UPMC Cardiothoracic Transplant: Innovative, Multidisciplinary, and Patient-centric

From robotic and completely minimally invasive coronary artery bypass (CAB), to expanding the lung and heart transplant donor pool by adopting novel protocols, and paving the way for advanced treatment of Ebstein’s anomaly, UPMC cardiothoracic experts continue a legacy of research and innovation that spans four decades.

And these are just a fraction of the advances. Our team consists of cardiothoracic staff members that specialize in adult cardiac surgery and heart transplant, pediatric cardiothoracic surgery, and lung transplant and advanced pulmonary conditions. We are proud to have performed more than 3,500 heart, lung, and combined heart-lung transplants since 1981 and have gained valuable insights along the way.

Utilizing minimally invasive techniques when appropriate, taking a multidisciplinary approach to cardiothoracic transplant, and accepting high risk cases are among the aspects of our program that allow UPMC to deliver high quality cardiothoracic transplant care.

Making Minimally Invasive Care the Standard of Care

Certain complications with cardiothoracic transplant can be avoided when minimally invasive care is appropriately utilized. For people with heart failure, the development of minimally invasive ventricular assist device (VAD) technology has been a beneficial alternative to invasive, traditional VAD implantations.

When left-ventricular assist device (LVAD) technology was adopted, we recognized its potential not only as a bridge to heart transplant, but as a versatile device that can provide durable circulatory support. The technology has advanced over the past two decades to the point that LVADs can be implanted through a small upper sternotomy and anterolateral mini-thoracotomy – a less invasive approach than the traditional full sternotomy.

“I use the minimally invasive placement as my standard approach and reserve full sternotomy for special circumstances,” says David Kaczorowski, MD, surgical director, UPMC Advanced Heart Failure Program. “Not only does the minimally approach shorten time on cardiopulmonary bypass and a patient’s hospital stay, but recent studies have shown that it is associated with low perioperative mortality, reduces incidence of right ventricular dysfunction after surgery, and provides several benefits when it’s used as a bridge to transplant.”

UPMC discharged the first patient home on a VAD in 1990 and has provided more than 1,300 VADs to heart failure patients. As one of the largest mechanical circulatory support programs in the United States, our team is determined to continue advancing VAD technology – in addition to other minimally invasive and totally percutaneous modes of temporary mechanical support for patients in acutely decompensated heart failure and cardiogenic shock – to improve outcomes and quality of care.

A Team Effort – Innovative Collaborations

Successful cardiothoracic transplants involve a robust, multidisciplinary team, according to UPMC experts. The UPMC Advanced Heart Failure Center and UPMC Lung Transplant Program bring together physicians, surgeons, nurses, engineers, advanced practice providers (APPs), and imaging specialists from a wide variety of disciplines, including pulmonology, cardiology, radiology, and critical care, to name a few.

These faculty members often support novel programs within the organization. UPMC has offered extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant for two decades. Thanks to multidisciplinary collaborations, we can offer this treatment to cardiothoracic transplant patients alongside others including lung transplantation for scleroderma patients, in collaboration with the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease; and lung transplantation for drug-resistant cystic fibrosis patients, in collaboration with the Adult Cystic Fibrosis (CF) Care Program.

“Cardiothoracic transplant at UPMC is a team effort,” Dr. Kaczorowski said. “And ensuring people get the care they need with as few complications and as quick of a recovery as possible – that’s our shared goal. We keep that goal at the center of everything we do so our patients can return to daily life.”

Collaborating on High-Risk Cases

Our cardiothoracic transplant experts treat people from across the United States and the world with challenging, often life-threatening, diagnoses. High volumes, innovative techniques and technology, and a nationally recognized team allow us to accept high risk cases that other centers may turn down.

These include multiorgan cases like the recent heart-liver transplant performed by Dr. Kaczorowski and Christopher B. Hughes, MD, surgical director, UPMC Liver Transplant Program of the Thomas E. Starzl Transplantation Institute, on an 18-year-old. Just over 400 combined heart-liver transplants have been performed in the United States in the last 12 years.

As the number of patients in need of a lung transplant after severe pulmonary damage due to COVID-19 continues to grow, experts at the UPMC Lung Transplant Program including Pablo Sanchez, MD, surgical director of the program, take on these challenging cases as well. The virus caused such extensive damage to a recent 59-year-old patient’s lungs that his pleural space completely disappeared.

Our cardiothoracic transplant teams continue to expand, and with that growth comes the ability to provide more complex and advanced care. Dr. Sanchez and Chadi Hage, MD, medical director, UPMC Lung Transplant Program, lead a team of lung transplant experts who not only care for patients with complex diagnoses, but expand access to lung transplant through innovative techniques like ex vivo lung perfusion.

More Learnings to Come

UPMC experts routinely investigate devices, technology, and techniques as part of single-and-multi-center clinical trials. Within the last year, the UPMC Heart Transplant Program began using FDA-approved extracorporeal perfusion technology, which allows the team to perform donor after circulatory (DCD) death transplants.

Mary Keebler, MD, medical director, UPMC Advanced Heart Failure Program, is currently serving as UPMC’s site principal investigator on the Antiplatelet Removal and HemocompatIbility EventS with the HeartMate 3 Pump IDE Study, in which heart failure patients treated with the ARIES HM3 device and two different antithrombotic regimens are evaluated. Dr. Kaczorowski is serving as sub-investigator with Gavin Hickey, MD, medical director, Ventricular Assist Device Program.

Dr. Sanchez is actively working on research related to expanding the lung transplant donor pool, such as his participation in the Normothermic Ex Vivo Lung Perfusion (Evlp) As An Assessment of Extended/Marginal Donor Lungs interventional clinical trial. As part of the study, donor lungs initially deemed unfit for transplantation will be reexamined based on delta pO2, lung compliance, and opinion of the transplant surgeon.

Also part of the UPMC Lung Transplant Program, John McDyer, MD, director, Lung Transplant Translational Research Program at UPMC, is actively working to combat organ rejection in patients with immunodeficiency and end-stage lung disease through bone marrow transplant. As part of the study, double lung transplant recipients receive a bone marrow transplant from the same donor, which provides stem cells that help recipients’ bodies recognize their new organs.

“Our team is filled with enthusiastic researchers and scientists,” Dr. Kaczorowski said. “We study innovative devices and processes and apply findings to the work that we do every day to ultimately deliver improved care to patients. At the end of the day, from diagnosis to treatment, successful cardiothoracic transplant care is all about keeping the patient’s well-being at the heart of everything we do.”