Heart Center Research and Innovation

Today, we can anticipate major advances in survival, in quality of life, and an eventual cure for congenital heart disease (CHD) from research in basic science and engineering. The discoveries that we make in our BASE program at Stanford combine cutting-edge engineering and bioprinting approaches with molecular biology to build heart pumps and heart valves and whole hearts from stem cells. We combine computational biology and gene editing to find mutant genes that we pinpoint to precise events in heart development to determine why a particular heart defect occurs and what we can do to correct it before birth.

This biorepository (a place that collects, catalogs, and stores biological samples) saves donated skin and blood cells that can be turned into stem cells (immature cells) in the lab, called induced pluripotent stem cells (iPSC). These altered cells are then used to help identify genetic causes of and find cures for heart disease. The Stanford Biobank is used by more than 500 affiliated Stanford scientists and researchers who are working to prevent and treat heart and vessel disease.

The Clinical and Translational Research Program (CTRP) establishes a collaborative framework for our pediatric cardiologists who are interested in conducting clinical research. It provides research support (study design, data support, statistical analysis, etc.) so that our doctor-researchers can test their theories on new heart devices, drugs, biologics (treatments from natural sources), and other clinical observations—all so children with heart conditions can have a better outcome. The majority of our doctors at Lucile Packard Children’s Hospital Stanford, the center of the Stanford Medicine Children’s Health network, are involved in research and are teaching at Stanford Medicine.

The aim of the Pediatric Cardiac Surgery Laboratory is to improve heart surgery for children before and after birth. The lab is focused on resolving key challenges that are common across the board for babies who need heart surgery. The challenges that our heart surgery lab seeks to tackle include discovering ways to repair the hearts of babies while they are still in the womb, protecting the brains of newborns who undergo heart surgery shortly after birth, and building living heart valves that can self-renew and grow with your child who was born with a heart abnormality, saving him or her from future heart surgeries to replace artificial valves.

The ongoing research in the Pediatric Vascular Research Laboratory addresses vascular health during childhood, which is a key priority in preventing atherosclerosis (the stiffening and thickening of arteries). Atherosclerosis can occur in a number of conditions, including congenital heart disease, Kawasaki disease, diabetes, and obesity. This innovative lab uses noninvasive measures to easily acquire information about a child’s vascular health. By identifying vascular dysfunction early in children, it can be reversed.

Pioneered by one of our pediatric cardiologists, this innovation helps to expand the heart transplant donor pool and shorten waiting-list times for children in need of a heart. When a child is in heart failure, their heart is bigger, so it can sometimes match the size of an adult heart or that of an older child. We use a computed tomography (CT) scan and special software in Stanford’s sophisticated 3-D lab to measure the volume of the donor and recipient hearts to determine if there’s a good match. This unique heart-size matching approach helps save the lives of children on the waiting list by getting them hearts, and sooner. Without this innovation, many donated hearts would not even be considered for children. 

EchoPixel digitally converts computed tomography (CT) and magnetic resonance imaging (MRI) scans into 3-D images that allow cardiologists to examine every layer of your child’s heart and virtually run through their heart surgery prior to the actual operation. This unique partnership has resulted in increased accuracy for heart surgeons and improved outcomes for your child with complex or rare heart disease.

Children with certain heart conditions, such as congenital heart disease, cardiomyopathy, heart failure, and atherosclerosis, need frequent echocardiograms. This innovation empowers parents like you to perform an echocardiogram at home to check the state of your child’s heart, with real-time support from expert sonographers. This new technology brings you peace of mind because it allows for more regular testing, helps you avoid unnecessary travel or time off from work or school, and adds another home-based clinical tool for your family to care for your sick child while minimizing some risks that can be associated with travel for children with severe heart conditions.

This physical model allows surgeons in our Complex Biventricular Reconstruction Program to study your child’s complex or rare structural heart defect in detail so that they can evaluate the best multistep surgical repairs that they need to perform to bring your child’s complex congenital heart as close as possible to normal anatomy. This exciting innovation aids our heart surgeons in offering your child with complex heart needs a better chance at a well-functioning heart.

This invention uses biomechanics to empower heart surgeons to test different surgical options before your child’s heart surgery and select the one that will produce the best blood flow in and out of the heart—ultimately helping your child feel their best. The digital map helps optimize surgical plans, reduce risk, and improve outcomes for children with complex congenital heart conditions. 

If your child was born with one working ventricle instead of two, they could benefit from this groundbreaking research that is testing devices in animal studies to slowly expand small heart ventricles (called hypoplastic left heart syndrome) to make them larger so that your child could have two working ventricles and hopefully avoid the need for a future heart transplant. The devices, one placed inside the heart and one placed outside the heart, encourage the heart to stretch and grow heart muscle over time.  

This virtual reality technology creates a movable 3-D heart that can be taken apart and studied so that students and residents can learn the anatomy of the heart and understand what happens in many congenital heart conditions. We are beginning to use it with children and families to help you and your child better understand your child’s heart condition. 

