Heart Center OVERVIEW AND OUTCOMES

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1 Heart Center OVERVIEW AND OUTCOMES Three-star rating from The Society of Thoracic Surgeons For more about the program, visit rileychildrens.org/heartcenter. To refer a patient to the Heart Center, call HEART.

2 Currently one of only 12 hospitals in the U.S. with the highest quality rating (three star) from The Society of Thoracic Surgeons (STS), the Heart Center is one of the nation s more highly respected programs for diagnosis and treatment of congenital and acquired heart conditions in children. With consistently high volumes and a unique integrated care model, achieves exceptional patient outcomes year after year and is recognized among the top 25 pediatric heart programs by U.S.News & World Report. One of the highest-volume pediatric heart programs in the nation Annually, the Heart Center team: Performs more than 500 cardiac surgeries Completes over 550 cardiac catheterizations Interprets nearly 17,275 echocardiograms Conducts more than 9,700 outpatient visits Unique care model Anchored by world-class facilities, the latest technology and a team of skilled professionals, the Heart Center provides the full continuum of care from fetuses and premature babies to adults who survive with congenital heart disease or discover it later in life. Comprehensive inpatient care From fetal diagnosis to complex surgical interventions like the Ross procedure, s range of expertise makes it possible to deliver the full continuum of heart care to infants, children and adults with congenital heart defects. 3 OPERATING SUITES specially designed for CV cases 2 ADVANCED HYBRID CATHETERIZATION LABS 36 BEDS 12 CVICU 16 step down neonatal cardiac unit Mark W. Turrentine, MD Director, Cardiovascular Surgery, Heart Center John W. Brown Professor of Cardiothoracic Surgery, IU School of Medicine Skilled multidisciplinary team Experts in advanced heart care, cardiovascular physicians work alongside a dedicated team of specialists and medical professionals trained to care for children with heart disease congenital cardiac surgeons pediatric cardiologists adult congenital cardiologists pediatric cardiovascular intensivists cardiac-dedicated neonatologists pediatric cardiac anesthesiologists dedicated cardiac advanced practice providers pediatric CV nurses dedicated to the heart center

3 Exceptional patient outcomes Surgical site infections 0 SURGICAL SITE INFECTIONS in 2016 and 2017 Overall survival rate (over a four-year period) Source: Society of Thoracic Surgeons (STS) Congenital Heart Surgery Data Summary, Table 16 and public reporting January 2014 December 2017 RILEY 97.7% NATIONAL AVERAGE (Society of Thoracic Surgeons) 97.1% Operative and adjusted operative mortality Source: Society of Thoracic Surgeons (STS) Congenital Heart Surgery Data Summary, Table 16 and public reporting January 2014 December 2017; publicreporting.sts.org/chsd NEONATES/INFANTS/ CHILDREN/ADULTS # DEATHS/ ELIGIBLE RILEY OBSERVED MORTALITY RILEY EXPECTED MORTALITY RILEY STS OVERALL All STAT Mortality Categories 33/1, % 3.7% 2.9% STAT Category 1 3/40 0.7% 0.4% 0.4% STAT Category 2 6/ % 2.0% 1.6% STAT Category 3 2/20 1.0% 1.9% 2.3% STAT Category 4 16/ % 9.5% 6.4% STAT Category 5 6/ % 1.1% 14.6% Post-operative length of stay Source: STS Benchmark Operations Table 1 for STS Data Harvest January 2014 December 2017 Patients extubated in the operating room (observed rate) Source: Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database, Anesthesia Module January 2014 December 2017 Percent of patients % 24.3% STS national benchmark Norwood Truncus 25 2 Fontan 13.9 Glenn/ 9 Hemi Fontan 14.5 patients return ASO + VSD home 5 days sooner ASO 12 than the STS national 17.3 AVC 11 average across procedures with TOF accordingly better VSD 5 overall mortality..7 Off By-pass 7 Coarctation Cardiovascular intensive care unit Central line-associated blood stream infection (CLABSI) Source: Pediatric Cardiac Critical Care Consortium-CA BSI 201, Dec. 20.2/1,000 CENTRAL LINE DAYS 1.03/1,000 CENTRAL LINE DAYS Pediatric Cardiac Critical Care Consortium (PC4) Extracorporeal membrane oxygenation (ECMO) Survival to hospital discharge Source: Extracorporeal LIfe Support: The ELSO Red Book, Fifth Edition; 2017 Extracorporeal Life Support Organization, Ann Arbor, Michigan STS hospitals 64.9% 16.3% higher 4.6% 69.6% 11.6% higher 5% 0 Neonatal cardiac patients Pediatric cardiac patients All Extracorporeal Life Support Organization (ELSO) centers

