Stories about: cardiac surgery

Using newborns’ own umbilical cords as shunts for heart surgery


Cardiac surgery is reducing the use of plastic — starting with an operation for newborns who have life-threatening heart disease generally called single ventricle.

Single ventricle is so dangerous because it means only one of the heart’s two ventricles can adequately pump blood. Typically, affected infants undergo open-heart surgery to receive a Blalock shunt, which is a skinny tube made of PTFE — a synthetic polymer — that re-routes their blood flow to the lungs so enough oxygenated blood can get to their bodies. But when blood is exposed to foreign material, such as a plastic shunt, clots can form very easily.

This fall,a clinical trial at Boston Children’s Hospital will use patients’ own umbilical veins to create the shunt instead of plastic tubing.

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An energy boost to the heart: Infant’s own mitochondria save her life

20160606_AveryHeart-12_with MomShe’s small for a 6-month-old, but otherwise Avery Gagnon looks perfectly healthy. She smiles, kicks, laughs and grabs her toys and pacifiers. What you’d never know is that Avery has complex congenital heart disease and might not be alive today if it weren’t for an innovative procedure that used mitochondria from her own cells to boost her heart’s energy.

The procedure is the brainchild of James McCully, PhD, a cardiovascular research scientist at the Heart Center at Boston Children’s Hospital, who spent most of his career working to solve a common complication of heart surgery: damage to heart muscle cells.

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Making ‘simple’ heart surgery simpler, with minimally invasive techniques

minimally invasive heart surgeryTertiary care centers such as the Boston Children’s Hospital Heart Center have led the way in groundbreaking surgical innovations for years, pushing boundaries and correcting ever more complex abnormalities.

But innovation is also making a difference when it comes to more “common” procedures.

“We’re always trying to make the less complex procedures shorter and less invasive,” says Sitaram Emani, MD, director of the Complex Biventricular Repair Program at the Heart Center. “Making surgery and recovery less painful and disruptive for all of our patients is a priority.”

Emani and his fellow cardiac surgeons have pioneered a minimally-invasive “scope” approach, repairing a host of common problems normally requiring open-heart surgery — including ventricular septal defects, atrial septal defects, tetralogy of fallot, aortic valve defects, vascular rings and patent ductus arteriosis (PDA) — through small incisions.

The new method not only decreases pain discomfort, and scarring, but also gets patients in and out of the hospital in half the time.

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3-D printed hearts of hope

Jason Ayres Patrick and Emani cropped
Jason Ayres with son Patrick, Dr. Emani, and Patrick’s 3-D printed heart

Jason Ayres, a family doctor in Alabama, was speechless as he held his adopted son Patrick’s heart in his hands. Well, a replica of his son’s heart — an exact replica, 3-D printed before the 3-year-old boy had lifesaving open-heart surgery.

Patrick was one of the first beneficiaries of 3-D printing technology at Boston Children’s Hospital, which last year helped open a new frontier in pediatric cardiac surgery. Patrick was born with numerous cardiac problems; in addition to double outlet right ventricle and a complete atrioventricular canal defect, his heart lay backwards in his chest.

“We knew early on that he’d need complex surgery to survive,” says Jason.

Finely detailed models of Patrick’s heart created by the Simulator Program at Boston Children’s gave surgeon Sitaram Emani, MD, at the Boston Children’s Heart Center an up-close-and-personal look at his complex cardiac anatomy.

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Cardiac RESTORE: Decreasing medication dependency in the cardiac intensive care unit

child getting medicineChildren undergoing heart surgery need strong sedation and pain medications. Weaning them off these medications is complicated; many have withdrawal symptoms that require additional medications. Unfortunately, says Patricia Lincoln, RN, MS, CCRN, CNS-BC, “the medications we use to manage withdrawal may keep patients in the hospital longer.”

Last spring, Lincoln and her nursing colleagues in the Boston Children’s Hospital Cardiac Intensive Care Unit (CICU) launched an initiative called Cardiac RESTORE to help wean patients from pain and sedation medications according to a carefully designed algorithm.

“Cardiac RESTORE helps us continually assess what patients need and regulate their physiologic response to changes,” says Lincoln. “Medication doses are constantly being titrated or weaned unless the patient has an acute deterioration.”

Early results show decreased usage of pain and sedation medications with no ill effects.

