For some children diagnosed with a severe congenital heart defect or end-stage heart disease such as cardiomyopathy, transplantation offers a second chance at life.
One of only three pediatric heart transplant programs in Florida, and the most active program in South Florida, the Heart Transplant Program at Joe DiMaggio Children's Hospital Heart Institute provides highly-specialized cardiac transplantation and heart failure management for children with a variety of life-threatening cardiac conditions.
Recognized for its excellence and comprehensive approach to cardiac care, the pediatric heart transplant program is led by Maryanne Chrisant, MD, who has an established reputation for helping pediatric heart transplant programs grow and thrive. Her expertise, paired with the collective experience of our highly-skilled healthcare team, has resulted in a program that offers world-class cardiac care.
The transplant team is comprised of:
- Cardiac surgeons
- Pediatric subspecialties
There are several reasons why a transplant may be needed, including:
- Structural congenital heart defects that cannot be corrected with conventional surgery (e.g., hypoplastic left-heart syndrome not amenable to the Norwood palliation)
- Persistent life-threatening arrhythmias (abnormal heart rhythms) that don't respond to medication or ablation therapy
- Cardiomyopathy (a primary disease of the heart muscle) that results in end-stage heart failure
We follow our patients closely prior to transplant, and in certain cases, palliative surgeries (such as a hybrid procedure) may be indicated to act as a “bridge” to transplant. Following up with patients for months—even years—after the transplant surgery has proven to be critical. We monitor and follow approximately 24 patients who received transplants elsewhere (prior to 2010).
Ventricular Assist Device (VAD) Program
For a child awaiting a heart transplant, a ventricular assist device (VAD) can provide a veritable lifeline until the time of transplant. Joe DiMaggio Children's Hospital is the only medical center in South Florida to use the FDA-approved Berlin Heart, a mechanical pumping device that is a lifesaving option for children who must wait weeks, if not months, for a heart transplant. The revolutionary device, available on-site at Joe DiMaggio Children's Hospital, is able to sustain a child whose heart may be too weak to work on its own. Though the device is implanted surgically in the operating room, children recover from this surgery relatively quickly. Infants and children supported by the device do not need prolonged mechanical ventilation or sedation. They typically are awake, alert, mobile and active. In this way, infants and children may grow and develop with relative normalcy while awaiting transplant.
Patients may need a VAD if they have severe congestive heart failure that cannot be controlled with medicines. Such infants and children are typically failing to thrive, struggling to breath and do not have enough energy to perform even simple tasks or play. Some patients are so ill they may already be on a bedside heart-lung bypass machine (extra corporeal support or ECMO), which can provide temporary circulatory support.
A ventricular assist device (VAD) may then be surgically implanted to support the failing heart as it struggles to pump blood from the main pumping chamber (the left ventricle) to the rest of the body. At times these devices are also used to support the right ventricle as it pumps blood to the lungs.
Pediatric Heart Transplant Evaluations
Once a heart transplant is indicated, each child is evaluated on an individual, case-by-case basis. During the evaluation process and before your child is listed for a heart transplant, we review all of your child's information and meet with you and your child. We will explore other treatment options that could improve your child's health and quality of life, including medical therapies and other types of surgeries, which may prevent the need for a heart transplant.
At the time of evaluation, you and your child will spend a full day at Joe DiMaggio Children's Hospital Heart Institute in South Florida, meeting with members of our team, including a:
- Transplant cardiologist
- Advanced practice nurse
- Social worker
- Child life specialist
- Members of other medical subspecialties
It is likely that your child will need an echocardiogram and/or other imaging and diagnostic studies such as cardiac MRI and cardiac catheterization. Evaluation will include specific blood tests to assess your child's immunologic function, liver and kidney function, blood type and exposure to viruses and vaccines.
This can be a difficult time for both your child and the family. Our goal during the pre-transplant period is to help your child remain in the best possible health and to support your family through this difficult time with close medical monitoring, nutritional guidance and psychological support.
If a pediatric heart transplant is being considered, please request an evaluation at Joe DiMaggio Children's Hospital Heart Institute as early as possible by calling 954-265-3437.
Adult Heart Transplants
Adults with structural heart problems and congenital heart failure who are in need of a heart transplant soon will have to look no further than our Heart Transplant Program. The program, in conjunction with Memorial Cardiac and Vascular Institute (a leader in cardiovascular treatment in South Florida), is on track to start its adult heart transplant program by March 2014, having received a Certificate of Need for Adult Heart Transplant from the State of Florida.
Heart transplant patients and their families are best served by an experienced team of support professionals who are familiar with their special needs and concerns. Our psychosocial support team is comprised of a social worker, child life specialist and pediatric psychologist, who work collectively with our transplant team to provide ongoing psychosocial support to patients and their families.
Education and Support
A variety of subspecialists work closely with our cardiac transplant team to provide outstanding follow up and support for transplant patients and their families, including professionals from the following areas:
- Critical care
- Pulmonary medicine
- Pediatric neurology
- Pediatric infectious disease
- Occupational therapy
- Rehabilitation and outpatient physical therapy
Our multifaceted social service team provides all the care a patient's family might need. Social workers provide a wide range of supportive services and meet with the patient and family to determine what support is needed, from arranging accommodations for lodging to providing meal passes and gift cards through our partnership with Angel's Pediatric Heart house. Other services include:
- Connecting patients and their families to community services and resources
- Initiating monthly cardiac support groups
- Verifying insurance information
- Facilitating psychology services with in-house staff or referrals to outside providers
- Arranging lodging, including referrals to Conine Clubhouse, located on the Joe DiMaggio Children's Hospital campus, where families can stay free-of-charge (based on availability)
After a heart transplant, patients are required to take medications for life. These immunosuppressant (anti-rejection) drugs must be taken as directed to help prevent the immune system from rejecting the new organ. Additional prescription drugs might also be prescribed. Our pharmacy group works closely with our nurse and the heart transplant program director, to educate families and patients about the importance of adhering to their specific medication regimen. Our trained pharmacists also secure and provide access to needed medications in-house.