December 13, 2016

121416perfusionists640When a child has open heart surgery at Texas Children’s Hospital, they receive some of the best care in the country. Our Heart Center, ranked No. 2 in the nation, is equipped with state-of-the art technology, highly trained and skilled surgeons and anesthesiologists, as well as a team of unsung heroes called perfusionists.

Perfusionists operate the heart lung bypass machine needed to keep a patient alive during open heart surgery. The machine takes deoxygenated blood out of a patient’s body, runs it through an artificial lung to give it oxygen, and then pumps it back into the patient’s blood stream.

While the idea may sound simple, the procedure and process is not and is performed at the Heart Center by a longstanding team of experienced and professional perfusionists.

“Perfusionists are absolutely vital when we perform open heart surgery,” said Surgeon-in-Chief Dr. Charles D. Fraser Jr. “What they do is extraordinary and allows us to do very complicated operations on children who otherwise would not be able to survive.”

Fraser recognized the benefit of a strong perfusion team early on and is responsible for creating a dedicated pediatric team at Texas Children’s in 1995 shortly after being named chief of Congenital Heart Surgery. All three members of the original team – Mary Claire McGarry, Maryann Mueller and Deb Surprise – are still working in the Cardiovascular Operating rooms today and remember what it was like in the beginning.

Mueller remembered Fraser recruited her and her colleagues from the Texas Heart Institute where they worked with both adult and pediatric patients. The first few years at Texas Children’s, she said, were spent honing their skills to provide the best perfusion for children.

Surprise recalled how Fraser brought with him a new approach to pediatric perfusion. His idea was to create a specialized pediatric protocol that would be tailored to each individual child.

“Everyone was invested in the success of Dr. Fraser and what he was trying to accomplish,” Mueller said. “We wanted him to be successful – and for our patients to come in, have surgery and then head home to lead healthy lives.”

Over time the team grew to what it is today, eight perfusionists who work closely with the surgical team. Due to their ever evolving skill levels, the team continues to see more complex patients, many of whom have benefited from the hard work of the surgeons and clinical staff at Texas Children’s Heart Center.

Fraser and his team recently performed their 10,000th heart procedure with the use of heart lung bypass on Adult Congenital Heart Disease Program patient 31-year-old Stephanie Granger, who was born with a congenital heart defect and had two surgeries as a baby and another when she was 6. Years later, she developed secondary problems from her heart defect.

“I started having some abdomen pain, so I went to my primary doctor,” Granger said. “They ran a CT scan and found there was a problem with my liver due to my heart.”

Soon thereafter, Granger scheduled heart surgery at Texas Children’s not only for herself but for her newly adopted daughter, Zoey, as well. Zoey was born with a similar congenital heart defect and needed surgery just like her mother.

“When we adopted her, we told them we were open to various conditions,” Granger said. “We told them we had a family history of congenital heart disease and that we fully understood it.”

McGarry said she can’t believe the team just reached the 10,000 pump case milestone and that it’s a testament to how far they’ve come.

“People now from all over the world come to see what we do,” she said. “It’s amazing and makes me very proud to have been a part of the program for so long.”

121416drluersson175Dr. Thomas Luerssen has been given the 2016 Franc D. Ingraham Award for Distinguished Service and Achievement by the American Association of Neurological Surgeons/CNS Section of Pediatric Neurological Surgery. The award is the highest honor given by the organization and recognizes individuals whose achievements have advanced the field of pediatric neurosurgery. This is only the ninth time the award has been given since its inception in 1988.

Dr. Luerssen is chief quality officer for surgery and a neurosurgeon at Texas Children’s Hospital and a professor of neurosurgery at the Baylor College of Medicine. He is also the former chief of neurosurgery at Texas Children’s.

“It is a true honor for me to follow the great legacy of Dr. Tom Luerssen who has built an incredibly strong neurosurgery service at Texas Children’s,” said Dr. Howard Weiner, chief of Neurosurgery at Texas Children’s.

