2009 Annual Report

The pages of this report containthe names of hundreds of surgeons, corporate supporters, patients and friends who have invested in the future of cardiothoracic surgery by supporting the Thoracic Surgery Foundation for Research and Education. On behalf of those surgeons who have benefited from the Foundation’s research and educational programs and the multitude of patients who will ultimately benefit from the programs, I would like to say thank you for your generous support. TSFRE was established in 1992 by the four leading American thoracic surgical associations, AATS, STS,WTSA and STSA, to respond to the decrease in research funding from the federal government and institutions for education and research in thoracic surgery—seventeen years later, these challenges continue. The Foundation has become a pivotal force for the growth and vitality of our specialty and its role is increasing, particularly in the areas of research, academic career development and postgraduate education. Perhaps most importantly, the Foundation has chosen to play a leading role in changing the current training paradigm for thoracic surgeons by becoming a founding organization of the Joint Council on Thoracic Surgery Education (JCTSE). Along with the American Association for Thoracic Surgery (AATS), the American Board of Thoracic Surgery(ABTS) and the Society of Thoracic Surgeons (STS), TSFRE has committed its resources to support and empower the JCTSE to overhaul the current thoracic surgery training program and coordinate all thoracic surgery education in the United States. The Thoracic Surgery Foundation for Research and Educationis our foundation and the lifeblood of our specialty. It depends on us to be informed, to fund the research to support our fellow surgeons and our ability to embrace new technology and learn its application. The efforts of our supporters—through donations or networking—will impact the future of cardiothoracic surgery and the welfare of our patients. I hope that you continue your support of today’s research so we can serve our patients with even better techniques and technology tomorrow. I urge each of you who have not given to the Foundation in the past to do so now, and if you have given generously in the past I ask that you consider another gift at this time. Such generosity will help us insure a bright future for young surgical scientists and excellent care for our patients. Thank you.

Michael J. Mack, M.D. President Thoracic Surgery Foundation for Research and Education

THE HISTORY AND PHILOSOPHY OF TSFRE:

The Thoracic Surgery Foundation for Research and Education (TSFRE) was established in 1992 by the four leading thoracic surgery societies: the American Association for Thoracic Surgery (AATS), the oldest national thoracic organization; the Society of Thoracic Surgeons (STS), the largest national thoracic organization; the Southern Thoracic Surgical Association and the Western Thoracic Surgical Association. Representatives from each of these organizations serve on the TSFRE Board of Directors and each organization provides annual financial support to TSFRE. The TSFRE represents all of thoracic surgery in the United States and its research and education initiatives support the broad spectrum of thoracic surgery.

THE MISSION OF THE TSFRE IS TWO-FOLD:

Increase knowledge and improve the care of patients with thoracic disease To nurture the development of the surgeon-scientist

The specialty and TSFRE remain committed to research, recognizing that it is today’s research that is the practice of tomorrow. Without the thousands of research hours and millions of dollars, new surgical techniques and today’s miracle drugs would remain undiscovered. Hundreds of thousands of lives would be adversely affected.

Thoracic surgeons, indeed all surgeons, face a changing health care system. TSFRE recognizes that education plays a vital role in the future of our specialty. Thus, TSFRE has developed new initiatives that will support thoracic surgeons in acquiring the transdisciplinary skills necessary for success in the years and decades ahead, developing new training programs that will utilize simulation activities for thoracic surgery and creating an emphasis on patient safety within the specialty.

The Thoracic Surgery Foundation for Research and Education (TSFRE) is the focal point for research and education programs and projects within cardiothoracic surgery. TSFRE ensures that research and education, the foundations for progress within the medical specialty, remain at the forefront and that innovative, new endeavors receive the support and commitment necessary to advance thoracic surgery in future years.

