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Coming to the Stollery

Congenital Heart Program Areas

 

Heart Surgery Program

The cardiac surgical program at the Stollery Children’s Hospital was established in 1996. It is now the second largest surgical program in Canada for pediatric heart surgery, and the primary surgical referral center for the western Canadian provinces and territories. Each year we perform over 750 procedures including operations and cardiac catheterizations. Of the 10 hospitals performing the most pediatric heart surgeries in North America, the Stollery has some of the best rated clinical outcomes.

A patient’s journey into the Congenital Heart Program at the Stollery Children’s Hospital begins with a referral. Surgical referrals are discussed every week by telehealth conference with a team of pediatric cardiac specialists across Western Canada. This multidisciplinary team discusses over 1000 patients every year. Once the decision for your child’s surgery is made, a priority is assigned and scheduling/pre-operative planning begins.

Pediatric Cardiac Catheterization Program

The Stollery Children's Hospital is a western Canadian referral center for cardiac catheterization. Over 450 pediatric and adult procedures are performed in the Mazankowski Alberta Heart Institute’s Cardiac Catheterization Lab every year. Our team provides services to patients from Alberta, Saskatchewan, Manitoba and the Northwest Territories. Our interventionalists (cardiologists who perform the procedure) work in a catheterization lab that was designed specifically for the diagnosis and treatment of children, adolescents and adults with congenital heart disease. With state-of-the-art equipment, our newest hybrid laboratory allows for close collaboration with the congenital cardiothoracic surgery program, and provides a full spectrum of procedures and treatments.

Pediatric Cardiac MRI Program

Our dedicated cardiac Magnetic Resonance Imaging (MRI) program operates out of the Elko Cardiac MRI unit at the Mazankowski Alberta Heart Institute and uses the latest in equipment and technology. The team is comprised of radiologists, pediatric and adult congenital cardiologists, and a group of dedicated cardiac magnetic resonance (MR) technologists. This program performs and interprets cardiac MRI on all types of acquired or congenital heart disease. We are a referral center for patients from Winnipeg and Saskatoon, and work closely with the Alberta Children’s Hospital in Calgary to standardize clinical and research protocols. We also collaborate with physicists in the University of Alberta’s department of Biomedical Engineering to develop in-house advanced imaging techniques.

Pediatric Ventricular Assist Device Program

The Pediatric Ventricular Assist Device (VAD) Program provides mechanical circulatory support for children whose hearts are too ill to effectively pump blood to their body. The Pediatric VAD Program has established itself as a leader in mechanical circulatory assist device treatment. Our multidisciplinary Pediatric VAD team follows the patient through all stages of care. During the process of pre-operative evaluation, and in consultation with a cardiac surgeon, the VAD team will select the most appropriate ventricular assist device that is best suited for the child in order to facilitate the best possible outcome. Post implantation, the pediatric VAD team monitors patients closely to successfully bridge them to decision, transplant or long term (destination) therapy.

Pediatric Cardiac Extracorporeal Life Support (ECLS) Program

The Stollery pediatric extracorporeal life support (ECLS) program provides short term mechanical support including extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT) and therapeutic plasma exchange (TPE) for pediatric patients with heart disease, as well as non-cardiac patients in other areas of Stollery Children’s Hospital. Annually, over 30 pediatric cardiac patients are supported with ECMO, with a median support time of 78 hours. We provide pediatric ECLS retrieval and cannulation for our referral base throughout Western Canada, annually transporting 8-12 patients on ECMO from distances as far as 1400 km. The Stollery program ECMO circuits and protocols have been imitated at other centers across North and South America.

We have a dedicated multidisciplinary ECLS team that is very involved with the Extracorporeal Life Support Organization (ELSO) having previous and current membership on the steering committee and various subcommittees. The Stollery program runs an annual ECLS training course on site, which is attended by Doctors (MDs), nurses (RNs), respiratory therapists (RTs), and perfusionists from around the world.

Our team of bedside ECLS specialists includes RNs and RRTs who complete ongoing intensive training, simulation and recertification throughout the year. Bedside care is provided using an integrated multidisciplinary approach.

Pediatric Heart Transplant Program

The Stollery Children’s Hospital has been offering heart transplantation to children and infants in terminal heart failure since 1986 for congenital heart disease, cardiomyopathy, and inflammatory heart disease. 183 infants and children receiving 193 transplantations have since been followed at the Stollery which has become the centre for pediatric heart transplant for all Western Canada. With a structured transition into adult care, we help to set our children up for long-term success in adult life. The International Society for Heart and Lung Transplantation (ISHLT) reports an average survival mark of 50% at 15.5 years. The Stollery has yet to cross that threshold, now 30 years into the establishment of the program.

With a population spread out over 4,531,711km2 (an area equal to 50% of the USA) this program faces unique challenges. Long wait times for transplantation require creative strategies by very progressive intensive care and ventricular assist device programs to bridge critically ill patients to transplantation. Due to further travel distances than required by most programs, over 60% of donor hearts experience longer than four hours cold ischemic time (compared to 12% in the North American average). In order to optimally use these scarcely available organs, innovative strategies such as ABO incompatible transplantation, desensitization of highly HLA-sensitized children, and novel approaches to severely elevated pulmonary vascular resistance have been pioneered in Edmonton. Using these strategies in addition to standardized protocols, survival from listing and post-transplant survival in our program is significantly above the North American average despite the high risk profile of our children and the demographic adversities.

