, researchers and others to discuss the challenges of caring for patients with heart, vascular and kidney disease.

Anand Prasad, MD

Dr. Prasad has helped develop and test technology to limit acute kidney injury in patients undergoing these procedures and teach patients and practitioners about the risks of kidney disease in heart patients. He was the first nationally to use DyeVert Plus, a device that offers a safer way for patients with kidney problems to undergo heart catheterizations.

The contrast dye used in those procedures can be toxic, and the new technology allows doctors to measure precisely — and reduce — the amount of dye they use for the first time.

Another area of focus for Dr. Prasad is treating patients with ventricular failure and shock. He plans to develop a center of excellence for treating patients in cardiogenic shock — a common, hard-to-treat condition with a high mortality rate. One of his tools is the Impella catheter, a pencil-thin, motor-driven heart pump that can be threaded via catheter through the groin to pump blood from the weakened left ventricle.

Congenital heart disease is another area of focus at the HVI. John Calhoon, MD, Chair of Cardiothoracic Surgery at UT Health San Antonio and Medical Director of the Heart and Vascular Institute at University Hospital, who is board-certified in congenital cardiac surgery, works with pediatric and adult colleagues to offer expert care to both children and adults with congenital heart problems. One of the team’s newest members is Jayasree Pillarisetti, MD, a cardiologist specializing in electrophysiology and Assistant Professor of Medicine at UT Health. She works with Manoj Panday, MD, Associate Professor of Medicine at UT Health, to provide a range of diagnostic and treatment options for those with arrhythmias such as atrial fibrillation and other electrical problems in the heart.

The vascular program, led by Mark Davies, MD, PhD, Chief of the Division of Vascular and Endovascular Surgery at UT Health, offers advanced treatments for all sorts of vascular diseases and works closely with the heart team.

“We make our decisions the way you make your decisions for your family,” Dr. Calhoon says. “Have I got the right team on it? Am I using the right information? What’s the best value? And we make that decision after listening to you and then explaining your options plainly.”

New State-of-the-art Facilities

In September, Bexar County Commissioners Court and the Bexar County Hospital District Board of Managers approved a financing plan to build new, state-of-the-art facilities for the HVI on the first floor of University Hospital’s Sky Tower, which opened in 2014.

The new facilities, to be located in 43,000 square feet of shell space, are part of a $390 million expansion that also will include a new 250-bed Women and Children’s Tower to be built alongside University Hospital.

The new HVI, which should be complete in late 2019, will include four to five catheterization labs, 28 cardiology treatment rooms, and 30 prep and recovery beds. Inpatient rooms for both cardiology and cardiothoracic surgery will remain on the ninth floor of the Sky Tower. Marc Feldman, MD, who holds the Joaquin G. Cigarroa, Jr., M.D. Distinguished Chair at UT Health, is Medical Director of the Cardiac Care Unit at University Hospital.

The hospital’s dedicated cardiac and vascular integrated operating rooms are on the second and third floors of the Sky Tower and include multiple high-resolution video displays and touch screen controls. One is a hybrid surgical suite combining the functions of an operating room and cath lab in one room.

The Health System has its own cardiac rehabilitation center located at its Robert B. Green Campus near downtown, led by William Campbell, MD, a cardiologist and Clinical Associate Professor of Medicine at UT Health.

The Cardiac Rehabilitation Center at University Health System’s Robert B. Green Campus

A catheterization lab at University Hospital

University Hospital, named best hospital in the San Antonio area for the seventh year in a row by U.S. News & World Report, is rated as high performing in heart bypass surgery and heart failure treatment by the magazine. The program also was recognized with a 2017 Mission: Lifeline STEMI Receiving Center — Silver Achievement Award from the American Heart Association.

In January, University Health System earned accreditation as a Chest Pain Center with Primary PCI (percutaneous coronary intervention) by the American College of Cardiology. That accreditation means patients who arrive with chest pain are quickly evaluated and treated if need be, with the goal of preventing heart attacks in the first place, says HVI Executive Director Sara Hansen.

“The big part of the accreditation is early heart attack care,” Hansen says. “The goal is to get people here before they have a heart attack. We have a chest pain observation unit in the Emergency Department. If patients have certain symptoms, abnormal labs or a history of heart problems, they’ll get a workup to determine whether they’ll be discharged home or admitted to the hospital.”

Community education — teaching people to understand the signs and symptoms of a heart attack and to seek help immediately — is one of the responsibilities of an accredited Chest Pain Center. University Hospital is part of a communitywide heart alert system of care to get those having a heart attack into the cath lab rapidly.

“One of the most important things when you’re having acute coronary trouble is to go to a place that has people who are available to get a catheter into you and open up your arteries as quickly as possible,” Dr. Calhoon says.

For more information about the Heart and Vascular Institute at University Health System, Call 210-64-HEART or visit