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At Cleveland Clinic Children's
one of our main missions is providing lifelong care
for patients with congenital heart issues.
By delivering the most optimal care for patients
in their youth, we can better prepare their hearts
for a healthier and happier adulthood.
One way we can achieve this is through surgical innovations.
Today I'm speaking with two of my esteemed colleagues
who are experts and innovators in the field,
Dr. Hani Najm and Dr. Tara Karamlou.
Thanks for joining me today.
Thank you, Brad.
It's great to be here.
Let's talk about the newest surgical innovations
and where we think
the future of pediatric heart care is headed.
Dr. Karamlou, what can we do
to make innovations more portable
and easier for other centers to adapt and utilize?
There's a couple of things that we can leverage
in that regard.
The first is disseminating what we do
not only our colleagues, surgeons,
and cardiologists, and ICU physicians
but also to our patients and their families.
We do this by using media, just like this video
surgical videos, publishing using high quality graphics,
giving our patients the surgeons lens
I think is also critical component of this.
One of our colleagues, surgeons, professor Ozaki.
We have to give him credit for revolutionizing the idea
of templating aortic valve repairs,
which is probably one of the operations
with a huge Achilles heel in terms of
it really is difficult to reproduce.
He has developed a procedure that is now portable
to all surgeons, by virtue of template.
Dr. Najm, you were recently involved in a very, very
interesting case where you performed fetal heart surgery
on a 26 week old fetus to treat a very rare
and challenging issue.
Tell us more about this case
and how you prepared for the surgery.
Absolutely incredible, Brad.
And I tell you this procedure that cannot happen
in a place that does not have the talent
that Cleveland Clinic does.
Operating on a fetus to me was totally
beyond even imagination.
We're able to operate on a fetus who's 26 weeks
in the uterus to have the baby partially delivered,
a tumor resected within the heart, and then closed.
The fetus is put back into the uterus
and the uterus is closed
and the mother's discharged to come back
for a normal delivery term or a maturity of the fetus.
It's the team that brings together that trust
that we can actually deliver such an operation
on a fetus that is now is actually enjoying
the first few months of his life in a very normal life.
Being part of the team that helped
with the fetal surgery and then ultimately the delivery
and ICU care after this child was born was extraordinary.
And like you said, knowing that this baby's now home
with his mother and his father doing so well.
It's pretty incredible.
So, Hani, what are some of the new surgical techniques
you've adapted into your practice
while you've been here at Cleveland Clinic?
We've been able to innovate newer operations
for lesions that have not been, believe it or not,
tackled before by the surgical community.
Such as the anomalous origin of left coronary artery
from the right coronary artery that runs
inside the septum of the heart.
This basically used to be treated by a bypass surgery,
which is a palliative procedure
that never actually worked very well
because these lesions do not do well
with bypass surgery cause of competitive flow.
The graphs will go down.
We've been able to innovate a newer operation
for this to unroof them.
We've been able to innovate newer repair techniques
for atrioventricular valves.
We've been able to innovate a technique
for routing pulmonary veins
which are distant from the heart
into the left atrium or where they're supposed to drain.
The more important than bigger contribution that
I believe that we've been able to coin
down is the ventricular switch procedure.
Which is a concept and a change of thinking
or a paradigm shift on how we treat
some of these complex congenital hearts
in a way that we make them having two ventricle
hearts rather than a one ventricle heart.
Which has been the typical route
for those children before is routing,
cause of the complexity,
routing them into a uni-ventricular repair
will been working with with technology to evolve
with an expandable valve that will actually
have the valve grow with the child.
And this is something as an evolution is still in the lab,
but I'm hoping that we'll see light in the near future.
And the beauty of being surrounded by an innovative team
of practitioners at the Cleveland Clinic gives us
this amazing edge that we're able to explore newer ways
of treating these patients.
We push the limits in innovation,
being able to treat these patients who have not been
able to be treated somewhere else in the world.
Dr. Karamlou, what about you?
Another innovative thing that actually spans all
of these is looking at how we treat valve disease.
We know that percutaneous therapies have been
transformative for our congenital heart population
and we've actually now started a trial here to
use transcatheter aortic valve placement
in adults and adolescents with aortic valve disease.
And we're learning a lot about this technology will be one
of three centers who will be starting this IDE trial.
And I think it's wonderful to be at a place
that can push the limits and not just thinking
about innovation in one particular discipline
but how we provide innovative therapy
across the entire arc of care.
So 3D printing has changed how surgeons operate
on patients, Hani, what do you thinks next
in the future 3D printing in medicine?
I believe that our ability to see more granular anatomy
on all these more complex lesions
is gonna get better and better.
We have actively utilized 3D printing
and we do actually have a library of them
these unique hearts that are differently formed
and needing a different type of repair
and hence these complex rerouting
and reconstruction of the internal part of the heart
is the important in the 3D printing.
So Tara, can you tell us a little bit
how research drives innovation?
One of the areas that we are very excited about
is genomics and precision based medicine leveraging
all of the available patient information
so that we can really deliver
individualized care to our complex patients.
And this care can be used even to prognosticate
for mothers who are coming in for prenatal
you know, counseling, what is the best option.
And similarly throughout the lifespan,
what other innovative therapies are going to be
at the forefront of this particular patient
and which ones will help the next patient
that comes through the door.
So we're really excited about that.
Well, I want to thank you both so much
for your time today.
You know, Cleveland Clinic Children's
is at the forefront of pediatric cardiothoracic
surgical techniques and approaches.
We're also doing so in the adult congenital population.
I'm excited to see what's in store for the future
and how we'll be a part of bettering
our patient's hearts and lives.
Dr. Karamlou Dr. Najm, thank you so much
for sharing your thoughts and expertise.
It's a pleasure, Brad.
Thank you so much for, for having us.
Thank you.
So if you have any questions about our pediatric
and adult congenital cardiothoracic surgical program,
procedures or innovations
please call (216)444-5819.
Again, (216)444-5819.
Or if you have a patient you would like to refer
to Cleveland Clinic Children's please call 855 refer 123.
Again 855 R E F E R 123.
Thank you very much.
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