Summer 2013

Pediatric Heart Failure and Pediatric Heart and Lung Transplant Program

With the recruitment of Gordon A. Cohen, M.D., Ph.D., M.B.A, as the new chief of the Division of Pediatric Cardiothoracic Surgery, UCSF Medical Center is establishing the new UCSF Pediatric Heart Failure and Pediatric Heart and Lung Transplant Program. This comprehensive program will treat the full range of conditions related to pediatric heart and lung failure, and will serve as a resource and model of excellence both nationally and internationally.

Cohen, a distinguished pediatric cardiothoracic surgeon, brings substantial expertise in performing complicated heart and lung surgeries and transplants for newborns, infants, children and adolescents. He has performed more than 100 pediatric heart transplants, 12 pediatric lung transplants and several combined pediatric heart-lung transplants, as well as hundreds of surgeries to correct congenital heart defects. He was recruited from Seattle Children's Hospital, where he built one of the country's leading pediatric cardiac care programs.

"Our goal is to build the most successful and comprehensive program in the western United States at UCSF," said Cohen. "Because there are so many different birth defects of the heart, there are dozens of different operations that we do. It is like going to a restaurant and ordering off an a la carte menu: you can have a missing part here, or a hole there, or an inappropriate connection there. We know how to fix each of those defects individually, and we then put them together, so you can create normal or survivable physiology."

Full Spectrum of Treatments

The most common procedure is ventricular septal defect closure. Among the more complex lesions is hypoplastic left heart syndrome, in which patients are born without a functioning left ventricle. Cohen has been highly successful in treating this condition using a three-stage operation, including a Norwood procedure on neonates, a second-stage operation at about 6 months of age, and a third-stage operation around 3 years of age.

"That is an example of a palliative operation," said Cohen. "We create survivable physiology, in which we ask the right ventricle to function as the systemic ventricle and pump blood to the body. While we can palliate that birth defect for a period of time, a large number of those patients will ultimately develop heart failure and require transplantation. By establishing a transplant program here, we will be able to offer the full spectrum of treatment on-site. Because a lot of these patients are diagnosed prenatally, you actually work with the parents before the patient is even born. We want to be able to walk with the patient and their family through the entire trajectory of care."

Cohen is well equipped to establish this full spectrum of service at UCSF. His experience includes:

  • Ventricular assist device: The median wait time for pediatric donor hearts is 119 days. Between 12 and 17 percent of children and 23 percent of infants die while awaiting a donor organ, according to the US Food and Drug Administration (FDA). In 2011, the FDA approved the Berlin Heart EXCOR Pediatric System, the first ventricular assist device for children to obtain approval in this country. The bridge-to-transplant device has supported patients for up to 877 days. Cohen served as a co-investigator in the study that led to FDA approval, and has implanted the device in patients ranging from neonates to adolescents.
  • Congenital heart transplants: Patients with heart failure caused by congenital heart disease have very complex anatomy, including abnormal connections, structural abnormalities and intracardiac communications. Cohen has extensive experience with transplanting structurally normal hearts into pediatric patients with anatomically abnormal chests, constructing the necessary connections during transplant. While only a handful of centers in the country perform these complicated procedures, the majority of Cohen's heart transplant cases have been congenital transplants.
  • Neonatal and infant transplantation: The majority of patients that Cohen has transplanted were less than 1 year of age. Cohen also performed the first ABO mismatched heart transplant west of the Mississippi, in which an infant received a donor heart of a different blood type. Because the recipient's immune system was still immature, his body was able to accept the new heart. ABO mismatched heart transplants were developed to save the lives of patients who might otherwise die waiting for an organ of their same blood type.
  • Combined pediatric heart-lung transplants: Only about four or five centers nationally perform pediatric lung transplants, and combined pediatric heart-lung transplants are almost unheard of in the US. Cohen was trained in these combined transplant procedures during his tenure at Great Ormond Street Hospital for Children in London.
  • Expanding research: Cohen has studied neovascularization, and is involved in multidisciplinary and multi-institutional collaborations to identify a hepatic factor that he and his colleagues believe helps to regulate this process. He also hopes to encourage other research efforts to recover failing hearts, using a combination of stem cell, pharmacological, growth factor and potentially mechanically based therapies.

Cohen is currently recruiting a pediatric transplant cardiologist and transplant coordinator, and hopes to be able to begin offering pediatric heart and lung transplants within the next 12 months.

"It is an honor to be part of the faculty here," said Cohen. "UCSF is filled with intellectual firepower that allows for the development of the very best programs and the highest levels of research."

Consultations and Referrals:

For more information or to refer a patient, please call (415) 476-3501.

Related Information

News Releases

Heart Failure Patient Loses 100 Pounds Before Transplant Surgery
Suitulaga "Sugi" Hunkin has been overweight most of his life. Because of his size, he also had trouble breathing and experienced irregular heartbeat — symptoms his doctors diagnosed as a heart disease called cardiomyopathy, which usually leads to heart failure. He needed heart transplantation surgery to replace his failing heart, but before that could happen, he needed to lose at least 100 pounds.

Teen Liver Transplant Recipient to Honor Donor at 2013 Rose Parade
Alfonso Garcia still carries around a baseball cap that belonged to a 22-year-old man who passed away in 2010 having never met him. But the cap is just a small token of an even bigger reminder that the 18-year-old college freshman carries with him every day: the man's liver, which saved Garcia's life. Since receiving the liver transplant at UCSF, Garcia has made it a mission to spread the word about the value of organ donation.