The UAB Division of Pediatric Cardiology & Cardiac Intensive Care had a productive year in research. The division continues to be a leader in multi-institutional collaborations such as NEPHRON, the Congenital Catheterization Research Collaborative (CCRC), and Advanced Cardiac Therapies Improving Outcomes Network (ACTION). In 2021, the division continued their collaboration with the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome (HLHS). This collaboration will help provide valuable research and clinical options for our patients with HLHS, one of our most vulnerable patient populations. Members of our team are assisting in valuable efforts toward expanding our knowledge of Xenotransplantation and its potential use in our patient population. This is the first year we have been invited to participate in the Pediatric Heart Network. We are participating in two trials within this network. For one of these trial we have been chosen as the core angiography lab for this multi-institutional trial. The divisions is currently participating in several Industry Sponsored Research Protocols, as well as various Investigator Initiated/Bench Research Projects with multiple other divisions throughout UAB.
This past year we participated in multiple industry sponsored device trials in our cardiac catheterization laboratory. Mark Law, M.D., serves as the principal investigator for these trials.
One of these is a multi-institutional collaborative entitled “Congenital Catheterization Research Collaborative”. Through this collaborative researchers across the country have contributed data to better understand how neonates born with Tetralogy of Fallot are managed from a surgical/interventional and what their outcomes are. This collaborative has led to publications comparing the management strategies of patients with symptomatic Tetralogy of Fallot and those who weighed <2.5kg.
Additional publications from our cath lab include a review of the current literature associated with trans-catheter pulmonic valve implantation, complications post Transcatheter Aortic Valve Replacement, and factors that influence re-intervention following ductal artery stent implantation for ductal dependent pulmonary blood flow. We have contributed data to a multi-institutional project looking at patient outcomes of urgent transcatheter pulmonary valve implantation in a medical failing patient.
We received industry sponsored funding from Edwards Lifescience for two pulmonary valve device studies. We concluded enrollment in the SAPIEN XT Transcatheter Heart Valve and Dr. Law and our team has been featured in a national newsletter highlighting our study participation. We are currently enrolling in a separate Edwards trial for the COMPASSION S3 Transcatheter Heart Valve and have been asked by the study sponsor to speak regarding our success in this trial.
We continue to enroll subjects into our Pediatric Cardiac Biorepository (PCaB). Currently there are over 500 patients’ samples stored in PCaB. PCaB collects prospective biological samples on cardiac surgical patients and stores them for future research. From our division Ahmed Asfari, M.D., has performed analysis on samples from PCaB to identify biomarkers associated with acute lung injury (ALI) in neonates after cardiopulmonary bypass. This multi-plex panel identified an enzyme, proteoglycan-4 (PRG-4), as being potentially related to ALI. This is leading to further investigation and collaboration for this particular biomarker.
Samples from PCaB have been used by a collaborating department, Pediatric Cardiac Anesthesiology, to try and see the relationship between free heme and nitric oxide on post-operative acute kidney injury.
Leslie Rhodes, M.D., performed free T3 and free T4 analysis on PCaB samples to investigate the correlation of these biomarkers and clinical outcomes following cardiac surgery.
The NEPHRON Collaborative was initiated here at our institution and has grown into a 25 institutional collaboration to better understand neonatal acute kidney injury (AKI) after cardiac surgery. Santiago Borasino, M.D., leads this initiative here at UAB and has been involved in the analysis of the data and manuscript preparation for multiple projects within NEPHRON. Publications from this collaborative have described: the methods of this multi-institutional collaborative, the epidemiology of AKI in neonates after cardiac surgery, and fluid accumulation after cardiac surgery. A specific analysis of the data of patients undergoing cardiac surgery without bypass had very interesting findings. AKI is associated with bypass but this phenomenon had yet to be described in patients undergoing cardiac surgery without bypass. More manuscripts within this collaborative are in the works for 2022.
Our cardiac transplant team and xenotransplant team have been very busy this past year. Waldemar F Carlo, M.D., serves as the principal investigator in the first of its kind, multi-institutional, prospective collaborative looking at standardizing immunosuppressant therapy six months post-cardiac transplantation. Dr. Carlo, F. Bennett Pearce, M.D., and Leslie Collins, M.D., have also published their findings on racial and socioeconomic disparities in our pediatric heart transplant patients. Other manuscripts involving our heart transplant patients include: our sites induction strategy changes, heart transplantation in a patient with hypoplastic left heart syndrome with an intact atrial septum, clinical outcomes of children receiving ABO incompatible heart transplants, and practice variation in the diagnosis of acute rejection among pediatric heart transplant centers.
