Heart of The Matter
For a child on the heart transplant list, the wait can be from several weeks, to several months. The Pediatric Advanced Heart Failure and Transplant team at Children's of Alabama is dedicated to keeping the blood pumping and keeping children healthy until a donor arrives. Once a new heart is transplanted, our team boasts a 97 percent survival rate – well over the national rate of 90.2 percent. The experience, cohesiveness and stability of the transplant team are credited with giving children not only a new heart, but a new life.
Featured Speaker:
F. Bennett Pearce, MD
F. Bennett Pearce, M.D. joined the faculty in 1993 as a pediatric cardiologist at Children’s of Alabama and the University of Alabama at Birmingham (UAB). Pearce is also a professor and medical director of heart transplantation and heart failure at the Pediatric and Congenital Heart Center of Alabama. His clinical roles include heart transplantation and heart failure, cardiac biopsies, general cardiology, echocardiography (TTE, TEE, fetal), fetal cardiology and inpatient cardiology. Pearce completed his pediatric residency at Ochsner Medical Center in New Orleans, where he served as chief resident, and completed fellowships at Duke University and Boston Children’s Hospital. His research interests include heart transplantation and pulmonary hypertension. Transcription:
Heart of The Matter
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski and today we are talking with Dr. Bennett Pearce who is a Pediatric Cardiologist at Children’s of Alabama and UAB, the University of Alabama at Birmingham. He is a Professor and Medical Director of Heart Transplantation and Heart Failure at the Pediatric and Congenital Heart Center of Alabama. Welcome Dr. Pearce.
F. Bennett Pearce, MD (Guest): Thank you.
Host: February is Heart Month here at Children’s of Alabama and across the country. And we celebrate in a big way. So, we are talking to you about pediatric heart transplant today and 1981, the first pediatric heart transplant was performed. Do you remember where you were Dr. Pearce?
Dr. Pearce: Yes, I remember I was in medical school.
Host: And then the first adult transplant of course happened several years earlier.
Dr. Pearce: In the 1960s, Christiaan Barnard.
Host: Okay.
Dr. Pearce: And I was in grammar school.
Host: And you read his book, right?
Dr. Pearce: I read his book. He had a book called “One Life,” it was an autobiography and it was one of the choices we got for book reading in grammar school and it was late grammar school and I read that book.
Host: Do you think that’s what sparked your interest in being a pediatric cardiologist or being a cardiologist in general, or just knowing more about the heart?
Dr. Pearce: I think just knowing more about the heart and interest in transplant and of course, after the 1960s, we didn’t really have the medication to prevent the rejection, so, although Dr. Barnard and people like him tackled the technical challenges of the transplant; preventing rejection in a safe way afterwards didn’t happen until the 1980s.
Host: So, the pediatric heart transplant team here at Children’s of Alabama does a wonderful job. One of the things that you all work with is technology. Tell us about some of the technology that allows the heart transplants to happen or a bridge to transplant to happen as some of these pieces of hardware do.
Dr. Pearce: Well as you may know, the waiting period for a heart transplant for children is the highest mortality of any organ of any age. So, a big challenge to us is and has been and will be, how to get the kids safely to a point where they can receive a transplant and they can wait successfully for a donor to arrive. And our armamentarium has improved over the years with the advent of these mechanical devices. Circulatory support devices, LVADs, left ventricular assist devices and we have now several to choose from. Perhaps the best known one is Berlin Heart for Children. And we have had great success with that device since 2005, here in our program.
Host: So, describe what the Berlin Heart looks like and what it does for those kids who are waiting for a transplant.
Dr. Pearce: Well, it’s a pump that actually sits outside of the patient’s body. It takes blood from the left atrium and returns it to the aorta, and you can actually see the pumping action. It has mechanical valves in it. It usually rests on the outside of the child. Usually on the abdomen and we watch closely for formation of clots. We manage the anticoagulation. And in the right patient, it does wonders.
Host: How long would a child be on a device like that? It just depends?
Dr. Pearce: Months to up to a year. Sometimes even longer.