The American Association for Thoracic Surgery

The Society of Thoracic Surgeons

The Southern Thoracic Surgical Association

The Western Thoracic Surgical Association

2009 Research Committee David R. Jones, M.D., Chair University of Virginia Charlottesville, VA James S. Allan, M.D. Emile A. Bacha, M.D. Frederick Y. Chen, M.D. Yolanda L. Colson, M.D. Kenneth R. McCurry, M.D. Marc R. Moon, M.D. Richard G. Ohye, M.D. Mark B. Ratcliffe, M.D. Bruce R. Rosengard, M.D. Thoralf M. Sundt, M.D. Patricia A. Thistlethwaite, M.D. Y. Joseph Woo, M.D.

In January of 2009, the Research Committee met to review 51 applications. Each major subspecialty area—congenital heart disease, adult acquired surgery, thoracic oncology and thoracic transplantation—was well represented. The proposals varied widely in scientific focus, ranging from transplantation immunology and molecular oncology to biomechanics and tissue engineering. There was also a healthy mix of mechanical, translational and clinical science. Most importantly, all of these proposals addressed issues important to improving care for our thoracic surgical patients. The Committee’s work includes providing constructive criticism for each applicant. We strongly believe that this feedback will help young residents and faculty to submit ever more polished applications, and thus compete more effectively in traditional venues for increasingly scarce research funds. The committee is acutely aware that academic departments can no longer depend on diverting professional revenues to support research. Lack of this traditional bridge or seed funding enhances the need for fundraising to make it possible for TSFRE to increase the amount of individual awards, particularly to young faculty. Despite the grinding pressures and financial uncertainties we all face in our clinical practices, the breadth and high quality of the TSFRE supported research effort reflects a strong commitment to fundamental and clinical thoracic surgical investigation. This vital basis for the future evolution of our specialty remains healthy and vibrant, thanks to your participation.

Since its inception, TSFRE has awarded and administered over $8.5 million in research grants, fellowships and career development awards for thoracic surgeons. Awards are made after a rigorous examination of applications by the TSFRE Research Committee, composed of outstanding research surgeon-scientists.

Research Awards Available:

Research Fellowship AwardsSupport of up to $30,000 per year for up to two years for surgical residents who have not yet completed cardiothoracic surgical training.

Research Grants

Operational support of original research efforts by cardiothoracic surgeons who have completed their formal training and who are seeking initial support and recognition for their research program. Awards of up to $40,000 a year for up to two years are made each year to support the work of an early-career cardiothoracic surgeon (within five years of first faculty appointment).

Nina Starr Braunwald Career Development Awards

Provides a biennial award of $115,000 for two years to support the research career development of a woman cardiac surgeon who holds a full-time faculty appointment and who is within ten years of completion of thoracic surgery residency.

TSFRE has formed valuable partnerships with the National Heart, Lung and Blood Institute and the National Cancer Institute to offer K08 and K23 awards. Through this partnership, the Foundation is able to increase the dollars available to support cardiothoracic research.

National Heart, Lung And Blood Institute – K08 & K23 Awards

Support to outstanding clinician research scientists who are committed to a career in cardiothoracic surgery research and have the potential to develop into independent investigators.

National Cancer Institute – K08 & K23 Awards

Provides support to outstanding clinically trained professionals who are committed to a career in laboratory or field-based research and have the potential to develop into independent investigators.

TSFRE Research Fellowships:

Karen M. Kim, M.D.
Massachusetts General Hospital
“The Effect of Donor Brain Death and Prolonged Cold Ischemia on Cardiac Allograft Tolerance in Miniature Swine”

Alykhan Nagji, M.D.
University of Virginia
“Effect of Combined Histone Deacetylase Inhibitors and Proteasome Inhibitors on Epithelial-Mesenchymal-Transition in Non-Small Cell Lung Cancer Cells”

TSFRE Research Grants:

Ashish Shah, M.D.
Johns Hopkins University
“Consequences of Phosphodiesterase Type 5 Inhibition on Nitric Oxide Synthase Biochemistry in Experimental Lung Transplantation”

LUNGevity Foundation/TSFRE Research Fellowship:

Onkar Khullar, M.D.
Brigham &Women’s Hospital
“Prevention of NodalMetastasis in Lung Cancer via Lymphatic Trafficking of Paclitaxel-Loaded Expansile Nanoparticles”

LUNGevity Foundation/TSFRE Research Grant:

Sai Yendamuri, M.D.
Roswell Park Cancer Institute
“AMicroRNA Profile to Predict Recurrence After Surgical Resection of Stage I Non-Small Cell Lung Cancer”

Career Development Award:

Arnar Geirsson, M.D.
Yale University
“Role ofMicro RNA in Cardiac Ischemia and Heart Failure”

TSFRE/NHLBI Jointly SponsoredMentored Clinical Scientist Development Awards (TSFRE/NHLBIMCSDA)

Christine L. Lau, M.D.
University of Virginia
“Adenosine2A Receptor Signaling in Lung Transplant Injury and Rejection”

Sunjay Kaushal, PhD, M.D.
Children’s Memorial Hospital, Chicago
“Characterization of Cell-Based Therapy for Congenital Heart Patients”

TSFRE/NCI Jointly SponsoredMentored Clinical Scientist Development Awards (TSFRE/NCIMCSDA)

Sasha A. Krupnick, M.D.
Washington University
“The Role of Non-Hematopoietic Cells in Tumor Tolerance Induction”

JayM. Lee, M.D.
UCLA Medical Center
“GeneModified Dendritic Cell Therapy in Lung Cancer”

Chukwumere E. Nwogu, M.D.
Roswell Park Cancer Center
“Radioguided Detection of Lymph NodeMetastasis in Non-Small Cell Lung Cancer”

TSFRE Supporter

Alley-Sheridan Scholarships

Medical innovation doesn’t always happen in a lab. Sometimes it happens in an unexpected place, like an unassuming red barn in rural New York.

It was there in 1955 that David Sheridan developed the bubble principle that revolutionized how catheters, cannulae and tubes are used in operative procedures and patient care.

While the bubble principle was one of Mr. Sheridan’s most significant inventions, it was not his only one. In fact, he held or shared more than 50 patents for innovations that greatly improved medical care throughout his lifetime.

Fortunately, Mr. Sheridan collaborated with others throughout his life. Dr. Ralph D. Alley, former head of the Division of Thoracic Surgery at Albany Medical Center, was one of them.

Moved by his collaborator and friend’s commitment to thoracic surgery, Dave Sheridan donated $1 million to the Thoracic Surgery Foundation for Research and Education to establish the Alley-Sheridan Fund. Harvard University’s Kennedy School of Government. Over the past 15 years this fund has supported 192 thoracic surgeons through scholarships to the Leadership and Health Policy Program both at the Kennedy School and most recently at Brandeis University.

Through his generosity, Dave Sheridan has ensured continued innovation in a field that has greatly benefited from his inventiveness.

Sai Yendamuri, M.D.
LUNGevity Foundation/TSFRE
Research Grant Recipient

The Foundation/TSFRE Research Grant serves as a validation of my research and a vital source of seed funding at a crucial time in my academic career. Starting an independent laboratory was the next logical step after completion of a fellowship in thoracic surgery and starting my first job at the Roswell ParkCancer Institute. Our research is focused on the utilization of microRNA expression patterns as clinically relevant biomarkers. As a first experiment we decided to attempt to identify a microRNA signature for the prediction of recurrence after resection of early lung cancer. We identified a promising signature that deserved additional validation.

However, microarray experiments are expensive and difficult to accomplish without external funding. While we were given access to tissue and clinical data from a co-operative group, we still needed to get funding to complete this crucial part of our project in order to move this signature to a prospective study.

At this critical juncture, the TSFRE award provided the funds required to complete our experiment. Thanks to the award, our validation study is moving ahead. While the funds given by the TSFRE are important, the award itself is a shot in the arm for young investigators beginning their career in academic research. With the difficult funding environment that researchers face currently and the pressure to be clinically productive at the same time, such seed funding is crucial to obtain the data that enables us to apply for competitive NIH funding.

