sutures newsletter


P and T Approvals, Changes for Hydrocodone, Tramadol

Pharmacy Focus

See highlights of the Aug. 5 meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Drug Enforcement Administration is more strictly controlling hydrocodone combination products, and more details are available about tramadol's new status as a controlled substance.

Mark Your Calendar

Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Educational Schedule

Click the PDF link below to see the Department of Surgery's educational schedule.

Educational Schedule - September 2014 (PDF)

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

25 Years, 1,000 Heart Transplants

By Danny Ramzy, MD, PhD
Surgical Director, Lung Transplant Program
Director, Extracorporeal Life Support Program

This month, Cedars-Sinai passed a milestone achieved by very few heart centers: We have performed more than 1,000 adult heart transplants since the inception of our program.

In 2013, the Cedars-Sinai Heart Institute set a record for U.S. heart transplantation by completing 119 adult heart transplants. The previous mark, set in 2005, was 98 adult heart transplants performed in a single year. The previous record for annual heart transplants (adult and pediatric combined) performed by a single center in one year was 118.

These accomplishments underscore the work of the past four years, when the Heart Institute and the Cedars-Sinai Comprehensive Transplant Center performed more adult heart transplants than any other U.S. medical center, according to statistics compiled by the United Network for Organ Sharing, the nonprofit organization that manages the nation's transplant system and collects data on every transplant performed in the U.S.

One must recall the past to understand where we are now. The first heart transplant at Cedars-Sinai was performed in December 1988. The patient was in her 60s, which at the time was considered rather old for a heart transplant.

When she asked how long she would live after her transplant, she was told that the goal was for her to live at least five more years. However, she had a very full life, living more than 20 years with her transplanted heart. Her family had many more years with her than expected.

We now have two patients who are alive 24 years after heart transplantation.

In the 1990s, approximately 30 transplants per year were performed at Cedars-Sinai, while in the first decade of the 2000s, there were as many as 47 per year. This put Cedars-Sinai in the top 5 percent of programs in the U.S. With the addition of Jon Kobashigawa, MD, and his colleagues, and subsequent recruits on both the surgical and medical sides, the combined team of physicians and surgeons has achieved yearly heart transplant volumes of 75, 87, 95 and 119 in 2010, 2011, 2012 and 2013, respectively.

That makes our heart transplant program the largest not only in the U.S. but in the world for the past four years. And we are well on our way to another outstanding year, with 75 heart transplants to date in 2014.

The Cedars-Sinai Heart Transplant Program has a number of firsts. We were the first U.S. program to adopt the bicaval technique for heart implantation. We were the first in the nation to perform the total orthotopic heart transplant technique, with a bicaval and pulmonary venous anastomoses versus the previous standard of biatrial anastomoses. Superior vena cava anastomotic stenosis is a complication that was eliminated by a modification of the standard technique that was developed here at Cedars-Sinai.

It is important to know that our achievement of record volumes and scientific firsts did not come at the expense of quality. We described 100 consecutive patients who underwent heart transplantation without a single early mortality within the first 30 days post-transplant. This record extended to more than 125 consecutive patients without mortality, a feat achieved by no other program in the world.

When examining our results for the 832 patients who received a heart transplant through December 2012, our survival rate of 96 percent at 30 days, 92 percent at one year and nearly 80 percent at five years exceed expected survival rates when compared to averages from the International Society for Heart and Lung Transplantation.

The Cedars-Sinai Heart Transplant Program also has performed several dual organ transplants. We reported the largest experience with combined heart-kidney transplantation in peer-reviewed medical journals, with survival rates similar to heart transplantation alone. Our first heart-kidney recipient remains alive more than 22 years after transplantation.

In 1998, we also performed the first heart-liver transplant in the western U.S. This patient also has remained alive more than 16 years following transplantation. The Cedars-Sinai Heart Transplant team has a close relationship with the Lung Transplant Program, allowing us to perform two heart-lung transplants last year and five total over the last four years.

We also have performed a triple organ transplant. The patient, who received a heart-lung-kidney transplant, remains alive and has undergone a successful redo lung transplantation.

Cedars-Sinai's leadership in heart transplantation extends to a mechanical pumping device called the SynCardia Total Artificial Heart. Total Artificial Hearts are implanted in heart failure patients who otherwise might not live long enough to receive a heart transplant. In 2013, Cedars-Sinai surgeons implanted 23 Total Artificial Hearts, according to SynCardia, the company that invented and manufactures the device.

The manufacturer said Cedars-Sinai set a yearly record for the number of Total Artificial Heart devices implanted by a single medical center. This year, we have completed 21 Total Artificial Heart implantations, and are poised to possibly set a record.

Another aspect of our program is its academic strength. Our program frequently has one of the highest numbers of abstracts accepted at international meetings, and several of our faculty members are invited speakers. We are participating in 12 clinical trials.

Throughout its 25-year history, the Cedars-Sinai Heart Transplant Program has strived to improve the quality of life for its patients, whether with a heart transplant or a mechanical assist device. We are continuing to strive to improve the outcomes of our patients, and to lead the development of our field for the next 25 years.