Dr. Carlo, Leslie Rhodes, M.D., and other members of our xenotransplant team published multiple manuscripts involving opinions regarding xenotransplantation, racial attitudes to xenotransplantation, and describing providers attitudes towards xenotransplantation.
Several of our faculty have contributed data to multi-institutional, investigator initiated, non-funded research projects that have increased the knowledge of particular areas within the heart center.
Santiago Borasino, M.D., collaborated with Colorado Children’s Hospital on a few research projects. One of these was describing the use of prophylactic peritoneal dialysis and its use after the arterial switch operation as one institution uses it ubiquitously while the other does not. An additional collaboration with Colorado Children’s and Cinicinnati Children’s Hospital looked into the different phenotypes for acute kidney injury after the Norwood operation.
Jonathan Byrnes, M.D., published multicenter collaboration on the outcomes of multiple ECMO runs using the ELSO Registry. The study showed a growth in the number of patients undergoing multiple runs, unfortunately, the outcomes remain poor. He is also working on a multicenter analysis comparing heparin and bivalrudin for ECMO anticoagulation. This could become a landmark paper for ECMO in pediatrics.
Ahmed Asfari, M.D., was able to use our own institutional data to describe postoperative outcomes in early versus late sternal closure. He initiated a study to determine the clinical morbidities associated with delayed sternal closure after cardiac surgery which he was asked to present at the Pediatric Cardiac Critical Care Consortium (PC4) national meeting.
Leslie Rhodes, M.D., collaborated on a publication describing workforce demographics and unit structures of pediatric cardiac critical care unites in the United States.
Yung Lau, M.D., collaborated on a multi-institutional trial describing myocarditis post COVID-19 vaccination in adolescents.
Waldemar F Carlo, M.D., is our sites principal investigator for the multi-institutional trial administering umbilical cord collected stem cell injections in patients undergoing Stage II palliation for hypoplastic left heart syndrome (HLHS) versus a control group of subjects who do not receive stem cell injections. Due to our success of enrollment into this trial we have been asked to participate in the subsequent trial administering the umbilical cord stem cell injections in patients undergoing Stage III palliation for HLHS.
Dr. Lau and our team continue to participate in an international collaborative looking at catecholaminergic polymorphic ventricular tachycardia.
Austin Kane, M.D., participated in a multi-institutional collaborative looking at dual chamber versus single chamber ventricular pacing in isolated congenital complete heart block in infancy.
Dr. Carlo participated in multi-institutional projects looking at Fontan patients who received ventricular assist devices and describing the Fontan liver after cardiac transplantation.
Hayden Zaccagni, M.D., participated in a multi-institutional project looking at pre-intubation cardiac arrest in congenital heart patients.
This is our first year to be included in trials performed by the Pediatric Heart Network. Camden Hebson, M.D., and Mark Law, M.D., will serve as PI’s for two separate trials.
Dr. Hebson is leading a study here at our site that is retrospectively and prospectively enrolling patients diagnosed with MIS-C post COVID-19 infection.
Dr. Law has been chosen as the core angiography director for a multi-institutional trial that will be the first of its kind to randomize neonates with Tetralogy of Fallot to either initial trans-catheter intervention or surgical repair.
Drs. Byrnes, Borasino, Zaccagni, Law and Asfari collaborated with our perfusionists (Timpa, O'Meara C, Buckman, Maxwell) and the Cardiac Surgery team (Sorabella, Padilla, Cleveland DC, Dabal RJ) . to published our centers experience with post-cardiotomy ECMO.
Mark Law, M.D., is our sites acting PI for a phase III randomized trial of subject to either endoxaban tosylate versus standard of care therapy for prevention of thromboembolic events in children with heart disease and has been features in a national newsletter highlighting our research participation.
Leslie Rhodes, M.D., is our sites acting PI for a phase IV trial randomizing subjects to apixaban to standard of care therapy for treatment of venous thromboembolism.
Am J Cardiol. 2021;147:147-148. Bicuspid aortopathy and sports clearance. Hebson C, Iannucci G.
Ann Thoarc Surg. 2021;111(2):655-661. Propylactic peritoneal dialysis after the arterial switch operation: A retrospective cohort study. Gist KM, Henry BM, Borasino S, Rahman AKMF, Webb T, Hock KM, Kim JS, Smood B, Mosher Z, Alten JA.