Sai Yendamuri, M.D.
Roswell Park Cancer Institute
2009 LUNGevity
Foundation/TSFRE Research
Grant Recipient

Jane Yanagawa, M.D.
LUNGevity Foundation/TSFRE
Lung Cancer Award Recipient

The TSFRE research fellowship has provided me with an amazing learning experience. After my third year of general surgery residency, I entered the lab with minimal previous research experience and little direction other than that I was interested in lung cancer research. The process of applying for the award introduced me to grant-writing as well as taught me how to develop a detailed project with meaningful goals and realistic aims. The funding I received gave me the opportunity to learn and utilize a variety of techniques, including three-dimensional cell culture, gene expression and tissue microarray analysis, as well as a variety of murine tumor models.

As a result, I have had the honor of presenting at national meetings and publishing my work on the previously un-described impact of a transcriptional repressor called Snail on the tumor progression of non-small cell lung cancer. In addition to the immediate benefits related to my recent research project, this research fellowship has also contributed to my long-term commitment to pursue academic thoracic surgery. The satisfaction of garnering support for a cause one believes in leaves no doubt that such a career path would be incredibly meaningful.

Jane Yanagawa, M.D.
University of California
Los Angeles
2008 LUNGevity
Foundation/TSFRE Lung Cancer
Research Award Recipient

Education Committee Thoralf M. Sundt, M.D., Chair Mayo Clinic Rochester, MN Ajay Carpenter, M.D. Shanda H. Blackmon, M.D., MPH Nora L. Burgess, M.D. Yolonda L. Colson, M.D. Kristine Guleserian, M.D. Cynthia Herrington, M.D. Leslie J. Kohman, M.D. Raj B. Lal, M.D. M. Blair Marshall, M.D. Ross M. Ungerleider, M.D. Ara A. Vaporciyan, M.D. Stephen C. Yang, M.D.

The specialty of cardiothoracic surgery has always been defined by two inseparable attributes: the capacity to imagine a future that others cannot see; and a determination to discover and implement the knowledge and practical skills necessary to make that new future a commonplace reality. These attributes are pertinent to understanding the work of the TSFRE Education Committee.

The dissemination of new knowledge about cardiothoracic medicine and providing surgeons with the capability to implement this new knowledge and skills is a critical element to the progress of our specialty. TSFRE enables surgeons to constantly refine and improve their skills as physicians, surgeons and leaders in medicine.

The Foundation offers a variety of educational programming. Most notably, the Health Policy Leadership Program offered in partnership with Brandeis University. This initiative provides a comprehensive, weeklong program that focuses on the changing nature of the nation’s health care system, its management and how physicians can impact that system.

2009 was a year of many educational accomplishments for the Thoracic Surgery Foundation for Research and Education

6 Alley-Sheridan Scholars attended the Health Policy and Leadership program offered at Brandeis University. This program has had a profound impact upon the hundreds of surgeons who have attended and gained invaluable insight into the public policy process of the US health care system.

Simulation in Thoracic Surgery Education

A Visioning Simulation Conference was held in April 2007 to provide a forum for leaders in thoracic surgery and invited simulation experts to discuss our shared vision for development and use of simulation in education and certification. The Foundation believes that cardiothoracic surgery is an ideal specialty to demonstrate and evaluate the use of advanced simulation and other innovative approaches to quality and safety as a model for other highly technical medical specialties. The outcome of this forum has resulted in a new educational simulation grant offered by the Foundation. In January 2009, the Foundation’s Education Committee reviewed 19 proposals for grants to support the demonstration of the application of simulation in thoracic surgery education. The Board of Directors approved $100,000 total for funding 7 of these Simulation Grants.

TSFRE/Edwards Lifesciences New and Emerging Technology Fellowship

This award is providing support of $30,000 to allow for travel, temporary relocation and training costs associated with 3 fellows to spend approximately 3 months learning new and emerging technology and skills.