We took two of our flagship procedures at Stanford Children’s—pulmonary artery reconstruction and heart transplant—and rolled them into one to help children who are likely facing a heart-lung transplant. We are the first medical center in the world to perform this highly complex, life-changing operation that we named PARplant. The surgery gives children a better chance of survival, significantly superior to that of a heart-lung transplant, and it is a preferred surgical approach especially with the overall limited availability of donor lungs.

Our Stanford Children’s arrhythmia researchers teamed up with software experts to develop an app that can be used on smartwatches to help expand the ways in which we diagnose arrhythmia in children. The app and watch give us data on the child’s heart rhythms over several hours and days, empowering us to identify the exact characteristics of the child’s arrhythmia and then provide an accurate and precise treatment recommendation, if necessary.

One of our electrophysiologists (heart rhythm and arrhythmia doctors) discovered how to visualize the electrical system of the heart. The heart has specialized cells, called CCS cells, that generate and transmit electrical signals to create rhythmic contractions. These cells could not be visualized apart from other heart cells, until now. Our doctor-researcher engineered an antibody-dye combination to light up the conduction system in real time using a special camera. This work has been successfully done in mice, and our doctor-researcher’s goal now is to adapt this technology to humans. This discovery has the potential to improve accuracy in heart surgery, cardiac imaging, and arrhythmia care for children with heart disease.

Read more about this study: In vivo visualization and molecular targeting of the cardiac conduction system.

When a child has a serious arrhythmia, their heart doesn’t beat efficiently, and they sometimes need a pacemaker. Yet pacemakers often use a single lead on one part of the heart to help set the heartbeat’s pace. This can create uncoordinated squeezing of the heart. One of our electrophysiologists ran the largest single-center study in the world to test pacing from multiple sites and places in the heart. The Stanford study’s findings showed a stronger and more efficient heartbeat, helping children avoid heart transplant and achieve a better-functioning heart.

Read more about this study: Impact of Cardiac Resynchronization Therapy on Heart Transplant—Free Survival in Pediatric and Congenital Heart Disease Patients.

Little is known about how the right side of the heart handles stress in children with heart disease. In these studies, our scientists discovered that the energy-generating machinery of the heart becomes damaged and is unable to keep up with the demands of the heart. The findings could help us discover brand-new treatments to fix problems in your child’s heart and preserve long-term function of the right side of the heart. Read more about this study: Transcriptomic and Functional Analyses of Mitochondrial Dysfunction in Pressure Overload–Induced Right Ventricular Failure.

Our heart doctors joined forces with another leading national pediatric heart center to co-lead a large 25-center randomized trial in child heart transplants. The study tested immunosuppression drug combinations to determine which work best to ensure that a donor heart is not rejected and which drugs produce the fewest side effects post-transplant. Stanford Children’s was the clinical coordinating center for the trial.

Read more about this study: The TEAMMATE Trial.

Several of our specialty heart programs, including our Single Ventricle Program, Pediatric Advanced Cardiac Therapies (PACT) Program, and Pulmonary Vascular Disease Program, have teamed up to use advanced therapies to try to postpone the need for heart transplant in children with these conditions. The study is exploring the best timing for transplant evaluation, how to reduce risk, how fragility or a patient’s overall state affects success, and other key factors to maximize the chance of a good outcome for children with Fontan heart circulation.

The standard belief is that children with a single ventricle heart shouldn’t exercise, but our physician-scientists are challenging that belief. This real-time supervised exercise training via live video helps kids with Fontan circulation (a surgery that reroutes the blood of single ventricle hearts), ages 9 to 19, to improve their fitness from the comfort of their home. The ongoing study evaluates whether exercise can improve not just fitness but also muscle and vascular health, as well as quality of life, in children who have a Fontan heart.

Read more about this study: ReEnergize FONTAN.

White blood cells that have been genetically reprogrammed back into an immature stem cell (iPSC) and then induced to form heart muscle cells were used by our researchers to better understand some of the most potentially devastating heart diseases, dilated and hypertrophic cardiomyopathy. By better understanding how gene mutations lead to these heart problems, doctors will be able to develop new precision-based drug therapies for children and adults with cardiomyopathy, helping them live a healthier life.

Read more about this study: Changes in myosin biomechanics influence growth and maturation of iPSC-cardiomyocytes.

This study is a retrospective review of pediatric patients treated at Stanford Children’s who required unifocalization (our flagship pulmonary artery reconstruction surgery, invented by our chief of pediatric cardiac surgery) for tetralogy of Fallot with major aortopulmonary collateral arteries. The study concluded that when using an approach that emphasized early complete unifocalization and repair that incorporated all pulmonary vascular supply, the team achieved excellent results in both patients who had a first-time repair and those who had undergone a previous surgery.

Read more about this study: Programmatic Approach to Management of Tetralogy of Fallot With Major Aortopulmonary Collateral Arteries: A 15-Year Experience With 458 Patients.