Ann Thorac Surg. 2021 Jan 11;S0003-4975(21)00070-9. Late Heart Transplantation in Hypoplastic Left Heart Syndrome with Intact Atrial Septum. Waldemar F Carlo, J Leslie Collins, F Bennett Pearce, Robert J Dabal, Jeffrey A Alten.
Ann Thorac Surg. 2021 Jun 4;S0003-4975(21)00982-6. The Genetically Engineered Heart as a Bridge to Allotransplantation in Infants Just Around the Corner? David C Cleveland, Abhijit Jagdale, Waldemar F Carlo, Hayato Iwase, Jack Crawford, Gregory P Walcott , Robert J Dabal, Robert A Sorabella, Leslie Rhodes, Joey Timpa, Silvio Litovsky, Carlisle O'Meara, Luz A Padilla, Jeremy Foote, David Mauchley, Mohamed Bikhet, David Ayares, Takayuki Yamamoto, Hidetaka Hara, David KC Cooper.
Ann Thorac Surg. 2021; 111(5):1740-1741. The prophylactic peritoneal dialysis conundrum: It is worth it? Reply. Gist KM, Borasino S, Alten JA.
Ann Thorac Surg. 2021; S0003-4975(21)01745-8. Online ahead of print. Epidemiology of neonatal acute kidney injury after cardiac surgery with cardiopulmonary bypass. Sasaki J, Rodriguez Z, Alten JA, Rahman AF, Reichle G, Lin P, Banerjee M, Selewski D, Gaies M, Hock KM, Borasino S, Gist KM.
ASAIO J. 2021; 67(7):e124-e126. Biventricular support using ProtekDuo cannula in a child. Tan C, Mauchley DC, Byrnes JW, Carlo WF, Law MA, O’Meara LC, Timpa JG, Pearce FB.
Cardiovasc Revasc Med. 2021 Mar 23;S1553-8389(21)00149-4. Percutaneous closure of iatrogenic VSD and paravalvular leak: Two complications of TAVR. Shazib Sagheer, Shane Prejean, Thomas Watts, Mark A Law, Mustafa Iltimas Ahmed.
Clin Transplant. 2021 Apr 10;e14314. Impact of induction strategy change on first-year rejection in pediatric heart transplantation at a single center—from postoperative basiliximab to either postoperative anti-thymocyte globulin or preoperative basiliximab. T Miller Sisson, Luz A Padilla, Meloneysa Hubbard, Sally Smith, F Bennett Pearce, J Leslie Collins, Waldemar F Carlo.
Crit Care Explor. 2021 Sep 7;3(9):e0528. Biomarkers for Adverse Lung Injury Following Pediatric Cardiopulmonary Bypass. Ahmed Asfari, Kristal M Hock, Jonathan W Byrnes, Santiago Borasino, Brian A Halloran, James A Mobley, Namasivayam Ambalavanan.
Pediatr Transplant. 2021 Feb 1;e13979. Examining racial and socioeconomic disparity in the pediatric heart transplant evaluation. Waldemar F Carlo, Samantha Floyd, Frank B Pearce, Jacqueline L Collins, Meloneysa Hubbard, Robert J Dabal, Joseph R Buckman, Luz A Padilla, James K Kirklin.
Pediatr Transplant. 2021;25(2):e13851. Attitudes toward xenotransplantation: A survey of parents and pediatric cardiac providers. Padilla LA, Rhodes L, Sorabella RA, Hurst DJ, Cleveland DC, Dabal RJ, Cooper DK, Paris W, Carlo WF.
Phys Ther Sport. 2021; 49:196-203. Age, rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction. Law MA, Ko YA, Miller Al, Lauterbach KN, Hendley CL, Johnson JE, Tsai LC.
World J Cardiol. 2021 May 26;13(5):117-129. Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications. Mark Aaron Law, Arka Chatterjee.
World J Pediatr Congenit Heart Surg. 2021 Sep;12(5):589-596. Early Versus Late Sternal Closure in Infants-Perioperative Associations and Outcomes. Ahmed Asfari, Matthew G Clark, Kristal M Hock, Jordan L Huskey, A K M F Rahman, Robert J Dabal, Santiago Borasino.