Pediatric Echocardiography

The Stollery Children's Hospital is the main referral site in Western Canada for the Fetal & Neonatal Cardiology Program for high risk pregnancies. The Stollery Children’s Hospital’s Echocardiography Laboratory consists of full and part-time echo faculty, sonographers, and an educator. In addition to pre and post intervention transthoracic and transesophageal echo assessments of congenital and acquired pediatric heart disease, the laboratory employs state-of-the-art technologies including tissue doppler and speckle tracking for myocardial function assessments and 3D imaging on a daily basis. The Laboratory is internationally recognized as leading in areas of 3D echocardiography and functional imaging in pediatric heart disease.

Fetal and Neonatal Cardiology Program

The Lois Hole Hospital for Women is the largest obstetrical, perinatal, and neonatal center in Alberta and is the primary care provider for high-risk pregnancies. The Fetal & Neonatal Cardiology Program, established in 2008, now includes five faculty sonographers and a dedicated research nurse. We receive fetal cardiac referrals from nonsurgical centers in Western Canada through the WCCHN for evaluation and potential delivery in Edmonton. We have optimized relationships between perinatology, neonatology, genetics and cardiology to enhance multidisciplinary care for pregnancies at-risk-of or diagnosed with fetal heart disease. Annually, 200-300 pregnancies are identified as having structural, functional or rhythm related fetal pathology.

Pediatric Heart Function & Cardiomyopathy Service

The Stollery Pediatric Cardiomyopathy and Heart Function (CHF) service was launched in 2014 to improve the care of children with diseases of heart muscle or established heart failure. The team provides consultative service on inpatients in the Stollery and to the WCCHN. We offer a weekly outpatient clinic providing multidisciplinary care for children with primary heart muscle diseases as well as systemic disorders impacting the function of the heart.

Our dedicated team has helped to educate the community, hospital staff and families about heart failure in children. The CHF team conducts research into the causes and treatment of cardiomyopathy and heart failure in children, as well as advocates for improved national resources for this important population.

The home milrinone program was established in 2015 after collaborative efforts between the Heart Function Team, Children’s Home Care, Home IV Therapy and Pharmacy, with the first patient discharged in 2016. This program allows children with advanced heart failure who are dependent on milrinone intravenous therapy to be discharged into the community while awaiting transplant. This was an important milestone, returning children to their communities and their homes while waiting for transplantation.

Pediatric Pulmonary Hypertension Program

The Pediatric Pulmonary Hypertension (PH) Service began in 2008 to provide family centered care for children of all ages with pulmonary hypertensive vascular disease. The PH service provides inpatient and outpatient care for children with pulmonary vascular diseases, and screens children with underlying conditions that place them at high risk for pulmonary hypertension. An important part of our work has been to provide specialist training in PH. Four of our trainees have established pediatric PH services in their home countries.

We are active members of the Pediatric Pulmonary Hypertension Network of North America composed of PH specialists from nine major children’s hospitals. We are passionate about family and community education. We pioneered the inclusion of families and children at the International Conference on Neonatal and Childhood Pulmonary Vascular Disease, supported graciously by the Stollery Children’s Hospital Foundation, so that clinicians, scientists and families could interact and exchange ideas to promote patient and family centered research. We collaborated with staff and children at the Victoria School of the Arts in Edmonton to produce a video describing from the child’s point of view what it is like to be diagnosed with PH. The video was premiered at the national PHA Canada meeting. The team is involved in extramurally funded research trials to bring state-of-the- art care and cutting edge treatments to children with PH in Alberta and Western Canada.

Pediatric Electrophysiology

The electrophysiology service which assists children and adults with congenital heart disease at the University of Alberta was established almost 25 years ago. We are one of the two largest programs in Canada. We have three electrophysiologists who work in close collaboration with pediatric and adult congenital cardiologists and electrophysiologists throughout Western Canada. The Western Canadian pediatric electrophysiologists have formed the PACEWest group (Pediatric and Congenital Electrophysiologists of Western Canada) fostering comprehensive patient care and an education curriculum for pediatric trainees. Our program serves as the referral center for high risk and complex pediatric cases from Alberta and neighboring provinces.

The service provides a full spectrum of patient care for children, adolescents and adults with arrhythmias and congenital heart disease. The annual service workload includes 80-100 EP cases per year and 30 transvenous device procedures. Our EP studies and ablations are done using a minimal and often zero fluoro technique which places us at the forefront for procedural practices with other large international pediatric centers. Our success rates are congruent with published data.

Pediatric Cardiac Anesthesia Program

Pediatric cardiac anesthesiologists are an integral part of the care for complex congenital cardiac patients at the Stollery Children's Hospital and Mazankowski Alberta Heart Institute. The Pediatric Cardiac Anesthesia program at the Stollery is a group of highly trained experts caring for children with very complex cardiac disease. Our team of five dedicated cardiac anesthesiologists, with specialist training and expertise in managing children with heart disease, provides anesthetic care for approximately 400 pump and 300 nonpump cases yearly, and supports clinical fellowship training in pediatric cardiac anesthesia.

We work collaboratively with surgeons, cardiologists, and intensive care teams to provide family centered, expert care and strive to optimize perioperative outcomes. In addition to managing these patients in the cardiac operating room, this group cares for high-risk cardiac patients requiring anesthesia, or sedation for MRIs, cardiac catheterizations, and interventional radiology procedures. Our cardiac anesthesiologists are also part of a vibrant and diverse group of pediatric anesthesiologists at the Stollery Children's Hospital. As a major referral center for Northern

Alberta and Western Canada, they provide anaesthesia across all sub-specialties for approximately 13,000 cases per year, both in and out of the operating room.