The University of Florida College of Medicine has a strong affiliation with the North Florida/South Georgia Veterans Health System. Many UF surgeons share dual privileges at UF Health Shands Hospital and the Malcom Randall VA Medical Center in Gainesville. Surgery and other residents also receive a significant portion of their education treating VA patients and assisting in surgical procedures.
“The Malcom Randall VAMC is a wonderful resource for UF surgeons, residents and students. We have extensive collaboration with the VA in our clinical, research and education missions,” said Kevin E. Berhns, MD, chairman of the UF Department of Surgery and the Edward R. Woodward Professor. “The collegiality of the VA administration and faculty helps foster these relationships and promote new endeavors.”
The two hospitals also partner in certain patient care initiatives — including the transcatheter aortic valve replacement, or TAVR, program at the Malcom Randall VAMC. Since March 2012, UF’s TAVR program has allowed surgeons and cardiologists to treat patients who face a high risk of complications during a traditional aortic valve replacement. Once UF Health established the TAVR program, its team approached surgeons and cardiologists at the Malcom Randall VAMC.
“It was a natural extension to take this skill set and apply it to a population of VA patients who could benefit from the surgery,” said Anthony Bavry, MD, an associate professor in the UF Department of Medicine’s division of cardiology. Bavry currently practices at UF and the Malcom Randall VAMC.
Veterans tend to have multiple comorbidities that make them poor candidates for traditional aortic valve replacements, explained Wade Stinson, MD, an associate professor in the UF Department of Surgery’s division of thoracic and cardiovascular surgery.
“For example, many veterans have lung diseases, like chronic obstructive pulmonary disease. Putting them under general anesthesia with an endotracheal tube for even a short amount of time can be detrimental,” said Stinson, who practices solely at the VA and oversees the TAVR program there.
The team at UF worked with their colleagues at the Malcom Randall VAMC for about a year to bring th TAVR program to the veterans, Stinson said. That included helping optimize the hybrid operating suite for TAVR procedures, running mock cases and assisting in training cardiothoracic surgeons and cardiologists. In the early stages of the program, UF cardiothoracic surgeons proctored TAVR cases at the Gainesville-based VA.
“We are presently the highest-volume TAVR program among VAs nationwide, and we have the fourth-largest cardiac surgical program in the United States,” Stinson said.
Malcom Randall now serves as a referral center for hospitals in Florida, the surrounding region — including Georgia and South Carolina — and Puerto Rico.
The TAVR programs at UF Health and the Malcom Randall VAMC now function independently. TAVR teams from both hospitals, however, may collaborate on difficult patient cases, or share best practices. UF cardiothoracic surgeons are also available to assist in complex TAVR cases as needed.
“We are working in parallel with UF Health,” Stinson said. “The interchange of ideas between the VA and UF helps our surgeons to keep up with current practice.”