Host: Okay. So, while they are waiting for that heart transplant; this device helps them to get the blood through their body?
Dr. Pearce: Right, it sort of takes the place of part of their heart. It allows their other organs to work because those other organs are receiving fresh amount of blood all the time. So, it allows us to rehabilitate the children in some cases, allows us to get them off the respirator, feed them, and make them a good candidate to ultimately receive a heart.
Host: And so, we talked about Berlin Heart, what about HeartWare?
Dr. Pearce: It’s a mechanical heart device, left ventricular assist device, usually. That one works a little differently. It’s completely implantable except for one little wire that goes to a power suppling control unit that exits the patient. The wire that exits the patient is no larger than some of our central venous lines. So, that’s a well-tolerated device in the right patient. The nice thing about that one is you can actually send the patient home for a period of time. And so, we’ve had great success with that device since 2011, in our program.
Host: I’m sure that parents appreciate that being able to have their children home with them.
Dr. Pearce: Yes, they do. Home with that device is a special challenge. They need to be trained. Our transplant coordinators and VAD coordinators will go out not only and train the family, they’ll train the local EMS personnel, they’ll train the local emergency room personnel. And we’ve had those devices in patients at home in all corners of our state, north, south, east, and west.
Host: What do you think about some of the research that’s coming out of UAB and Children’s regarding heart transplant? Tell us about some of that. Share some of that with us.
Dr. Pearce: Well, we’re lucky here to have the largest pediatric heart transplant registry here at UAB. It was started under Dr. Kirklin and that’s called the Pediatric Heart Transplant Study. And that’s the source of most of the information that we use everyday in making clinical decisions and talking to parents. So, there is always ongoing research with the Pediatric Heart Transplant Study since about the mid-1990s.
Host: And that’s a collaborative effort, right?
Dr. Pearce: Multiple institutions in the US and Canada and worldwide now. But it’s housed here at UAB and so we’ve been participating in that since its beginning. Other research that we’re doing is research on agents to try to improve our immune suppression for children. These agents that we use to prevent rejection are strong medicines and they can cause problems and almost always do cause problems after a lifetime of exposure. So, we’re trying to cut back on those. We’re trying to look for less toxic substitutes.
Host: Okay so, in other words, after a child does receive a heart transplant, they are receiving these medications, multiple medications –
Dr. Pearce: Lifelong.
Host: To help them so that their heart is never rejected by their body, right?
Dr. Pearce: Correct.
Host: Okay. Tell me about the uniqueness about this program, about the Pediatric Advanced Heart Failure and Transplant Team here.
Dr. Pearce: Well, this program actually began in conjunction with the adult transplant program with Dr. Kirklin. And I believe it was even before 1990 that they did the first pediatric heart transplant. But it got going in earnest in the early 1990s and I moved here in about 1993 and received the opportunity to work with Dr. Kirklin in the heart transplant program. We worked together for many years before we moved the program here to Children’s when the new facility was built in 2012. At that time, we were under the umbrella of the adult transplant program.
So, even though for administrative purposes, we are a new program here at Children’s; it’s been the same people working together. The coordinators, myself, Dr. Wally Carlo, Dr. Kirklin is actually retired. Dr. Wally Carlo Junior works with me. We’ve hired a new physician Dr. Leslie Collins. She’s going to be working with us. But she’s been here for a number of years already. And we have an excellent surgical team, Dr. Bob Dabal is our surgical director of heart transplant. He came to us in 2008 and so he overlapped considerably with Dr. Kirklin and worked with him and so he brings a lot of experience to our program.
And we also have Dr. David Mauchley who joined us in the last couple of years and who has a great deal of experience and interest in children with mechanical circulatory support devices and heart transplant. So, I feel like we have a very experienced surgical team and our coordinators are all people that worked in the transplant area at UAB. So, they’re not new to the process.
Although for administrative purposes, this is a relatively new program after 2012; it’s clinically a very mature program with very, very low personnel turnover which is key for the families that form relationships with the people that they work with, which ensures expertise, people who do it everyday and have done it for a long time. A lot of experience brings a lot of advantages to our families.
