UCLA is among the world’s busiest and most successful programs for adult heart transplantation and a major referral center of care for some of the most difficult cases. But the program’s true strength is derived not merely from transplant outcomes or the ability to handle complex patients, according to the program’s director.
“We have an incredibly talented multidisciplinary team that provides the full spectrum of care for patients with heart failure — from the genetic workup to pharmaceutical care for patients who need optimal medical therapy, to mechanical support with assist devices, to care for patients who need heart transplantation in conjunction with a kidney or lung transplant, to the postoperative management of any potential complications,” says Abbas Ardehali, MD, director of the UCLA Heart, Lung, and Heart-Lung Transplant Programs. “These patients all have different needs, and by excelling in every area, we are able to provide care that is tailored to their circumstance.”
The multidisciplinary heart-transplant team is poised to expand based on the depth of its offerings, Dr. Ardehali notes. In weekly calls, team members representing surgery, medicine and psychiatry, as well as social workers, case managers, advance-care planners and others take a holistic approach to each case in determining the best course of therapy. “Our team prides itself on being able to offer patients options that, in certain cases, can allow them to delay or avoid a transplant,” says Ali Nsair, MD, medical director of the UCLA Heart Transplant Program. “Patients do better and live longer when we can get the maximum out of their own heart, so if someone can benefit from surgery, an interventional procedure or medical therapy to postpone transplantation, then we have succeeded. And if they need the transplant, we have that option available as well.”
To expand patient access to UCLA’s advanced heart-failure programs, heart- failure clinics are being held at several community sites. UCLA Health heart-failure cardiologists regularly see patients at weekly clinics in Downtown Los Angeles, Torrance, Thousand Oaks and Santa Clarita, and a heart-failure clinic in Santa Barbara is set to open in early 2022. “To be able to piggyback on UCLA Health’s satellite clinics for heart failure has led to meaningful relationships with our community providers and allowed us to offer advanced cardiac therapies to patients who can avoid the inconvenience of traveling to Westwood, as well as improving continuity of care posttransplant,” Dr. Nsair says.
In addition, a mobile ECMO (extracorporeal membrane oxygenation) program, which partners with outside hospitals that lack ECMO capabilities, provides life-saving mechanical support that allows patients at these facilities to be safely transported to UCLA. The program, under the direction of Peyman Benharash, MD, has grown rapidly and continues to cannulate patients at community facilities who have life-threatening heart and/or lung problems.
Overall, Dr. Nsair notes, heart-failure patients are benefiting from improved devices for getting them to transplantation safely — including mechanical pumps that allow patients to go home from the hospital while awaiting transplant, and ventricular-assist devices that improve quality of life for patients who aren’t transplant candidates.
For patients posttransplant, UCLA’s was among the first programs to use blood-based genetic testing as a noninvasive method for evaluating the risk of rejection of the transplanted heart. Advances in both surgical techniques and the use of immunosuppression have reduced complications and increased survival times.
“We have seen significant advances in the field at the level of pretransplant, peritransplant and posttransplant care that have translated to improved outcomes for patients,” Dr. Ardehali says. Particularly important, Dr. Ardehali notes, has been the expansion of donor criteria that has allowed programs such as UCLA’s to accept hearts that were not previously considered suitable, including the resuscitation of hearts that have stopped in patients. This has increased the available supply, reducing waiting times. UCLA’s program also stands out for the frequency with which it performs combined transplantations, such as heart/lung/kidney and heart/liver procedures, for patients with end-stage liver, kidney or lung disease.
Dr. Ardehali believes that the comprehensive nature of the UCLA Heart Transplant Program has implications for referral patterns. “In the past, physicians might have waited to refer their heart-failure patient until that patient needed a transplant,” he says. “But if there is any uncertainty with that patient, we recommend not waiting. We can provide advice where needed and supportive care at whatever stage the patient is in, toward the goal of referring the patient back to them — potentially without the need for a transplant.”