By: Dr. Robert J. Dabal, chief of pediatric cardiac surgery and an associate professor of surgery in the Division of Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB).
Every year surgeons at the Pediatric and Congenital Heart Center of Alabama at Children’s of Alabama perform hundreds of cardiopulmonary surgeries. If a child in Alabama needs one of these life-saving procedures, they will likely get it at Children’s.
Our expertise in treating congenital heart disease (CHD) in children can be traced back to Dr. John W. Kirklin, a legendary heart surgery pioneer, clinician and scientist who came to UAB from the Mayo Clinic in 1966 and died in 2004. In recent years, we have moved into state-of-the-art facilities at Children’s where we perform most of our procedures.
These days, we take a team approach to treating patients. In the past, doctors would work more or less independently, for instance, with patients moving from cardiologists, to surgeons, to ICU. Now, everybody is involved in every aspect of care. When patients enter the hospital, a team of doctors and nurses provide a continuum of care from admission to discharge and beyond. For example, a child coming in for open heart surgery will have a minimum of three doctors taking care of him or her at all times.
We spend much time and effort sharing data with a nationwide collaborative, run by the Society of Thoracic Surgeons, of congenital heart surgery programs. Every time we perform an operation, we enter all the information in a database that allows us to compare time in hospital, time in ICU, time on ventilators and other variables. We are proud of our outcomes. Last year, our surgical mortality rate was 2.6 percent, which is lower than the national average of 3.2 percent. That’s great for us and great for the children here.
A third of our patients are under 30 days old, and those tend to need the most complicated operations. Therefore, they spend the most time in the hospital. Another third of our children are between about 30 days old and 2 years old. And the final third of patients are toddlers through adults. Our program also has a component for adults who have congenital heart disease, and most of those operations are performed at UAB by Dr. James K. Kirklin. Because of the outstanding success of the current surgeries, we expect that portion of our program to expand as generations of pediatric patients grow older and require follow up care.
A significant percentage of surgical patients need to be followed for a lifetime. Recently, Dr. Kirklin saw a 39-year-old patient who had surgery as a baby. The patient had been followed by a pediatric cardiologist until she was 13 and then released from care. It turns out that her pulmonary valve had been removed, and needed to be replaced. It shows that many if not most patients need lifelong follow up. The more complicated an operation is early in life, the more likely that follow up is needed late in life.
We also work cooperatively with interventional cardiology on hybrid procedures. Our new facility at Children’s includes a large cardiac catheterization lab that can double as an operating room, a hybrid room.. It has equipment for both specialties. While the cost of building and equipping this one room in the hospital was extremely high, it allows complicated operations to be performed in a more stream-lined fashion. Recently, I opened a child’s chest, performed a surgical repair and then put a catheter into an artery so a cardiologist could put a stent in a blood vessel. Then I removed the IV. The hybrid room made it easier on me, easier on the cardiologist and easier on the staff. But most importantly, the hybrid room made the operation easier on the patient.
As the field has evolved, results have improved, and now, there’s more emphasis on outcomes other than mortality. In the next decade we will be looking more closely to what happens to patients after the immediate post-op period. We want to see problems that arise in 6 months, 12 months or 5 years. That will help ensure that we are doing everything possible to protect the brain and other critical organs. Our goal is to provide patients a lifetime of good health, with hopes to restore a normal life expectancy.
Dr. Robert J. Dabal is the chief of pediatric cardiac surgery and an associate professor of surgery in the Division of Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB). His areas of expertise include neonatal and pediatric cardiac surgery. Dr. Dabal graduated from Duke University School of Medicine and completed his cardiac training at the University of Washington Medical Center. He completed fellowships in congenital heart surgery at Denver Children’s Hospital and Children’s Hospital Boston.