Host: How many heart transplants have you guys performed to date?
Dr. Pearce: Well we’ve done 176 since 1981. And 59 heart transplants in children since 2012.
Host: And how long do you follow these kids? I know that there’s definitely a transition period where they need to be followed as adults or…
Dr. Pearce: Correct. We follow them through their teenage years. We start them in a transition program at about age 14. We are teaching them independence, we are teaching them about their medications, we’re teaching them how to give their medications, how to know when and where to seek medical care and that process goes on until they reach age 18 and they have their first visit in the adult heart transplant clinic.
Host: And they can just transfer over right – UAB?
Dr. Pearce: Right down the street.
Host: They already know some of the doctors there.
Dr. Pearce: Correct. And some of the doctors already know them and many times we’ve walked down there when there’s been questions or sometimes for their first heart Cath procedure with the adults. I’ve been the one doing their catheterizations for so many years, it’s good for them to see a familiar face. So, I’ll walk down the street and make sure they know I’m there and make sure everything is okay.
Host: Right. And what do you think inspires you as a physician now working with these kids who have grown up as transplant kids?
Dr. Pearce: Well, there are lots of ways to be inspired. One is just the watching the difference it makes after their circulation improves, once a successful heart transplant takes place and then, you watch the challenges that the families have, you watch them rise to these challenges and that’s inspirational and then I’ve had a number of these kids grow up, have families, have careers. That to me is very, very inspirational, especially when some time has gone by before I see them and I run into them in a store, run into them on the street. Sometimes I don’t even recognize them. Until they say something. So, that’s very inspirational to see that.
Host: Absolutely. Anything else that you wanted to share about the team, about the program, about our uniqueness here in the southeast?
Dr. Pearce: Well, I think that we’re lucky here that we have a good mature program. We have something that we can really offer to these families, a product that all of us who work on the team feel good about being a part of. And not only do we provide this clinical care, but just the program itself provides a locust for research, a locust for education. This – people visit with our program all the time, doctors from other states.
So, we’re engaged with the community in ways beyond just the clinical care. Employment. Look at all the people that help us with this program. That’s one of the real joys of the program is working with all the different disciplines. We’ve got social work, pastoral care, child life, pharmacy, psychology, not to mention all the other physician specialties that help us and take care of these patients every day. I think that’s the most fun for us is to be able to work with all these excellent clinicians in other ways every day.
Host: Yeah, that’s truly inspiring as well. Thanks so much for joining us Dr. Pearce.
Dr. Pearce: Yes, thanks for having us.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics.
Heart of The Matter
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski and today we are talking with Dr. Bennett Pearce who is a Pediatric Cardiologist at Children’s of Alabama and UAB, the University of Alabama at Birmingham. He is a Professor and Medical Director of Heart Transplantation and Heart Failure at the Pediatric and Congenital Heart Center of Alabama. Welcome Dr. Pearce.
F. Bennett Pearce, MD (Guest): Thank you.
Host: February is Heart Month here at Children’s of Alabama and across the country. And we celebrate in a big way. So, we are talking to you about pediatric heart transplant today and 1981, the first pediatric heart transplant was performed. Do you remember where you were Dr. Pearce?
Dr. Pearce: Yes, I remember I was in medical school.
Host: And then the first adult transplant of course happened several years earlier.
Dr. Pearce: In the 1960s, Christiaan Barnard.
Host: Okay.
Dr. Pearce: And I was in grammar school.
Host: And you read his book, right?
Dr. Pearce: I read his book. He had a book called “One Life,” it was an autobiography and it was one of the choices we got for book reading in grammar school and it was late grammar school and I read that book.
Host: Do you think that’s what sparked your interest in being a pediatric cardiologist or being a cardiologist in general, or just knowing more about the heart?
Dr. Pearce: I think just knowing more about the heart and interest in transplant and of course, after the 1960s, we didn’t really have the medication to prevent the rejection, so, although Dr. Barnard and people like him tackled the technical challenges of the transplant; preventing rejection in a safe way afterwards didn’t happen until the 1980s.
