Cardiovascular Surgery

Overview

Rady Children’s Division of Cardiovascular Surgery, part of the Heart Institute, performs surgeries exclusively for the treatment of congenital heart defects. Our outcomes are among the best in the nation, and we are unwavering in our dedication to improving the lives of children, adolescents and adults.

Complemented by leading programs in pediatric electrophysiology, interventional cardiology, prenatal/pediatric cardiac diagnostics and affiliated high-risk obstetrics, the Division provides an integrated approach to the treatment of the full spectrum of complex congenital heart problems in newborns to adults.

Our highly skilled surgeons use advanced surgical strategies and techniques – including hybrid procedures – to achieve optimal outcomes and to make the surgery as safe as possible.

Areas of expertise include:

• Surgical treatment of complex newborn heart defects, such as hypoplastic left heart syndrome
• Heart transplant surgery for children with symptoms of heart failure
• Complex reconstructive surgery in previously operated on children or adults
• Integration of catheter-based therapies with surgery to reduce risk
• Integration of advanced electrophysiologic testing, arrhythmia ablation and surgery
• Minimally invasive and cosmetic approaches to open heart surgery, when appropriate

We also have a state-of-the-art Cardiothoracic ICU (CTICU), which  brings a new level of care for cardiac and cardiovascular surgery patients requiring specialized services.

Along with providing expert surgical care, we participate in evidence-based research through Rady Children’s Heart Institute. Through this research, we seek to advance the field of pediatric cardiovascular surgery.

Why Choose Rady Children’s?

• First in San Diego to have a 3-D Heart Modeling Program.
• Successfully performed Rady Children’s first heart transplant on Jan. 14, 2015. Read more.
• Participates in multiple clinical and basic research projects designed to evaluate and treat complex forms of congenital heart disease.
• Named a California Children’s Services (CCS)-designated Center of Excellence, based on meeting strict quality outcomes criteria.

Heart Transplant Center

Rady Children’s Heart Transplant Center is ranked among the nation’s best health transplant programs. Our healthcare professionals have developed a program that can provide heart transplants for every patient with congenital heart disease, from infancy through adulthood. At our heart transplant program your child will receive expert care from a highly skilled and experienced heart transplant team.

The center’s excellent outcomes for heart transplant recipients from healthcare professionals have made us a leading referral center for the entire Southern California region, as well as parts of Arizona, Hawaii and the South Pacific.

Because of our heart transplant team of medical professionals and services, we are also a California Children’s Services (CCS)-designated Center of Excellence, based on meeting strict quality outcomes criteria. CCS is a state program for children with certain diseases or health problems for children up to 21 years old.

Expert care and heart transplantation from our health professionals may be an option for your child if he or she has symptoms of heart failure from cardiomyopathy, congenital heart disease or life-threatening abnormal heart rhythms. Medical professionals from our Pediatric Heart Failure and Transplant Program will carefully and thoroughly evaluate your child to see if he or she is a suitable candidate for a transplant. If your child is deemed a suitable heart transplant candidate, the process can begin by preparing your child for the procedure. Learn about heart transplant surgery.

Heart Failure and Transplant Program

The Pediatric Heart Failure and Transplant Program treats children who have primary cardiomyopathies or have developed heart failure as a result of a congenital heart defect.

Our diverse team of specialists includes pediatric cardiologists, heart surgeons, nurses, geneticists, psychiatrists, neurologists, pharmacists, social workers and child life specialists, all with expertise in pediatric medicine. Together, we offer families a multidisciplinary approach to care at one of the most advanced programs for pediatric heart disease in the world.

Our team partners with the child’s entire family. We encourage open communication, welcome all questions about any aspect of their child’s care and are always available to explain the treatment plan and to re-evaluate a child as necessary. We also encourage each family to maintain a relationship with their referring physician, who is an integral part of their child’s care.

Some patients may see us only for an evaluation, while others may return for further therapy, including surgery or heart transplantation. In all cases, we will work with families and their physicians to provide the highest quality care.

What to Expect

When a family is referred to the Pediatric Heart Failure and Transplant Program, we arrange for an initial evaluation that usually lasts about three hours. Prior to the visit, the clinic coordinator gathers important information from the referring physician and the child’s parents to help determine which tests will be recommended.

While a family may be given preliminary information and perhaps treatment guidelines at the end of this visit, the full diagnostic evaluation is not complete until all the test results have been reviewed and the entire medical team has met to determine treatment recommendations. After this review, the pediatric heart failure cardiologist will discuss results of the evaluation and treatment plan with both the family and the referring physician.

