♪
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 esteem 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.
It takes a village to successfully care
for congenital heart patient and their families.
Dr. Karamlou, let's start with you.
Can you talk about why it's so important
to provide integrated
and competence of care across a patient's lifespan?
As you can imagine,
mothers and fathers who come in with a baby
with very complex congenital heart disease who is faced
with a lifetime of multiple interventions.
It is very comforting for that family
to know that they can come to one place
and have seamless integrated care
throughout that child's lifetime.
The other piece of this is that centers of excellence
like Cleveland Clinic Children's,
they have to evolve to meet the demands
of this very challenging population
of congenital heart patients.
We know that those demands include, first and foremost,
increasing complexity, a lot of single ventricle families,
patients with very complex hearts.
And we pride ourselves in being able to give
that very contemporary care to those families.
That however demands that you're able
to provide multiple services throughout the lifetime.
Including as you know, Brad, developmental outcomes.
Two, deployment of advanced heart failure therapies.
And three, needing to address the growing population
of adults with congenital heart disease.
Yeah, Tara, I would sum it a up by saying,
our goal now as a team here at Cleveland Clinic Children's
is to basically save not just lives, but lifetimes.
When it comes to congenital heart surgery,
it's important to do a comprehensive repair.
Dr. Najm, how do you use your surgical eye
to provide the best short-term results for a patient
while also focusing on their long-term health?
When I look at the process of decision-making
the way we do it here at the Cleveland Clinic,
it is quite complex and elaborate.
And it starts off right before
we get into the operating room.
First of all, making the right diagnosis.
What is the best repair for this child going forward?
Taking into account, not only that we wanna actually
get out of the operating room or the hospital stay
in the initial intervention with a successful surgery.
We have discussions as to what it's gonna mean
in 10 years from now or 20 years from now,
the surgery we do.
This is the first phase in decision-making.
Then the second one comes into the operating room
is when we execute this procedure that we've elected to do.
Executing it,
leaving the operating room without any residual lesions.
And that is also such an important thing
because we've also learned from previous studies
as well as from our experience that leaving
the operating room with any residual lesions
means that the patient is gonna have to come back
either early or late for another operation.
And then comes in the postoperative care.
And that is in the intensive care unit.
Tara, what are your thoughts on this?
We know that care has to take into account
not only the immediate outcome, but the long-term outcome.
We have recently begun to become much more in-tune
with patient reported outcomes,
health-related quality of life for example.
How does that family unit function best over time?
I think precision medicine and integrating
in all of the different aspects of that patients
and that family situation from a socio-demographic,
racial, and ethnic, and religious standpoint is critical.
So I think that we have to strive as surgeons
for technical perfection in the operating room,
but that has to be in the context of the entire patient.
Yeah, I'll just add.
As a outcomes researcher,
specifically focusing on quality of life in children
and young adults with congenital heart disease,
clearly the number of surgeries,
number of ICU stays that our patients have
and their families have to endure clearly results
in a lower quality of life.
So doing a less risky operation upfront
that may result in survival,
but then requires two or three operations
down the road may clearly not be as good as doing
a more aggressive operation as a newborn or an infant.
That then makes it,
you don't have to do two
or three more operations down the road.
And I think the thing that I'm most proud of here
at Cleveland Clinic is that we don't demur
from the toughest operations.
We do them, we do them with great technical expertise,
and then we care for these patients in the ICU
with very, very low complication rates
and very low morbidity.
This results in the patients having the best early outcome
and the best trajectory for the best long-term outcome.
Dr. Karamlou, Dr. Najm,
thank you so much for sharing your thoughts and expertise.
It's a pleasure, Brad.
Thank you so much 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.
♪