After graduating many outstanding pediatric neurosurgery fellows over the last decade, as well as recruiting a truly excellent core team of pediatric neurosurgeons here, Luerssen has been recognized for his many leadership roles in pediatric neurosurgery over the course of his career. Among those roles are chairman of the AANS/CNS Section on Pediatric Neurological Surgery and president of the American Society of Pediatric Neurosurgeons. He also spent 18 years on practicing at Indiana University and 11 years at Texas Children’s. These accomplishments are in addition to his many contributions to the fields of neurotrauma, quality improvement and patient safety in pediatric neurosurgery.

Dr. Charles D. Fraser, Jr., surgeon-in-chief at Texas Children’s said, “We are very proud of Dr. Luerssen’s accomplishments and are extremely fortunate to have him as part of the legacy of Texas Children’s Department of Surgery.”

November 29, 2016

113016surgicaloncologyinside250Texas Children’s Cancer Center is renowned for extraordinary care and outcomes and is ranked No. 2 in the nation by U.S. News & World Report. An important part of the program’s success is the multidisciplinary care children here receive – particularly in the area of surgical oncology. Many solid tumors – such as liver tumors, bone tumors, neuroblastomas and sarcomas – require complete surgical removal. Chemotherapy and radiation may be used to shrink the size of the tumor or to keep it from coming back after surgery, but surgical removal is a critical step for children with these cancers. In these cases, oncologists and surgical oncologists must work together to carefully plot the course of treatment and time the surgery just right to give young patients the very best chance at a cancer-free life.

Patient diagnosed with hepatoblastoma

In September 2015, Dr. Maria Garcia Fernandez, a pediatric infectious disease specialist, and Dr. Fernando Padilla, a family practitioner, discovered a mass in their 17-month-old baby Victoria’s abdomen. Fearing the worst, they immediately contacted the Solid Tumor Program at Texas Children’s Hospital, where Victoria was promptly evaluated and diagnosed with stage 3 hepatoblastoma.

Hepatoblastoma is a relatively rare type of childhood cancer, with approximately 200 cases diagnosed per year in the country. Usually occurring in children under the age of 5, there are often no initial symptoms other than the mass.

“Hepatoblastomas tend to present very large, because the liver is tucked under the ribs so the mass is hard to feel,” said Dr. Sanjeev Vasudevan, Victoria’s surgical oncologist specializing in liver surgery. “You have to remove the side of the liver that the tumor inhabits without damaging the normal side and still get the tumor completely out.”

The stakes for this type of surgery couldn’t be higher.

“If you attempt to remove the mass and wind up leaving some of it behind, the prognosis for the child becomes much more serious,” Vasudevan said. “Basically, if you can’t guarantee a negative-margin resection, it’s safer to skip the attempt and go straight to liver transplantation.”

Aggressive chemotherapy treatment

At the time of diagnosis, Victoria’s tumor was 6 cm in diameter and covered both sides of her liver. She had to undergo an aggressive regimen of chemotherapy to see if resection would be an option, or if transplant would be required.

“We were devastated,” Fernandez said. “We didn’t know if the chemotherapy would work, what kind of toll it would take on her, or if she’d have to have a transplant and deal with that her whole life. But, what we did know was that Texas Children’s was the best possible place for us to be. They had the numbers. They had the best track record for treating this type of cancer, whether it’s from an oncology perspective or surgery or transplant or intensive care.”

Only a handful of major centers in the country are equipped to take a case like Victoria’s. Of the 200 cases diagnosed in the U.S. annually, Texas Children’s treats approximately 10 percent of them.

“In addition to a strong cancer program, you need to have pediatric ICUs and intensivists, surgical expertise, anesthesia and pain services, all for children under the age of 5 – and enough volume to do it well and have good outcomes,” Vasudevan said.

Victoria underwent four intense cycles of chemotherapy. Each time, she was admitted back to the hospital for about a week, fighting fever, neutropenia and RSV. Knowing that four cycles was probably as much as the petite toddler could take, Victoria’s physicians were hoping to take her for surgery after one or two rounds. After the third cycle, she was placed on the transplant list briefly before scans finally showed a glimmer of hope. Victoria underwent a fourth cycle and was scanned again, and the team was delighted to find a margin of healthy tissue that made surgery possible.