TSFRE/Edwards Lifesciences New and Emerging Technology Fellowship
This award will provide support of up to $30,000 per year for each fellow to allow for travel, temporary relocation and training costs associated with one identified center where the Fellow will spend approximately 3 months learning new and emerging technology and skills.

Robert Smith, M.D.
Leipzig Heart Center
“Minimally Invasive/Percutaneous Valve”

Andrea Colli, M.D.
Leipzig Heart Center
“Endovascular Stents”

Cosmin Dobrescu, M.D.
Arizona Heart Center
“Endovascular Stents”

Simulation in Thoracic Surgery Education Grants
Provides grants to support the demonstration study for the application of simulation in thoracic surgery education.

Emile Bacha, M.D.
Children’s Hospital of Boston
“Improving Performance of Emergent ECMO High-Fidelity Simulation”

James I. Fann, M.D.
Stanford University Medical Center
“Simulation in Cardiac Valve Surgery and Cardiac Surgery Crisis Management”

Yvonne Carter, M.D.
Georgetown University Medical Center
“Development of aMinimally Invasive Simulator for Thoracic Surgery Training”

Eugene A. Grossi, M.D.
New York University School of Medicine
“Cognitive Task Training for Right Upper Lobe Resection Simulator”

Richard H. Feins, M.D.
University of North Carolina School of Medicine
“Thoracic Resection Simulation”

Nabil Rizk, M.D.
Memorial Sloan Kettering Cancer Center
“Thoracic Endoscopic Surgery Simulator”

Ashish Shah, M.D.
Johns Hopkins Hospital
“Simulation Training for Post Operative Cardiac Instability and Collapse”

2009 Simulation in Thoracic Surgery Education Award Winner

Like other surgical specialties, procedures in cardiac surgery can be partitioned into components and thus simulated using partial-task trainers. The TSFRE Simulation Grant has provided us with an opportunity to develop and evaluate a valve surgery simulation program and to refine our approach to crew resource and crisis management. In particular, understanding assessment of the mitral valve complex and knowledge of reparative techniques are critical before entering the operating room.

Using models and tissues, the resident has the opportunity to put into practice their reading of the literature on the requisites of valve surgery. One area requiring intensive practice is defining and visualizing the mitral annulus followed by determining appropriate needle angles to optimize suture placement. Our focus is to provide a three-dimensional appreciation of the annular surface so that a resident can place the needle perpendicularly into the annular tissue. The simulation effort thus emphasizes teaching and assessing the cognitive (the ability to visualize spatial constraints and target plane and to understand the anatomy) and technical (loading the needle and suture placement without undue tissue stress/strain) components of cardiothoracic surgery.

Crisis management training and team training have become increasingly important in the care of critically ill patients. The addition of adverse conditions into the scenarios strengthens the value of the training exercise and provides a method to rehearse responses to emergency situations. With the support of TSFRE, the proposed intensive, interactive program will augment the resident and staff’s ability to effectively manage perioperative cardiac surgery events and to better communicate during such events by simulating specific and global crises in the OR and ICU.

James I. Fann, M.D.
Stanford University Medical Center
2009 Simulation in Thoracic Surgery
Education Award Winner

STATEMENT OF FINANCIAL POSITION As of June 30, 2009 Assets: Total Current Assets $4,614,433 Plegdes Receivable $226,320      Total Assets $4,840,753 Liabilities: Awards Payable $2,828,738 Total Non-Current Liabilities $1,132,332      Total Liabilities $3,961,070 Fund Balances: Fund Balance $3,764,861 Year to Date Income (Loss) $-2,885,178      Total Fund Balances $879,683      Total Liabilities and Net Assets $4,840,753

REVENUES FOR THE YEAR ENDED JUNE 30, 2009

Surgeon Contributions	$125,576
Society & Corporate Contributions	$219,725
Investment Income	$18,985

EXPENDITURES FOR THE YEAR ENDED JUNE 30, 2009

Research	$924,327
Education	$1,018,500
Administrative	$377,468

TSFRE ensures that research and education, the foundations for progress within the medical specialty, remain at the forefront and that innovative, new endeavors receive the support and commitment necessary to advance thoracic surgery in future years.