Host: So, the pediatric heart transplant team here at Children’s of Alabama does a wonderful job. One of the things that you all work with is technology. Tell us about some of the technology that allows the heart transplants to happen or a bridge to transplant to happen as some of these pieces of hardware do.
Dr. Pearce: Well as you may know, the waiting period for a heart transplant for children is the highest mortality of any organ of any age. So, a big challenge to us is and has been and will be, how to get the kids safely to a point where they can receive a transplant and they can wait successfully for a donor to arrive. And our armamentarium has improved over the years with the advent of these mechanical devices. Circulatory support devices, LVADs, left ventricular assist devices and we have now several to choose from. Perhaps the best known one is Berlin Heart for Children. And we have had great success with that device since 2005, here in our program.
Host: So, describe what the Berlin Heart looks like and what it does for those kids who are waiting for a transplant.
Dr. Pearce: Well, it’s a pump that actually sits outside of the patient’s body. It takes blood from the left atrium and returns it to the aorta, and you can actually see the pumping action. It has mechanical valves in it. It usually rests on the outside of the child. Usually on the abdomen and we watch closely for formation of clots. We manage the anticoagulation. And in the right patient, it does wonders.
Host: How long would a child be on a device like that? It just depends?
Dr. Pearce: Months to up to a year. Sometimes even longer.
Host: Okay. So, while they are waiting for that heart transplant; this device helps them to get the blood through their body?
Dr. Pearce: Right, it sort of takes the place of part of their heart. It allows their other organs to work because those other organs are receiving fresh amount of blood all the time. So, it allows us to rehabilitate the children in some cases, allows us to get them off the respirator, feed them, and make them a good candidate to ultimately receive a heart.
Host: And so, we talked about Berlin Heart, what about HeartWare?
Dr. Pearce: It’s a mechanical heart device, left ventricular assist device, usually. That one works a little differently. It’s completely implantable except for one little wire that goes to a power suppling control unit that exits the patient. The wire that exits the patient is no larger than some of our central venous lines. So, that’s a well-tolerated device in the right patient. The nice thing about that one is you can actually send the patient home for a period of time. And so, we’ve had great success with that device since 2011, in our program.
Host: I’m sure that parents appreciate that being able to have their children home with them.
Dr. Pearce: Yes, they do. Home with that device is a special challenge. They need to be trained. Our transplant coordinators and VAD coordinators will go out not only and train the family, they’ll train the local EMS personnel, they’ll train the local emergency room personnel. And we’ve had those devices in patients at home in all corners of our state, north, south, east, and west.
Host: What do you think about some of the research that’s coming out of UAB and Children’s regarding heart transplant? Tell us about some of that. Share some of that with us.
Dr. Pearce: Well, we’re lucky here to have the largest pediatric heart transplant registry here at UAB. It was started under Dr. Kirklin and that’s called the Pediatric Heart Transplant Study. And that’s the source of most of the information that we use everyday in making clinical decisions and talking to parents. So, there is always ongoing research with the Pediatric Heart Transplant Study since about the mid-1990s.
Host: And that’s a collaborative effort, right?
Dr. Pearce: Multiple institutions in the US and Canada and worldwide now. But it’s housed here at UAB and so we’ve been participating in that since its beginning. Other research that we’re doing is research on agents to try to improve our immune suppression for children. These agents that we use to prevent rejection are strong medicines and they can cause problems and almost always do cause problems after a lifetime of exposure. So, we’re trying to cut back on those. We’re trying to look for less toxic substitutes.
Host: Okay so, in other words, after a child does receive a heart transplant, they are receiving these medications, multiple medications –
Dr. Pearce: Lifelong.
Host: To help them so that their heart is never rejected by their body, right?
Dr. Pearce: Correct.
Host: Okay. Tell me about the uniqueness about this program, about the Pediatric Advanced Heart Failure and Transplant Team here.
