Tag Archive for: heart transplant

3D model for heart valve replacement planning

Living tissue heart valve replaces mechanical mitral valve through partial heart transplant

3D model for heart valve replacement planning

3D model for heart valve replacement planning.

An 11-year-old boy is the first in the world to have an artificial heart valve replaced with a live tissue valve from a donated heart through a partial heart transplant. The procedure took place at Children’s National Hospital in Washington, D.C. The successful surgery, performed by the cardiac surgery team, is also the region’s first partial heart transplant.

“I am honored this family trusted our hospital and our team’s expertise to perform this life-changing first-of-its-kind procedure for Preston,” says Cardiac Surgery Chief Yves d’Udekem, MD, PhD. “I look forward to hearing about all the new activities and adventures he and his family can do once he is completely recovered from surgery.”

Heart valve recipient Preston

“Everyone is ecstatic with his progress so far,” says Lauren Porter, who is the patient’s mother. “We hope having this surgery will give him a lot more freedom to do the things he loves in his life, and we hope that by sharing our story we are helping to make procedures like this more available to kids who need them in the future.”

Artificial heart valves are the standard of care for a failing valve in a child born with congenital heart disease. But Dr. d’Udekem says they are exceptionally difficult in children. First, a traditional artificial tissue valve lasts only about a decade, so children like Preston who have their first valve inserted before age 2 will inevitably face at least two to three additional open-heart surgeries before age 40. Additionally, just like adults, an artificial mechanical heart valve requires the patient to take blood thinners and major precautions against injury for their entire lives. Research has also shown that the placement of an artificial heart valve causes the heart to change shape over time, impacting heart function later in life and leading to a shortened life span.

Replacing this valve with a living transplanted valve will give Preston freedom from a lifetime of blood-thinning medication. Research also shows these live tissue implants should grow along with him, greatly decreasing the likelihood of future open-heart surgeries.

“Everyone is ecstatic with his progress so far,” says Lauren Porter, who is the patient’s mother. “We hope having this surgery will give him a lot more freedom to do the things he loves in his life, and we hope that by sharing our story we are helping to make procedures like this more available to kids who need them in the future.”

Children’s National is the first hospital to remove a child’s previously implanted artificial valve and replace it with a live working valve from a donated heart through a relatively new procedure called a partial heart transplant. The Children’s National partial heart transplant replaced the heart’s mitral valve, which is the valve between the left upper chamber (left atrium) and the left lower chamber (left ventricle) of the heart. In general, partial heart transplants are rare. Prior to this surgery, four U.S. hospitals have used partial heart transplants to replace a failing, living heart valve with a valve from a donor heart, but no organization to date has ever replaced a prosthetic valve with a real one.

“Making this procedure an option for certain children who need a heart valve replacement is critical to having patients live their best lives and to providing hope to their family as they grow into adolescence and adulthood,” says Wayne J. Franklin, MD, senior vice president of the Children’s National Heart Center and a congenital cardiology specialist. “I am proud of our team that conducts such important research to innovate better clinical solutions for all of our patients with congenital heart disease.”

Live tissue partial heart transplants also offer an additional benefit. Donated hearts that do not qualify for use in a total heart transplant may have healthy components, like valves, that can be used for patients who don’t require total replacement. Candidates and potential donors are listed in a registry and matched according to biological factors including blood type, similar to the process for determining full heart transplant candidates.

Michael Tsifansky

Lung transplant expert Michael Tsifansky, M.D., F.A.A.P., joins Children’s

Michael Tsifansky

Earlier this year Michael Tsifansky, M.D., F.A.A.P., joined Children’s National Hospital as an attending physician in the Cardiac Intensive Care Unit and in the Division of Pulmonology and Sleep Medicine. He brings to Children’s National a unique mix of expertise in critical care and pulmonary medicine. That passion for these two subspecialties has also made him one of the country’s leading experts in lung transplant procedures and the recovery from them.

Dr. Tsifansky shared more information about caring for patients with complex lung diseases, especially those with end-stage lung disease. He outlines the patient population for pediatric lung transplants and the arduous process patients endure while waiting for a transplant, undergoing this major procedure, and then recovering from it.

What types of patients undergo lung transplant surgeries?

Lung transplantation in children is indicated when the following criteria are met:

  • End-stage lung disease
  • No reasonable alternative to the established diagnosis
  • No medical or surgical alternative to the current course of treatment
  • No other organ failure
  • Stable social environment

Could you describe the surgery process?

Pediatric lung transplantation may be performed on cardiopulmonary bypass, on extracorporeal membrane oxygenation (ECMO) or off extracorporeal cardiopulmonary support (ECS). The donor’s lungs are kept chilled prior to transplantation and should be transplanted within six to eight hours after removal from the donor. The donor’s main-stem bronchi and pulmonary arteries are connected to those of the recipient, and the donor’s pulmonary venous drainage is connected to the recipient’s left atrium using the donor’s left atrial roof tissue. This procedure typically takes six to eight hours.

Could you describe the recovery process?