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Minimally invasive tool uses light for beating-heart repairs

Last year, cardiologists at Boston Children’s Hospital reported developing a groundbreaking adhesive patch for sealing holes in the heart. The patch guides the heart’s own tissue to grow over it, forming an organic bridge. Once the hole is sealed, the biodegradable patch dissolves, leaving no foreign material in the body.

As revolutionary as this device was, it still had one major drawback: implanting the patch required highly invasive open-heart surgery. But that may be about to change.

Researchers from the Wyss Institute, Brigham and Women’s Hospital, Harvard’s John A. Paulson School of Engineering and Applied Sciences (SEAS) and Boston Children’s have jointly designed a radically different way to implant the patch without having to stop the heart, place patients on bypass or cut open their chests.

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3-D printed models may soon guide one-of-a-kind pediatric heart operations

Photo credit: Bryce Vickmark, MIT News
Photo credit: Bryce Vickmark, MIT News

No two hearts are alike. It sounds like poetry, but this adage takes on a special meaning for pediatric cardiac surgeons.

Children born with congenital heart disease have unique cardiac anatomies. To correct them, surgeons need a nuanced understanding of each structure and chamber of the heart, and for decades have relied on (increasingly sophisticated) imaging technology.

Soon, though, they will be able to touch, turn and view replicas of their patients’ hearts up close. Researchers at Boston Children’s Hospital and MIT have jointly designed a computer program that can convert MRI scans of a patient’s heart into 3-D physical models.

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New and improved device shows promise for pediatric heart surgery

In the Norwood procedure for HLHS, a graft creates a conduit between the right ventricle and the aorta, diverting blood flow from the underdeveloped left ventricle. But that graft can wear out. (BLUE represents oxygen-poor blood; RED, oxygen-rich blood; PURPLE, a mixture of the two.)

Hypoplastic left heart syndrome (HLHS) is a rare but serious form of congenital heart disease that leaves the left pumping chamber (ventricle) of the heart severely underdeveloped. Children born with HLHS can’t pump enough oxygenated blood from their heart to the rest of their body and need surgery as soon as possible to survive. Treatment ultimately involves three corrective surgeries throughout the infant and toddler years.

The first surgery, known as the Norwood procedure, is the riskiest of the three. Ideally performed within the first week of life, the procedure re-routes the heart’s plumbing to ensure enough oxygenated blood is circulated while the child grows big enough for the second surgery. A device called a graft is used to connect the fully-functional right ventricle to the aorta, bypassing the stunted left ventricle, for proper blood flow. However, with each ventricular contraction, the graft gets squeezed, which can cause it to shift or lose its shape over time. Repeat interventions to adjust the graft are often needed.

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Pathways to market for medical devices


You’ve got a great idea for a new medical device. After you’ve created the device and proved its usefulness in a clinical setting—a challenge in itself—the next step is getting your device to a commercial partner who can mass-produce and market it. Working through all of the regulatory hurdles, projecting the market for your product and figuring out your product’s long term potential can seem overwhelming.

“The more you know, the more prepared you will be,” says Pedro del Nido, MD, chair of the Department of Cardiac Surgery at Boston Children’s Hospital and principal investigator on the FDA-funded Boston Pediatric Device Consortium. “The more prepared you are, the more likely you will be successful.”

On January 6, 2015, from 5:30 to 7:30 p.m., del Nido will lead a panel discussion at Boston Children’s about moving medical devices from idea to commercial partnership,

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A portal for beating-heart surgery

Portal for beating heart surgery-analagous to mine entrance

When a patient needs a cardiac intervention, surgeons can choose to access the heart in one of two ways: open-heart surgery or a cardiac catheterization.

Open-heart surgery offers clear and direct access to the heart, but it also requires stopping the heart, draining the blood, and putting the patient on an external heart and lung machine. Catheterization—insertion of a thin, flexible tube through the patient’s groin and up into the still-beating heart—is less invasive. But it’s not suitable for very complicated situations, because it is hard to manipulate the heart tissue with catheter-based tools from such a far distance.

Both methods have been highly optimized, but each has its own risks, benefits and drawbacks. Wouldn’t it be nice if there were a way to directly access the heart and maintain normal heart function and blood flow while repairs are performed?

Nikolay Vasilyev, MD, thought so. A scientist in the cardiac surgery research lab at Boston Children’s Hospital, led by Pedro del Nido, MD, Vasilyev has designed a platform technology that may revolutionize the way we conduct cardiac interventions.

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