Dr. Ross Bremner, and the state of thoracic surgery in Arizona

Talking with Dr. Ross Bremner, Chief of Thoracic Surgery and Chair of Thoracic Disease & Transplant at St. Joseph’s Hospital in Phoenix, Arizona.

Dr. Ross Bremner

St. Joseph’s Hospital

After talking to Dr. Bremner of the phone, I felt compelled to come down to Phoenix and meet him in person.  I am glad I did.  While St. Joseph’s is a large 607 bed hospital – it’s just one of many large healthcare facilities in the Phoenix area.  The same can not be said of their robust thoracic surgery program.  They have a surprising range of thoracic surgery subspecialties, and sub-specialty programs including transplant, anti-reflux surgery, minimally invasive surgery, esophageal surgery program and robotic surgery.  As you can imagine, I felt a bit like a kid in a candy store – so overwhelmed by the array of services, that my mind was just bursting with questions.  (I rounded with the group and got to see the full spectrum of patients – including four recent post-transplant patients.)  They also have a pediatric thoracic surgery program and plan to start a pediatric transplant program soon.

Dr. Ross Bremner & Dr. Mike Smith, Heart & Lung Institute

The head of the program, Dr. Ross Bremner is one of five thoracic surgeons at the Heart & Lung Institute of St. Joseph’s Hospital in Phoenix, Arizona which is currently the state’s largest thoracic surgery program.  A native of Johannesburg, Dr. Bremner maintains international ties to his home country by staying active in the South African Cardiothoracic Surgery Society.  He began his thoracic surgery career at University of Southern California (USC) where he met and recruited both Dr. Michael Smith, MD and Sandra Ogawa, ACNP.

As Arizona has grown, so has thoracic surgery.  Despite the relatively small population of Arizona overall, both the esophageal surgery program and the lung transplant program maintain volumes that are competitive with the big-name east coast institutions.

With over 45 lung transplants last year – and the University of Arizona currently out of the running, Dr. Bremner* and his team are set to boost those numbers this year.  They have already done ten transplants here in the first quarter of 2012, and anticipate doing fifty to sixty this year.  (If you remember from our previous posts about lung transplantation – even very large institutions are not doing huge numbers of transplants.  In fact, you can check the numbers at the Organ Procurement and Transplant Network if you’re interested*.)

St. Joseph’s also has an esophageal surgery program which maintains the high volumes of esophagectomies needed for optimal outcomes.  Dr. Bremner reports that they perform on average 50 – 60 esophagectomies for esophageal cancer ever year in addition to their benign esophageal surgery program.  (As we discussed with Dr. Molena, ‘benign’ is a bit of a misnomer for esophageal conditions since achalasia, esophageal strictures and other non-cancerous conditions of the esophagus may have a huge negative impact on the individual’s quality of life.)

The Heart & Lung Institute also offers training courses for surgeons and residents in minimally invasive surgery – in fact, they are teaching a course the weekend of my visit.

As a practicing surgeon in Phoenix, Arizona, Dr. Bremner also sees numerous cases of Coccidoidomycosis** (or Valley Fever) which is endemic to this area of the country.  In fact, Maricopa county, which encompasses the city of Phoenix sees more cases annually than the California valley the disease was originally named for.

* At the site, you can create data reports by organ, region, outcome, waiting period, etc..  For example – using this data table – we can see that there were a total 1,516 isolated lung transplants in the United States in 2011 which is actually a decrease from 2010 and 2009.

** Readers can anticipate a future article on this topic

More about Dr. Ross Bremner, MD, PhD

Dr. Bremner is a genial gentleman and a ready conversationalist.  Our interview was relaxed, but informative.  He welcomed my questions on a variety of topics and was generous with his time.  In fact, I had ready access to multiple members of his team, and spent the entire afternoon with the department of thoracic surgery.  It was an engaging afternoon, and highlighted one of the reasons I pursue interviews and opportunities to speak to my colleagues within thoracics; it was an opportunity to learn more about the specialty, and the care of thoracic surgery patients.

Dr. Bremner is a board-certified thoracic surgeon.  After obtaining his baccalaureate degree and medical school training at Witwatersrand University in South Africa, he continued his education in the United States.

He completed his general surgery residency, PhD research and thoracic surgery residency at the University of Southern California. He was the Director of the Hastings Thoracic Oncology Research Laboratory on the USC campus.  At this lab, surgeons along with researchers from multiple disciplines conduct research on the diagnosis and treatment of lung cancer including research in gene therapies prior to coming to Arizona.

He has several YouTube videos talking about his current research projects at St. Joseph’s.