4 Specialized programs Cardiovascular Genetics Program With the only comprehensive cardiovascular genetics program in Indiana, the Heart Center provides complete genetic evaluation of all family members, along with coordinated heart screenings. This multidisciplinary program for aortic disease includes both clinical care and research in the wide spectrum of aortopathies in children and young adults. Our specialists are nationally recognized for their work with the Cardiovascular Malformations Consortium. Fetal Center As partners in the Fetal Center, cardiologists evaluate the cardiac condition of the fetus using in-depth diagnostic imaging and participate in care conferences with specialists in neonatology, obstetrics and cardiothoracic surgery. Patient volume has nearly doubled in the past seven years with heart specialists conducting an average of 1,300 fetal echocardiograms annually. Heart Transplant/Mechanical Circulatory Support Program The Heart Center, part of the IU Health Transplant Program, is one of the founding hospitals of the Pediatric Heart Transplant Society, an organization of 50 U.S. hospitals and hospitals in Canada, the United Kingdom and Brazil. Since the program s inception in 199, cardiovascular surgeons have completed more than 150 pediatric heart transplants. is one of the few 100% ONE-YEAR HEART TRANSPLANT SURVIVAL ( ) pediatric heart centers capable of implanting mechanical support devices, including total artificial hearts. Pulmonary Hypertension Program As a regional referral center for pediatric pulmonary hypertension, at IU Health offers inpatient and outpatient consultation by a cardiologist, pulmonologist and dedicated nursing team. Program highlights include: Participation in multiple clinical trials to evaluate the safety and efficacy of medications Leadership in the management of complex anatomy: The Ross procedure Heart transplantation (including adult congenital) Severely hypoplastic pulmonary artery staged rehabilitation Resection of complex atrial and ventricular-based tumors Engagement in collaborative research with other centers to improve care quality, shape practice and elevate standard of care Leadership in the Pulmonary Hypertension Professionals Network and the Pulmonary Hypertension Association Single Ventricle Home Monitoring Program Launched in 2010 to help decrease interstage mortality for babies born with hypoplastic left heart syndrome, this program has evolved to include all babies with single ventricle physiology discharged after initial intervention. Parents with questions or concerns are able to contact an on-call nurse practitioner via text message or phone, and there is 24/7 coverage by a cardiology staff physician. In 2017, at IU Health implemented a novel, web-based ipad program to assist parents in tracking and enable the cardiac medical team to evaluate data in real time. Heart care in Indiana and beyond cardiologists provide outpatient care in 14 practice locations in 12 Indiana communities. Services include diagnosis, consultation, treatment and follow-up care. The Heart Center attracts patients from more than 21 states and five continents. Expert heart care, global impact Through partnerships with hospitals in the Middle East, Asia and Africa, Heart Center specialists and team members have traveled the globe, volunteering their time to treat more than 400 patients since 2006 and to train local clinical teams in advanced heart care. Partner hospitals Al Khalidi Hospital Amman, Jordan Mulago Hospital Kampala, Uganda Beijing Children s Hospital Beijing, China Hammoud Hospital -- Saida, Lebanon

5 Patient-focused research The Heart Center is affiliated with Indiana University School of Medicine, one of the nation s largest medical schools and one of the highest funded institutions for pediatric research by the National Institutes of Health (NIH). The heart center is active in interventional and observational trials newborn through adolescence and adulthood. There are 63 ongoing active research studies representing the work of four clinical sections of the Heart Center. is one of 10 NIH-funded Pediatric Heart Network centers enrolling patients in clinical trials focused not only on improving outcomes, but also improving quality of life. s basic and physician scientists conduct innovative bench research concentrating on identifying new biomarkers and advancing knowledge of the basic mechanisms underlying heart formation and function. Our strength as a referral center within Indiana and nationally is based on the comprehensive nature of our program, our consistent exceptional outcomes and a commitment to research and patient-centered care. Larry W. Markham, MD, MS Director, Pediatric Cardiology, Heart Center Phillip Murray Professor of Pediatric Cardiology, IU School of Medicine Destination for advanced training In partnership with IU School of Medicine, the Heart Center offers training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Fellowships include: Cardiology Cardiothoracic surgery Cardiac intensive care Neonatology with a cardiovascular rotation Cardiac anesthesia Pediatric intensive care Mechanical Support Simulation Lab The Heart Center develops medical simulations to teach procedures, medical concepts and decisionmaking to team members. Simulation training is offered on a variety of devices, including Pedimag, ECMO, ECPR, VAD, balloon pump and SynCardia.

6 About Children s Health The children s health system of Indiana University Health, Children s Health has 200 primary care and 400 specialty care physicians across 40 specialties delivering healthcare for children of all ages. Its flagship hospital in downtown Indianapolis Hospital for Children at Indiana University Health is the only pediatric research hospital in Indiana and is among the few children s hospitals nationally to be ranked in multiple pediatric specialties. For more about the program, visit rileychildrens.org/heartcenter. To refer a patient to the Heart Center, call HEART IUHealth 1/19 #29435