Why Columbia Universtiy Medical Center Pediatric Heart Valve Center?

CLINICAL SERVICES

Every patient of the Pediatric Heart Valve Center is cared for by a dedicated team of experts in pediatrics, cardiology, and cardiac surgery.  Our leadership team reviews every case weekly, and our Heart Valve Clinic provides close follow-up to ensure the best outcomes and to detect any potential complications early.

Surgical Care & Expertise:

The Pediatric Heart Valve Center is one of the largest and most preeminent pediatric cardiology and cardiac surgery centers focusing on heart valve congenital malformations in the nation. We provide patients with congenital heart defects treatment options that would have never been thought possible just a short time ago, with outcomes that are among the best in the nation. Our center has one of the lowest mortality rates nationwide, despite treating some of the most complex cases – our surgeons routinely treat patients referred from other institutions. 

Our surgeons have helped shape the future of heart valve surgery by spearheading cutting-edge research, advancing new innovative surgical techniques and providing outstanding training to young surgeons in congenital heart valve surgery. Performing over 700 open-heart procedures a year, our pediatric cardiac surgeons stand among the best in the US and in the world.

The Pediatric Heart Valve Center is one of just a few centers in the U.S. is to offer hybrid cardiac surgery for infants and children. Hybrid heart surgery combines conventional surgical methods with minimally invasive, catheter-based interventional approaches to permit much smaller incisions, avoid cardiopulmonary bypass, and promote a faster recovery. Our center evaluates all patients for less invasive treatment options, which may also allow the surgeon to treat a condition with a single operation rather than a series of procedures.

We collect data on all the procedures we perform to help us define which preoperative variables and intraoperative techniques are important for long-term successful valve surgery.

Interventional Cardiology Care & Expertise

Interventional Cardiology is a unique specialty that involves non-surgical treatment of cardiovascular disorders. The Interventional Cardiology Team within the Pediatric Heart Valve Center is one of the few teams in the US with a dedicated congenital cardiac catheterization laboratory and fully trained interventional pediatric cardiologists with vast experience in balloon valvuloplasty of the aortic, mitral and pulmonary valves.  

More than 1200 complex procedures are performed annually in patients with congenital heart disease, from premature neonates to adults. Many of the pediatric interventional procedures that have become standard of care worldwide have been developed by our interventional cardiologists.  Our interventionalists have helped pioneer the investigation of multiple new catheter-placed devices and have participated in nearly every major multicenter FDA trial for pediatric cardiac catheter-based devices over the past 15 years, including the Melody® and Edwards-Sapien trials for transcatheter heart valve implantation in the pulmonic valve position. 

More than 150 transcatheter pulmonary valves have been implanted at the Pediatric Heart Valve Center, which places us among the institutions with the largest experience in the US. Transcatheter valves have also been implanted in the tricuspid valve position in patients with dysfunctional prosthetic tricuspid valves. Our center is one of ten centers around the country selected to participate in the prospective, multi-center, pivotal study for evaluation of the Alterra Adaptive Prestent device from Edwards Lifesciences, which will allow transcatheter pulmonary valve implantation in patients with large right ventricular outflow tracts. In addition, the Pediatric Heart Valve Center works in close collaboration with dedicated pulmonary hypertension, electrophysiology and adult congenital services providing outstanding care for all aspects of congenital heart disease.

Non-Invasive Imaging Care & Expertise

Our non-invasive cardiac imaging team plays a critical role in the peri-operative assessment of congenital heart valve disease.  At Columbia University Medical Center, we have an extremely high-volume, non-invasive imaging lab that includes fetal, transthoracic, and transesophageal echocardiography, as well as cardiac MRI and CT.  Last year, we performed nearly 12,000 transthoracic echocardiograms and 1,000 transesophageal echocardiograms.  We aim to bring the latest echocardiographic advances and technology, including 3D imaging and 3D printing, to patient care. 

RESEARCH ACTIVITY

The Pediatric Heart Valve Center develops innovative and creative solutions for all children and adults with heart valve congenital malformations. Our Surgery Department has a rich history of developing new surgical treatments that set the standard in pediatric cardiac surgery, and we seek to continue this proud tradition. Our research efforts are strengthened through our academic affiliations with both Columbia University and Cornell University, as well as our position within New York City, which is currently developing as the largest and most active city in the US and in the world for Biotech companies and biotech start-ups. 