He also has an informational series for patients about Lung Transplant over at EmpowHer.com

Dr. Ross M. Bremner, MD, PhD

Chief of Thoracic Surgery

Chair of the Center for Thoracic Disease & Transplantation

Heart & Lung Institute – St. Joseph’s Hospital and Medical Center

500 W. Thomas Road, Suite 500

Phoenix, Arizona 85013

Tele: (602) 406 4000

Fax: (602) 406 3090

Selected publications (not a full listing)

Jacobs JV, Hodges TN, Bremner RM, Walia R, Huang J, Smith MA. (2011). Hardware preservation after sternal wound infection in a lung transplant recipient. Ann Thorac Surg. 2011 Aug;92(2):718-20. [no free text available].

Felton VM, Inge LJ, Willis BC, Bremner RM, Smith MA. (2011). Immunosuppression-induced bronchial epithelial-mesenchymal transition: a potential contributor to obliterative bronchiolitis.  J Thorac Cardiovasc Surg. 2011 Feb;141(2):523-30.  [no free text available].

Gotway MB, Conomos PJ, Bremner RM. (2011)  Pleural metastatic disease from glioblastoma multiforme.  J Thorac Imaging. 2011 May;26(2):W54-8. [no free text available].

Coon KD, Inge LJ, Swetel K, Felton V, Stafford P, Bremner RM.  (2010).  Genomic characterization of the inflammatory response initiated by surgical intervention and the effect of perioperative cyclooxygenase 2 blockade.  J Thorac Cardiovasc Surg. 2010 May;139(5):1253-60, 1260.e1-2.  [no free text available].

Wu C, Hao H, Li L, Zhou X, Guo Z, Zhang L, Zhang X, Zhong W, Guo H, Bremner RM, Lin P. (2009).  Preliminary investigation of the clinical significance of detecting circulating tumor cells enriched from lung cancer patients.  J Thorac Oncol. 2009 Jan;4(1):30-6. [no free full-text available].

Backhus LM, Bremner RM. (2006).  Images in clinical medicine. Intrathoracic splenosis after remote trauma.  N Engl J Med. 2006 Oct 26;355(17):1811.

Backhus LM, Sievers E, Lin GY, Castanos R, Bart RD, Starnes VA, Bremner RM.  (2006).  Perioperative cyclooxygenase 2 inhibition to reduce tumor cell adhesion and metastatic potential of circulating tumor cells in non-small cell lung cancer.  J Thorac Cardiovasc Surg. 2006 Aug;132(2):297-303. [no free full-text available].

Backhus LM, Sievers EM, Schenkel FA, Barr ML, Cohen RG, Smith MA, Starnes VA, Bremner RM.  (2005).  Pleural space problems after living lobar transplantation.  J Heart Lung Transplant. 2005 Dec;24(12):2086-90.  [no free text available].

Backhus LM, Petasis NA, Uddin J, Schönthal AH, Bart RD, Lin Y, Starnes VA, Bremner RM. (2005).  Dimethyl celecoxib as a novel non-cyclooxygenase 2 therapy in the treatment of non-small cell lung cancer.  J Thorac Cardiovasc Surg. 2005 Nov;130(5):1406-12.  [no free full-text available].

Sievers EM, Bart RD, Backhus LM, Lin Y, Starnes M, Castanos R, Starnes VA, Bremner RM.  (2005).  Evaluation of cyclooxygenase-2 inhibition in an orthotopic murine model of lung cancer for dose-dependent effect.  J Thorac Cardiovasc Surg. 2005 Jun;129(6):1242-9.  [no free full-text available].

Bowdish ME, Barr ML, Schenkel FA, Woo MS, Bremner RM, Horn MV, Baker CJ, Barbers RG, Wells WJ, Starnes VA.  (2004).  A decade of living lobar lung transplantation: perioperative complications after 253 donor lobectomies.  Am J Transplant. 2004 Aug;4(8):1283-8.  [no free full-text available].

Starnes VA, Bowdish ME, Woo MS, Barbers RG, Schenkel FA, Horn MV, Pessotto R, Sievers EM, Baker CJ, Cohen RG, Bremner RM, Wells WJ, Barr ML.  (2004).  A decade of living lobar lung transplantation: recipient outcomes.  J Thorac Cardiovasc Surg. 2004 Jan;127(1):114-22.   [no free full-text available].

Haddy SM, Bremner RM, Moore-Jefferies EW, Thangathurai D, Schenkel FA, Barr ML, Starnes VA.  (2002).  Hyperinflation resulting in hemodynamic collapse following living donor lobar transplantation.  Anesthesiology. 2002 Nov;97(5):1315-7.

DiPerna CA, Bowdish ME, Weaver FA, Bremner RM, Jabbour N, Skinner D, Menendez LR, Hood DB, Rowe VL, Katz S, Kohl R.  (2002).  Concomitant vascular procedures for malignancies with vascular invasion.  Arch Surg. 2002 Aug;137(8):901-6; discussion 906-7.

Bremner RM, Hoeft SF, Costantini M, Crookes PF, Bremner CG, DeMeester TR. (1993).  Pharyngeal swallowing. The major factor in clearance of esophageal reflux episodesAnn Surg. 1993 Sep;218(3):364-9; discussion 369-70.