Additionally, since we are involved in research, the child will be offered the chance to participate in any clinical trials that are appropriate. The clinical coordinator and cardiologist will discuss these options with the family. Participation in research is purely voluntary and deciding not to participate in a study does not affect the care a child receives from our team.

All of this is part of our comprehensive program – and world-class care.

Before the Transplant

In order for the transplant to occur, a donor heart must be provided. Your child will be placed on a national transplant list through the United Network of Organ Sharing (UNOS), which matches donor organs with adults and children awaiting transplantation in the United States. How soon your child receives a heart is based on a number of factors, including medical urgency, your child’s blood type, the size of your child’s heart and time on the wait list.

While your child is waiting for a heart, our team closely monitors your child’s health and works with your family to provide the support you need. To prevent clots from forming in the heart, your child may be put on blood thinner medications. Your child may take medications to prevent dangerous heart rhythms from occurring as well, which are more frequent in failing hearts. We may also find ways to boost your child’s nutrition, as your child may have trouble taking in enough calories.

The Procedure

Once a suitable donor heart can be provided, a team (which includes a pediatric heart surgeon from Rady Children’s Hospital) travels to the donor hospital to retrieve the heart. The heart will be carefully transported back to Rady Children’s for the transplant surgery.

When the transplant begins, the surgeon will place your child on a heart-lung machine that takes over the work of your child’s heart. The failing, old heart is then removed, and the new donor heart is sutured into place. For children who have not had prior open heart surgery, the heart transplant surgery typically lasts six to eight hours.

Recovery

Recovering from the transplant typically requires a hospital stay of 10 to 14 days. If complications occur, they may include kidney dysfunction, infection, bleeding, and/or rejection.

To prevent rejection of the new heart, medications will be monitored and adjusted to suppress your child’s immune system without putting your child at undue risk for infection and other side effects. We will also monitor your child with regular echocardiographic studies and heart biopsies.

Although heart transplant patients must remain on various medications for the rest of their lives, most are able lead normal, active lives. Most children are able to eventually able to return to school full-time and often participate in activities they were unable to do before transplantation. We will work with you and your child to determine which activities your child can pursue.

Inpatient Care: Cardiothoracic ICU (CTICU)

The 30-bed Cardiothoracic ICU (CTICU) of Rady Children’s Heart Institute provides cardiac inpatient care for people of all ages (from newborns to adults) with congenital or acquired heart disease. It is a unique space within the Hospital solely devoted to all levels of inpatient cardiac care, from admission to discharge, with a focus on family-centered care.

In order to meet the needs of all patients, the unit consists of two components: a CTICU and a cardiac step-down unit (CSU). Staffed by critical care cardiac physicians, advanced practitioners and nurses, 24 hours a day, the CTICU cares for cardiology and cardiovascular surgery patients when they are most critically ill. Many patients are admitted to the unit within hours of being born. The CTICU also cares for patients with heart failure, heart transplants and those requiring assist devices. As patients recover from their critical illness, they progress to the CSU, where their care is continued under the supervision of cardiologists and cardiology advanced practitioners until they are ready to be discharged home.

Newborn infants with heart disease may also be cared for under the close supervision of neonatologists, who are experts in the care of infants, in collaboration with the cardiac team. All 30 beds in the CTICU are capable of functioning as a CTICU-level bed or CSU bed, assuring an appropriate level of care based on the needs of the patient. To ensure continuity of care, the teams that care for patients prior to their procedures continue to care for them in the unit afterwards. And since these teams care for all cardiac patients admitted to the unit, patients who return to the Hospital for subsequent procedures will recognize the doctors and nurses.

A full range of cardiac services and critical care services are provided, including:

• Intensive patient monitoring
• Lab testing
• Radiology exams and cardiac imaging
• Ventilation, invasive and non-invasive
• Renal replacement therapies, including peritoneal and hemodialysis
• Advanced life support therapies, including ECMO (extracorporeal membrane oxygenation), an advanced technology that circulates blood so that oxygen can be supplied to the body when the heart or lungs are not working

Patients also receive dietary services, social services and child life services.

The state-of-the-art unit was created to care for the growing number of cardiac patients requiring specialized services and advanced technology. Our renowned Cardiovascular Surgery team performs about 400-500 operations each year.

For information on all of our Critical Care services, click here.