Typically, pediatric lung transplant recipients are extubated and encouraged to sit up four to six hours after the transplant procedure and walk soon afterward. It is important that they be out of bed and moving as soon as possible, and our colleague from Rehabilitation Services (physical and occupational therapists and rehabilitation physicians) will be working with the children toward these goals. After transplantation, pediatric patients will be given discharge instructions with individualized guidelines for a healthy lifestyle. Patients should return to near-normal life approximately three to six months after transplantation.

How long does the recovery process take?

The patient will remain hospitalized for 11-14 days following surgery for acute rehab, titration of antirejection meds and initial healing.

You’ve mentioned that it’s important for transplant patients to get moving as part of recovery. When can a patient begin walking again?

Lung recipients will be assisted into a chair soon after the transplant. Within the first 24-36 hours, the patient is encouraged to take short walks, increasing the distance each day. A physical therapist will work with the patient during their hospitalization to meet their goals. We also encourage patients to exercise on the treadmill regularly while hospitalized. By the time the patient is ready to go home, he or she will be able to easily move around by themselves and do most of their care without assistance. They feel so much better than before transplant and have so much energy that we almost always have to gently limit their activity for a short while to allow their chest incision to heal properly.

What do you see as the next step in pulmonary care for end stage lung disease at Children’s National Hospital?

The development of a pediatric-specific lung transplant and respiratory failure program is the natural extension of the hospital’s cystic fibrosis program, heart transplant program and programs in pulmonary hypertension, bronchopulmonary dysplasia and extracorporeal membrane oxygenation for respiratory failure.

At present, there is no local option for a pediatric-specific program that can perform the transplant and provide the necessary comprehensive wrap-around services for patients in infancy up to age 18. As a top children’s hospital, Children’s National is uniquely positioned to provide the highest level of pediatric-specific care to this patient population and allow patients and their families to spend more time at home while undergoing this and other lifesaving treatments.

Dr. Tsifansky hopes to launch a comprehensive pediatric lung transplant and respiratory failure program at Children’s National in the very near future. Stay tuned for future developments from this area.

Shriprasad Deshpande

Accelerating advanced cardiac treatments for tiny patients

Shriprasad Deshpande

Shriprasad Deshpande, M.B.B.S., M.S., a pediatric cardiologist, joins Children’s National Health System as the director of the advanced cardiac therapies and heart transplant program.

Shriprasad Deshpande, M.B.B.S., M.S., a pediatric cardiologist, has joined Children’s National Health System as the director of the advanced cardiac therapies and heart transplant program.

Dr. Deshpande, an intensivist and heart failure and transplant cardiologist, will work within the Children’s National Heart Institute (the Division of Cardiology and the Division of Cardiac Intensive Care) to guide the diagnosis and treatment of pediatric heart failure. He will also work with researchers, surgeons and engineers to accelerate the field of biomedical research and make it easy for patients to receive advanced therapies, such as mechanical pumps to support circulation, and, if necessary, heart transplant.

“Subspecializing in personalized care is critical for all patients right now, not just adults,” says Dr. Deshpande. “This is one of the reasons I’m looking forward to working with Children’s National, a leader in the many subdivisions of pediatric medicine and research.

“Our priority is to recognize the special needs of infants and children as they relate to heart failure,” he adds. “We want to provide the best care and advance science at the same time.”

As an example, a grant from the National Institutes of Health enabled Dr. Deshpande to test ventricular assist devices for infants. Through another NIH grant, he analyzed the safety of organ transplants by testing a donor’s DNA, instead of conducting invasive biopsies in children.

“The field of cardiology is in a unique position now to take advantage of discoveries happening in science, technology and engineering,” says Dr. Deshpande. “In addition to thinking about the logistics of heart transplants, we’re thinking about how we can delay the need for a heart transplant, understand how to grow tissue better and utilize technology to improve these outcomes. We’re investing in a child’s quality of life.”

As the medical director of Mechanical Circulatory Support Program at Children’s Healthcare of Atlanta, Dr. Deshpande led the mechanical circulatory support program and created a subspecialty clinic to provide treatment for pediatric heart failure patients. He started the Muscular Dystrophy Cardiomyopathy clinic, which analyzes and treats cardiovascular comorbidities associated with muscular dystrophy. While he was an assistant professor of pediatrics at Emory University School of Medicine, he created a curriculum for pediatric cardiologists and for nurses training in the cardiac intensive critical care unit.

Dr. Deshpande has published more than 70 studies and abstracts and will oversee clinical practice models, subspecialty clinics and academic research efforts at Children’s. His current research portfolio, inclusive of grants from the NIH and other funding agencies, is robust and varied: He’s studying how to improve mechanical support for complex heart disease patients, how to improve the performance of current pumps and how to develop new algorithms for these devices. Improving the diagnosis of transplant rejection, using technology to improve compliance and using new technologies to diagnose rejection, without invasive biopsies, are his other research interests.

Dr. Deshpande serves as the chair of the scientific committee at the nonprofit Enduring Hearts and is on the American Heart Association’s Strategically Focused Research Network committee.