Talking with Dr. Orazio Amabile

a brief interview with Dr. Orazio Amabile, cardiothoracic surgeon from Phoenix Cardiac Surgery as we cross paths in Flagstaff, Arizona.

Dr. Orazio Amabile, a native Arizona resident and cardiothoracic surgeon is a youthful appearing 41-year-old with a ready smile and an engaging manner.  I am rounding with him today in Flagstaff, as he fills in for the local surgeon* who is on a much deserved vacation.

Dr. Orazio Amabile, MD

Dr. Amabile is one of several cardiothoracic surgeons at Phoenix Cardiac Surgery in Phoenix, Arizona, a metropolitan city of around 6 million residents.   He has been a board certified CT surgeon since 2008. It’s our second meeting, and I am impressed by his relaxed yet focused approach.  We start the interview when I ask him to recount the 2007 episode in Tucson that led to his police citation for bravery.  He, and his colleague, cardiothoracic surgeon, Dr. M. Christina Smith were out to satisfy a late pregnancy ‘tater tot’ craving after a long day in surgery, when they witnessed a drive by shooting.  After several shots were fired into a nearby car after being side-swiped by a larger vehicle, the two surgeons (Amabile & Smith) followed the injured man’s car – and finding the man gravely, and severely injured with a bullet wound to the chest, immediately arranged for transport and emergency surgery.  Dr. Amabile had already alerted the operating room, and was carrying the actively dying young man to a nearby squad car when an ambulance diverted to the scene.  He climbed into the ambulance and administered emergency aid during transport including CPR as the patient arrested at the entry to hospital.  He and Dr. Smith then performed the emergency surgery that saved the young man’s life.  (Dr. Amabile was a fellow in cardiothoracic surgery at the University of Arizona at the time.)

Since then, Dr. Amabile has worked in Phoenix, seeing patients at several institutions (St. Joseph’s, St. Luke’s and several other smaller facilities), though Banner’s Good Samaritan Hospital is his primary center of operations.  As a cardiothoracic surgeon, he operates on the whole spectrum of cardiovascular and thoracic conditions, specializing in LVADs, Aortic Surgery (aortic arch/ thoracic aortic surgery) and minimally invasive thoracic surgery including single port lobectomies, wedge resections and other lung surgeries.  He estimates that he does roughly 100 – 150 lung surgeries a year as part of his practice.  He states that 90% of these procedures are done via minimally invasive techniques but that he doesn’t hesitate to use open techniques if that’s what is required to get the best surgical results for his patients.

Dr. Amabile also feels that large, centralized surgery programs are essential for optimal patient outcomes.  For example, he states, “Arizona has 25 cardiac surgery programs which means that each surgeon, and each surgery program has much less volume [and thus experience] than if Arizona had just a few programs.”  This also has an impact on the allocation of resources – which are now shunted into twenty-five directions instead of three or four major facilities.

I ask his opinion of the future of thoracic surgery and robotics – of which he is not a fan.  Like many surgeons I’ve spoken to, Dr. Amabile does not feel that the use of robotics is always justified by the increased risks to the patients.  “It can make a dangerous operation more dangerous.”  We discuss the lack of technical advantages and the increased case durations with robotic approaches for a few minutes before the conversation turns.

Dr. Amabile sees LVADs and device therapies as the future of thoracic surgery – particularly the use of ECMO and ambulatory ECMO devices for end stage lung disease.  He became more interested in the new applications of ECMO after he attended the ELSO conference in Scottsdale last year.  He envisions this treatment, device therapy as a destination rather than a bridge to transplantation.  To this end – he recently started a LVAD program at Good Samaritan hospital and has recently implanted his 6th device this year.  He hopes to implant ten devices in the program’s first year.  As part of this, he is participating in the Intermacs database to continue research into circulatory devices. (It’s his interest in this area, and the pathophysiology involved in circulatory arrest that fuels his interest and enjoyment of aortic surgery.)

Brief Biography

At 41, Dr. Amabile is just at the beginning of a long career in cardiothoracic surgery.  After attending medical school at Universidad Autonoma De Guadalajara in Guadalajara, Mexico, D. Amabile returned to the United States to do an additional year at New York Medical College.  He then completed two years of  his general surgery residency at Creighton University in Omaha, Nebraska before returning to his home state of Arizona for the remainder of his general surgery training and his cardiothoracic surgery fellowship (at the University of Arizona in Tucson.)  Along the way, he gathered several awards in addition to his police citation mentioned above, including awards as best intern teacher,  a Golden Apple award nominee (2002) and an award for excellence in customer service (the ‘Target 100’).

Dr. Orazio Amabile, MD

Phoenix Cardiac Surgery

3131 East Clarendon Ave.

Suite 102

Phoenix, AZ 85016

(602) 253-9168

* Disclosure: I previously worked for the Flagstaff based surgeon, Dr. Steven Peterson at the Heart & Vascular Center of Northern Arizona.