The Pediatric Heart Valve Research Lab aims to devise solutions in cardiovascular fundamental and translational research areas. It is focused on research areas related to heart valve biology, biomechanics and engineering. Our projects are at the intersection of biomedical engineering, mechanical engineering, polymer science, smart material development, mathematical sciences, clinical cardiology, cardiothoracic surgery, and developmental biology. Our ultimate goal is to help patients with heart disease by developing better diagnostic tools and more efficient therapeutic devices.

Translational Research Projects

The Pediatric Heart Valve Research Lab is currently developing several new valve prosthesis options for children with valve disease. Unlike current options, these new valves can grow and expand with their developing bodies, eliminating the need for repeat operations as they grow older.  These new valves include:

Tissue-engineered heart valve:
This invention is based on the concept of in situ regeneration and cell recolonization of a valved tube made of a bioresorbable polymer which has been designed and produced specifically for this device. The use of a fully resorbable material would lead, ultimately, to the complete reconstruction of a valved vessel by an autologous living and growing tissue. The development of a composite prosthesis. whose two components (the tube and the valve) made of polymers featuring specific mechanical properties and resorbability rates, would ensure an optimal time-controlled recolonization of the implant. The grafting with biomimetic peptidic sequences would harness endogenous repair mechanisms through the recruitment of host-associated cells. 

Growing mechanical heart valve:
Growing mechanical heart valves devices are being developed based on the latest advances in polymer science, mechanical engineering and manufacturing. The Pediatric Heart Valve Research Lab has ongoing collaborations with polymer engineers, biomedical engineers, and mechanical engineers inside and outside Columbia University.

New polymeric materials for cusp extension or replacement:
Current patch materials used for heart valve repair or reconstruction are somewhat pro-thrombotic, do little to promote heart valve regeneration or strengthen damaged tissue, and can cause maladaptive remodeling due to the mechanical and compliance mismatch. More importantly, Dacron and Gore-tex patches and grafts are incapable of growing with the child, often necessitating either a delay in surgery until the child reaches adulthood or multiple surgeries over the course of childhood. There is thus growing interest in the development of new smart materials for cusp extension or replacement.

Clinical Research Projects

The Pediatric Heart Valve database collects all the data already described in the Society of Thoracic Surgeons (STS) database but adds specific preoperative anatomical and imaging features as well as intraoperative technical details, and long term follow-up of the repaired or replaced valve and patient condition. Collecting this data helps us define the variables and techniques that are important for long-term successful valve surgery.

Current studies include:

Pediatric Valve Database
The purpose of this study is to develop and maintain a database comprised of clinical and surgical information about CUMC patients. who have had heart valve surgeries or catheter interventions. Collecting this data helps us define the variables and techniques that are important for long-term successful valve surgery.

Xplore 2
This study investigates the early feasability and safety of the Xeltis Bioabsorbable Pulmonary Valved Conduit

Congenital Multicenter Trial of Pulmonic Valve Dysfunction
This study investigates the early feasability and safety of the SAPIEN 3 Interventional THV.

AoValve Repair Review
This study compares Cor Matrix with either autologous or bovine gluteraldehyde treated pericardium for aortic valve leaflet repairs by reviewing hospital course and following up on standard of care clinical outcomes prospectively. This is a muti center retrospective study that includes prospective review of clinical follow up.

Melody Valve in Mitral and Tricuspid Position
This Multi-Center Trial looks at clinical outcomes of Melody Valves surgically implanted in mitral or tricuspid positions

St. Jude’s Pediatric Valve (HALO)
The purpose of the study is to provide evidence of safety and effectiveness to support a supplement to the St. Jude Medical Masters Series PMA (P810002) for approval of the 15mm MHV. The rationale for this study is to offer a replacement mitral valve for patients with anatomy that is too small for the currently commercially available valves ranging in size from 16mm to 37mm.

Other pending studies will look at :

       Clinical outcomes and prognostic factors of Complex mitral valve repair

       Outcomes of the Cone Reconstruction technique in Ebstein disease

       Outcomes of atrio ventricular Valve Repair in patients with single ventricle