Dr. Pearce: Well, this program actually began in conjunction with the adult transplant program with Dr. Kirklin. And I believe it was even before 1990 that they did the first pediatric heart transplant. But it got going in earnest in the early 1990s and I moved here in about 1993 and received the opportunity to work with Dr. Kirklin in the heart transplant program. We worked together for many years before we moved the program here to Children’s when the new facility was built in 2012. At that time, we were under the umbrella of the adult transplant program.
So, even though for administrative purposes, we are a new program here at Children’s; it’s been the same people working together. The coordinators, myself, Dr. Wally Carlo, Dr. Kirklin is actually retired. Dr. Wally Carlo Junior works with me. We’ve hired a new physician Dr. Leslie Collins. She’s going to be working with us. But she’s been here for a number of years already. And we have an excellent surgical team, Dr. Bob Dabal is our surgical director of heart transplant. He came to us in 2008 and so he overlapped considerably with Dr. Kirklin and worked with him and so he brings a lot of experience to our program.
And we also have Dr. David Mauchley who joined us in the last couple of years and who has a great deal of experience and interest in children with mechanical circulatory support devices and heart transplant. So, I feel like we have a very experienced surgical team and our coordinators are all people that worked in the transplant area at UAB. So, they’re not new to the process.
Although for administrative purposes, this is a relatively new program after 2012; it’s clinically a very mature program with very, very low personnel turnover which is key for the families that form relationships with the people that they work with, which ensures expertise, people who do it everyday and have done it for a long time. A lot of experience brings a lot of advantages to our families.
Host: How many heart transplants have you guys performed to date?
Dr. Pearce: Well we’ve done 176 since 1981. And 59 heart transplants in children since 2012.
Host: And how long do you follow these kids? I know that there’s definitely a transition period where they need to be followed as adults or…
Dr. Pearce: Correct. We follow them through their teenage years. We start them in a transition program at about age 14. We are teaching them independence, we are teaching them about their medications, we’re teaching them how to give their medications, how to know when and where to seek medical care and that process goes on until they reach age 18 and they have their first visit in the adult heart transplant clinic.
Host: And they can just transfer over right – UAB?
Dr. Pearce: Right down the street.
Host: They already know some of the doctors there.
Dr. Pearce: Correct. And some of the doctors already know them and many times we’ve walked down there when there’s been questions or sometimes for their first heart Cath procedure with the adults. I’ve been the one doing their catheterizations for so many years, it’s good for them to see a familiar face. So, I’ll walk down the street and make sure they know I’m there and make sure everything is okay.
Host: Right. And what do you think inspires you as a physician now working with these kids who have grown up as transplant kids?
Dr. Pearce: Well, there are lots of ways to be inspired. One is just the watching the difference it makes after their circulation improves, once a successful heart transplant takes place and then, you watch the challenges that the families have, you watch them rise to these challenges and that’s inspirational and then I’ve had a number of these kids grow up, have families, have careers. That to me is very, very inspirational, especially when some time has gone by before I see them and I run into them in a store, run into them on the street. Sometimes I don’t even recognize them. Until they say something. So, that’s very inspirational to see that.
Host: Absolutely. Anything else that you wanted to share about the team, about the program, about our uniqueness here in the southeast?
Dr. Pearce: Well, I think that we’re lucky here that we have a good mature program. We have something that we can really offer to these families, a product that all of us who work on the team feel good about being a part of. And not only do we provide this clinical care, but just the program itself provides a locust for research, a locust for education. This – people visit with our program all the time, doctors from other states.
So, we’re engaged with the community in ways beyond just the clinical care. Employment. Look at all the people that help us with this program. That’s one of the real joys of the program is working with all the different disciplines. We’ve got social work, pastoral care, child life, pharmacy, psychology, not to mention all the other physician specialties that help us and take care of these patients every day. I think that’s the most fun for us is to be able to work with all these excellent clinicians in other ways every day.
Host: Yeah, that’s truly inspiring as well. Thanks so much for joining us Dr. Pearce.
Dr. Pearce: Yes, thanks for having us.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics.