New Approaches Transform Pediatric Cardiac Surgery

Columbia/NewYork-Presbyterian Morgan Stanley Children’s Hospital is the tri-state area’s largest congenital heart disease referral center and one of the largest pediatric heart transplant centers in the country. Emile Bacha, MD, director of cardiothoracic surgery, leads a team of surgical innovators at Columbia who are developing and refining mini-invasive procedures, hybrid approaches to congenital heart defects, and novel ways to repair or reconstruct heart valves in children.

“Recent advances in pediatric cardiac surgery have transformed the surgical approach for infants and children with congenital heart disease,” Dr. Bacha notes. Along with surgical colleague Dr. David Kalfa, Dr. Bacha is using a procedure called a right anterolateral thoracotomy instead of the traditional approach, a mid-line sternal split, to ensure greater safety, better function, and enhanced cosmetic appearance.

In addition, in an attempt to reduce the size of the incision, the Columbia team is now using video-assisted thoracoscopic surgery (VATS) in younger patients to treat defects that can be exposed easily through this mini-invasive approach. “The Columbia cardiac surgery and cardiac anesthesia teams are national experts and report the best results in the country using minimally invasive cardiac surgery,” Dr. Kalfa says.

“As a further step to decrease invasiveness we are using robotically assisted surgery in pediatric cardiac patients, and are collaborating to develop robots adaptable to the chest of children,” adds Dr. Bacha.

Other areas of expertise include hybrid procedures that combine elements from both percutaneous heart catheterization and surgery. These techniques and procedures are used extensively at Columbia/NewYork-Presbyterian Morgan Stanley Children’s Hospital for patients with:

• Hypoplastic left heart syndrome
• Tetralogy of Fallot
• Heart valve repair and reconstruction

Hybrid approaches also make sense for small infants or neonates in whom the use of a cardio-pulmonary bypass machine is contraindicated, and in children who need heart valve repair and reconstruction.

Innovation in pediatric cardiac surgery has transformed the specialty since its inception and pursuing new techniques as surgeons and researchers will improve the outcomes for children and adults with congenital heart defects.