World J Pediatr Congenit Heart Surg. 2022 Jan;13(1):46-52. Outcomes in Pediatric Post-Cardiotomy ECMO Support With Modification of Systematic Support Strategy. Robert A Sorabella, Luz Padilla, Jonathan W Byrnes, Joseph Timpa, Carlisle O'Meara, Joseph R Buckman, Kathryn Maxwell, Santiago Borasino, Hayden Zaccagni, Ahmed Asfari, Mark A Law, David C Cleveland, Robert J Dabal.
Xenotransplantation. 2021;28(2):e12656. Racial differences in attitudes to clinical pig organ Xenotransplantation. Padilla LA, Hurst DJ, Jang K, Rosales JR, Sorabella RA, Cleveland DC, Dabal RJ, Cooper DK, Carlo WF, Paris W.
The Division of Cardiology and Cardiac Critical Care participates in the following Quality Improvement Networks:
Multicenter Randomized Trial of Everolimus in Pediatric Heart Transplantation
The goal of this study is to compare the effects of arms of immunosuppression therapy in Pediatric Heart Transplant recipients
Role: PI - Waldemar F Carlo, M.D.
Prospective, multi-center, double-blind, randomized, placebo-controlled, parallel-group study assessing the efficacy and safety of macitentan in Fontan-palliated adult and adolescent subject
Role: PI - F Bennett Pearce, M.D.
New Enrollment SAPIEN XT Post-Approval Study (COMPASSION XT PAS)
Role: PI - Mark A Law, M.D.
Sponsored by: Edwards Lifesciences
An Open-Label, Randomized, Parallel-Group, Multicenter, Observational Trial to Evaluate Safety and Efficacy of Edoxaban Tosylate in Children from 38 Weeks Gestational Age to Less than 18 Years of Age with Cardiac Diseases at Risk of Thromboembolic Events
Role: PI - Mark A Law, M.D.
Sponsored by: Daiichi Pharmaceuticals, Ltd.
A randomized, open-label, active controlled, safety and extrapolated efficacy study in pediatric subjects requiring anticoagulation for the treatment of a venous thromboembolic event
Role: PI - Leslie Rhodes, M.D.
Sponsored by: Pfizer Pharmaceuticals, Ltd.
Congenital Multicenter trial of Pulmonic Valve Dysfunction Studying the SAPIEN 3 interventional THV Post-Approval Study (COMPASSION S3)
Role: PI-Mark Law, M.D.
Sponsored by: Edwards Lifesciences LLC
Long-Term Outcomes after the Multisystem Inflammatory Syndrome in Children: MUSIC
Role: PI-Camden Hebson, M.D.
Sponsored by: Pediatric Heart Network (PHN) of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH)
The UAB Pediatric Cardiac Critical Care Fellowship Program is dedicated to educating future cardiac intensivists in the independent management and care of pediatric patients with congenital and acquired heart disease. This one-year fellowship is uniquely designed to provide training based on our fellow’s previous clinical experience and focuses on developing clinical skills and knowledge specifically in pediatric cardiac critical care. As the only Pediatric Cardiothoracic Surgery Center in the state of Alabama, our fellow is exposed to a wide-breath of both acute and chronic congenital and acquired heart disease in children and young adults. This exposure includes pre- and postoperative care of neonates and children with congenital heart disease, medical management of patients with heart failure and arrhythmias, ventricular assist devices, ECMO, and heart transplantation. As part of their training, our fellow participates in multidisciplinary research with opportunities available in both clinical and basic science research.
Felicia Sifers, M.D.
First Year Fellow
Residency: University of Oklahoma
Leslie Rhodes, M.D.
The UAB Pediatric Cardiology Fellowship Program offers an innovative training opportunity to develop clinical excellence and the skills needed to be an independently practicing pediatric cardiologist. Our fellows are exposed to a broad diversity of congenital and acquired cardiac disease as well as ample opportunities for scholarly activity, advocacy and leadership. During their training, our fellows participate in multidisciplinary research with mentorship from division faculty. Our goal is to provide our fellows with the knowledge and skills necessary to become proficient and effective in identifying reasonable research hypotheses.
Matthew Coghill, M.D.
First Year Fellow
Residency: Carolinas Medical Center
Matthew Clark, M.D.
Second Year Fellow
Residency: University of Missouri, Columbia
Christian Tan, M.D.
Third Year Fellow
Residency: University of South Florida
Mark Law, M.D.
Robb Romp, M.D.
Associate Program Director