麻豆果冻传媒

Q&A with Stephen Roth, MD, MPH, Director, Children鈥檚 Heart Center at Lucile Packard Children's Hospital Stanford

How does the Children's Heart Center at Lucile Packard Children's Hospital Stanford and 麻豆果冻传媒 Children鈥檚 Health achieve such impressive outcomes with the highest acuity cases, as demonstrated by the data released in 2015 by the Pediatric Health Information System (PHIS)?*

鈥淥ne key is our willingness to take on those 鈥榣ast hope鈥� patients. Caring for these children often requires us to innovate. We learn something new every time we push the limits of what should be achievable. We get a little better and a little smarter each time we challenge ourselves. Ultimately, this creates new knowledge that changes our treatment paradigms, and it makes our team even more capable.鈥�

The Heart Center鈥檚 success has led to significant growth 鈥� can you provide details?

"The demand for our services has never been greater. Our patient volume nearly doubled in a decade, from 674 inpatient discharges in 2006 to 1,114 in 2015. In less than two years, with the $1.1 billion, 521,000 square foot expansion of Lucile Packard Children鈥檚 Hospital Stanford, the Heart Center will also expand 鈥� and its inpatient beds. It鈥檚 important that no patient needing our care is turned away from the Heart Center due to lack of space.鈥�

What鈥檚 the benefit of large patient volumes?

鈥淵ou need to perform specialized surgeries frequently 鈥� as our center does 鈥� to do them consistently well. That鈥檚 especially true for complex surgeries such as the unifocalization procedure for major aortopulmonary collateral arteries (MAPCAs) in pulmonary atresia.

鈥淲e aren鈥檛 the only ones to highlight this relationship to volumes. A recent commentary in JAMA noted that 鈥榯he highest volume centers tend to deliver the highest quality care at the lowest costs, particularly for children and young adults with the most complex heart disease.鈥�

鈥淥ur success derives from a team of more than 250 highly specialized professionals, including cardiologists, surgeons, anesthesiologists, nurses, social workers and others. We take on everything from complex medical management to the rarest of cardiac anomalies requiring innovative surgical approaches or cardiac transplantation. We鈥檝e also recently built one of the nation鈥檚 top adult congenital heart disease 辫谤辞驳谤补尘蝉.鈥�

How do your current achievements fit Stanford鈥檚 culture of innovation?

鈥淚nnovation in cardiac care is synonymous with Stanford. Norman Shumway, MD, pioneered America鈥檚 first successful human heart transplant here in 1968, and our team also performed the first pediatric heart-lung transplant in the country.

鈥淪tanford is world-renowned for its basic science research, and we have received many prestigious grants to develop fundamental discoveries. Our researchers also place a high premium on translating their findings on pediatric heart disease into new treatments and preventive techniques.

鈥淥n the clinical frontier, we鈥檝e also led the way in advanced bridge-to-transplant therapies for children. We have one of the largest and most experienced pediatric ventricular assist device (VAD) programs in the country, and we hold the record for the longest period of VAD support in North America, at 234 days. Our was, at the time of his treatment, the youngest child to ever receive this lifesaving therapy for severe heart failure. And in 2002, open-heart surgery was performed here on the .

鈥淥ur commitment to discovery never stops. It鈥檚 all part of the larger culture of discovery and innovation that exists at Stanford University and in Silicon Valley, and it ties in perfectly with our goal of continuously improving patient care and outcomes.鈥�

Who is behind Stanford鈥檚 success with new surgical techniques?

鈥淥ur surgery team is led by Frank Hanley, MD, a world-renowned surgical innovator and one of a handful of the most accomplished pediatric cardiac surgeons in the world. Many techniques he developed are now fairly routine in our Heart Center, and some are not available elsewhere. If there鈥檚 a better, safer or more efficient way to perform a pediatric cardiac surgical procedure, Dr. Hanley most likely helped improve it.

鈥淗e invented the one-stage unifocalization surgery for with pulmonary atresia and MAPCAs, in which the collateral arteries are surgically combined to create functioning pulmonary arteries. He has achieved a remarkable 98 percent success rate with this complex operation. He pioneered new techniques for staged operations for single ventricle defects done without a heart-lung bypass machine.

鈥淚n addition, Dr. Hanley performs many reoperations on patients from around the world. His ability to repair hearts that weren鈥檛 repaired properly elsewhere 鈥� and to do in one surgery what other surgeons would stage over months or years 鈥� is a real differentiator.鈥�

What are some other areas of collaborative discovery within the Heart Center?

鈥淥ur team approach enabled Chandra Ramamoorthy, MD, chief of pediatric cardiac anesthesia, to , and helped cardiologist Gail Wright, MD, develop a simple but game-changing home monitoring program for single ventricle patients 鈥� one that has decreased patient mortality following the Norwood procedure from the national average of 15 percent to only 2 percent. We are also using implantable pacemakers programmed to synchronize the pumping function of the heart鈥檚 lower chambers in kids with poor function to improve their heart鈥檚 performance.鈥�

鈥淚n addition, we have advanced techniques in cardiac catheterization to safely deliver catheter-implanted heart valves into the most vulnerable patients, including an 8-month-old infant who was the youngest ever to undergo this procedure.

鈥淎nd together with scientists at the , ongoing research is designed to understand the origins of congenital heart disease and pediatric heart failure. Plus, we鈥檙e currently taking part in 20 clinical research trials in pediatric cardiovascular medicine.鈥�

What鈥檚 next?

鈥淪ome believe that after 70 years of surgical innovation for congenital heart defects, we are nearing the peak of the pyramid of surgical procedures and techniques. We think that the next phase of major advances in our field will come from the biological sciences and include breakthroughs in areas such as tissue engineering, regenerative medicine and genomics.

"Heart problems in children and adult survivors of congenital heart disease aren鈥檛 going away anytime soon, so we need to focus on approaches other than existing surgical procedures to improve treatment of these conditions. It鈥檚 going to be an exciting new era, and we are positioning ourselves to be leaders both in quality outcomes and innovation going forward.鈥�

By the Numbers: 2015 at the Children鈥檚 Heart Center

• More than 600 heart surgeries, and another 500 surgeries at Heart Center partner programs: UCSF Benioff Children鈥檚 Hospital (Oakland, Calif.); Sutter Memorial Center (Sacramento, Calif.); and Valley Children鈥檚 Hospital (Madera, Calif.)
• 20 heart transplants
• 16 ventricular assist device implants
• 8,238 transthoracic echocardiograms
• 20 clinical trials under way
• 250 faculty and staff members, including:
  • 8 cardiothoracic surgeons
  • 36 faculty cardiologists
  • 11 cardiac anesthesiologists
  • 150 cardiac specialist nurses
  • 3 radiologists dedicated to cardiac imaging

* Data Source: Pediatric Health Information System (PHIS), 2013 and 2014. The PHIS hospitals are 47 of the largest and most advanced children's hospitals in America, and constitute the most demanding standards of pediatric service in America. The Children鈥檚 Hospital Association developed PHIS to provide a rich data source for clinicians to conduct comparative effectiveness studies that affect hospitalized children.