Johns Hopkins All Children's Hospital

Management of single ventricle defects, including tricuspid atresia, pulmonary atresia and hypoplastic left heart syndrome Interventional and electrophysiology procedures, including hybrid catheterizations and fluoroless ablations, are performed in the institute's two cardiac catheterization laboratories Access to state-of-the-art technology, such as ventricular assist devices and extracorporeal membrane oxygenation, helps make these advanced capabilities a reality. However, technology isn't the institute's only strength. "e biggest strength of our program is the people who work at the institute," Jacobs says. "Our team of high-quality doctors and nurses is a key factor that differentiates us from many programs." Eight months ago, for example, Melvin Almodóvar, M.D., came to Johns Hopkins All Children's from Boston Children's Hospital, where he was director of cardiac intensive care. Almodóvar is in the process of enhancing the highly specialized services within the 22-bed cardiovascular intensive care unit and broadening its academic focus. In the realm of pediatric heart transplantation, Transplant Cardiology Director Alfred Asante-Korang, M.D., F.A.C.C., has developed cutting-edge protocols to manage transplant patients with high levels of panel-reactive antibodies (PRA). e institute's results in the area of difficult-to-treat, high-PRA patients are among the best in the country. Surgical outcomes for all of the procedures performed within the institute are published online and are among the nation's best at every level of surgery, including the most complex procedures. e single ventricle program, which is specially designed to improve outpatient management of single ventricle defects so families spend less time in the hospital, has also noted zero percent interstage mortality in recent years. AN ACADEMIC MISSION Clinical care is only one component of the institute's work. e co-directors are also committed to furthering the field of pediatric cardiology and cardiovascular surgery through research, education and advocacy. In February 2016, Johns Hopkins All Children's hosted its 16th Annual International Symposium on Congenital Heart Disease. One of the most widely respected international educational platforms for pediatric and congenital heart disease, the symposium attracted 400 attendees from five continents. Stapleton and Jacobs plan to take the institute's current educational initiatives one step further by integrating more fully with the Johns Hopkins All Children's graduate medical education programs. Next year, the institute will welcome a pediatric cardiac surgery fellow. Other advanced training programs are also in development, with a goal of offering accredited fellowship programs in the areas of cardiac surgery, cardiology, critical care and pediatric anesthesia. "Having an affiliation with Johns Hopkins Medicine, which is widely considered the top academic institution of medicine in the country, has allowed us to bring in nationally recognized experts with highly sought-after skill sets," Stapleton says. "We've always had good clinical outcomes in our surgery and cardiology programs. However, we now have the opportunity to grow the institute and expand our research and academic enterprises." THE NEXT GENERATION OF CARDIOVASCULAR RESEARCH e institute participates in multiple database research projects related to quality and patient outcomes. In addition, it is currently exploring new research projects in the areas of heart failure and cardiac transplantation, as well as genomics, proteomics and metabolomics—three areas of personalized medicine." "We are studying strategies that will allow us to match medical and surgical treatments to patients' individual biomedical profiles," Jacobs says. "Over the course of time, personalized medicine will become more and more prevalent. e large amount of research being done in genomics and proteomics will help facilitate these transformations in the delivery of care." e institute is also working to recruit physicians with the expertise necessary to expand the breadth of available drug and device trials and launch disease-specific research programs in areas such as cardiomyopathy and cardiopulmonary hypertension. FORECASTED TRENDS IN PEDIATRIC CARDIOLOGY According to Jacobs and Stapleton, the field of cardiology and cardiovascular surgery is on the cusp of breakthroughs in several areas. Later this year, the institute will launch a transcatheter pulmonary valve program. While the large instrumentation A LIFETIME OF CARE FOR CONGENITAL HEART DISEASE As surgical, interventional and medical modalities for the treatment of pediatric congenital heart defects evolve and improve, a greater number of children with these disorders are living into adulthood. This has highlighted agrowing need for congenital heart disease management in adult patients. Because of the partnerships Johns Hopkins All Children's Hospital has with sister organizations, including Johns Hopkins Medicine, the institute is uniquely positioned to expand the services provided to young adults. "Many institutions are widening their capabilities to care for adult patients," says Gary Stapleton, M.D. "However, pediatricians aren't skilled in caring for patients as they enteradulthood. We plan to optimize relationships with our colleagues who specialize in adult medicine. This will enable us to provide advanced surgical and outpatient care to adult patients, while also helping them transition to specialists who are equipped to manage adult health needs." Summer 2016 13 Heart Institute

• Cover