The combination of research and new technology, which go hand-in-hand, have advanced the capabilities of thoracic surgeons dramatically over the past two decades. Today, thoracic surgeons can very successfully treat diseases and medical conditions that were a short time ago deemed untreatable. The financial resources that made these advances possible were most often large private organizations or federal agencies. Within our specialty clinical work supported the bulk of research.

Our changing health care environment and radical transformation within industry have, quite frankly, diminished those traditional sources of funds. Research and training opportunities for young, talented surgeon-scientists have been sharply curtailed.

The specialty and the TSFRE remain committed to research, recognizing that it is today’s research that is the practice of tomorrow. Without the thousands of research hours and millions of dollars, new surgical techniques and today’s miracle drugs would remain undiscovered. Hundreds of thousands of lives would be adversely affected.

The results of thoracic research ultimately reduce the toll of thoracic diseases and defects. Given the pervasiveness of cardiovascular diseases and lung cancer, today’s research has the potential to improve millions of lives tomorrow. The TSFRE’s partnerships with the National Heart, Lung, and Blood Institute and the National Cancer Institute are critically important initiatives to further our knowledge and capabilities against these diseases, while strongly supporting very talented surgeon-scientists within the specialty.

Further, thoracic surgeons, indeed all surgeons, face a changing health care system. The TSFRE recognizes that education plays a vital role in the future of our specialty. Thus, the TSFRE will continue to support thoracic surgeons in acquiring the transdisciplinary skills necessary for success in the years and decades ahead, develop new training programs that will utilize simulation activities for thoracic surgery, and create an emphasis on patient safety within the specialty. The TSFRE will also remain active in assuring that thoracic surgeons continue to develop the skills necessary to remain in the forefront as health care policy leaders.

The Thoracic Surgery Foundation for Research and Education is an organization that will continue to steer the future of thoracic surgery through the sponsorship of surgical research and the education of surgeons in health care policy. TSFRE is your foundation for the future; by supporting TSFRE you are investing in the future of our specialty now.

Giving Opportunities:

Because TSFRE is a charitable organization with IRS 20 (c)(3) classification, your gift to TSFRE qualifies as a tax deduction. For some, an outright gift of cash, securities, or other property is the best means of contributing. Other giving options are outlined as follows:

Gifts of Cash

An outright gift of cash is the simplest method of giving. It is not subject to gift or estate taxes. You may be able to deduct the gift amount from your taxable gross income.

Gifts of Securities or Real Estate*

A tax-wise gift of stock or real estate can provide generous support for the Thoracic Surgery Foundation for Research and Education. Almost any type of real property — a personal residence, a farm, a vacation home, a commercial building, or a parcel of land — can constitute a gift. Gifts of securities or real estate are tax deductible and free of capital gains tax.

Life Income Gifts

Perhaps you would like to make a significant gift to TSFRE right now but believe that you cannot because you need the income your assets earn. If so, you may want to consider a "life income gift". A life income gift allows you to donate, yet retain life income for yourself and another, if you wish. These gifts frequently increase your income, save income tax, capital gains and estate tax, and also benefit TSFRE.

Bequests

You may wish to make a gift to TSFRE by utilizing one of the easiest, most frequently used methods — a bequest in your Will. Tax laws favor bequests, and consequently, they are an excellent way to provide support. If you would like to make a pledge or receive more information about giving to TSFRE, please complete and return the form included in this report, visit www.tsfre.org or call the Executive Director of The Thoracic Surgery Foundation for Research and Education at 978-927-8330.

Donations can also be made online at www.tsfre.org

*This information is not intended as specific legal or tax advice. Consult an attorney when planning for gift and estate giving. State and federal laws, which govern wills and contracts, vary and are subject to change.