“This entire team of oncologists, radiologists, pathologists, surgeons and transplant surgeons met so many times and discussed her case, all diligently trying to figure out what was best for Victoria,” Fernandez said. “It showed tremendous perseverance and dedication, and I will never forget that as long as I live.”

Surgical tumor removal

On January 6, 2016, Victoria went in for surgery, and she didn’t come out for more than nine hours. The vicinity of the tumor to the main portal vein, the primary blood supply to the liver, was close and required special attention to ensure that the tumor was completely removed.

“When operating on the liver, there is a high risk of disrupting the blood vessels and the bile ducts,” Vasudevan said. “What makes it really complicated is the fact that the liver is brown and completely opaque, and you can’t see the tumor. You rely on ultrasound guidance and external cues, the rest is up to feel and experience.”

Victoria’s procedure went smoothly. Vasudevan removed the tumor and the left lobe and was able to preserve about 60 percent of her liver.

There is a 30 percent chance of liver insufficiency post surgery, but after four or five days, the liver begins to regenerate and compensate for its loss. Victoria was stable and extubated by the next morning, and she went on to have two more cycles of chemotherapy to ensure no microscopic seeding had occurred. She has since celebrated her second birthday and returned to her normal, vibrant self.

Although Victoria is still checked regularly for signs of recurrence, overall her prognosis is excellent. She has an approximately 90 percent chance of an event-free, five-year survival.

“This is exactly why I got into this field,” Vasudevan said. “It’s an amazingly rewarding thing to do. Cancer is so devastating, in general, and to see a small 1- or 2-year-old child robbed of her whole life…that’s motivation enough for me.”

For more information about our Surgical Oncology Program, click here.

November 22, 2016

112316drmarybrandt175Pediatric Surgeon Dr. Mary Brandt has been reappointed to the Board of Governors of the American College of Surgeons (ACS) as the Governor-at-Large representing ACS fellows in the ACS South Texas Chapter. This is the second three-year term for Brandt.

In her position as a Governor-at-Large, she will facilitate communications between ACS Fellows and members of the Board of Governors. Brandt’s duties include attending local meetings, participating in the Surgical Training Workgroup and attending national leadership meetings.

Brandt is director of the Adolescent Bariatric Surgery Program and director of the Anorectal Malformation Clinic at Texas Children’s Hospital. She is also a professor of Surgery at Baylor College of Medicine.

November 15, 2016

Growing up, it took awhile for Michelle Roy to warm up to other children in her neighborhood and school classrooms. A bilateral cleft lip and palate caused her to be shy, introverted and at times feel a little isolated.

“I didn’t have anyone to share my experiences and feelings with,” she said. “I didn’t have access to a network of kids in similar situations.”

Fortunately, that’s not the case for the many children Roy now works with as a physician assistant to pediatric plastic surgeon Dr. Laura Monson. Monson helped start Camp Keep Smiling in 2014, a camp for children with cleft lip and palate.

The camp recently wrapped up with a record-setting number of campers and incredible experiences for the patients and staff members alike. Camp Keep Smiling provides a safe, fun environment for patients between the ages of 10 and 16 to engage in meaningful social interaction and gain self-confidence. The camp, hosted by nonprofit Camp for All, offers activities like canoeing, fishing, archery, ropes courses, basketball and arts and crafts. Admission is free of charge for patients as it is supported directly by donations.

This year, 61 campers attended Camp Keep Smiling versus the 30 who attended in 2014. Monson leads the camp with other team members from the plastic surgery division. Physicians, nurses, OR staff and child life specialists serve as counselors who notice tremendous strides in the campers towards the end of the session. Oftentimes, campers have never met another child with cleft lip and palate and this gives them the opportunity to form friendships with those who are just like them.

“Children with cleft lip and palate often will have four or more surgeries throughout their lifetime to address not only appearance issues but speech and dental issues as well,” Monson said, adding that cleft lip and palate affects one out of every 700 births. “Camp Keep Smiling was created to help these children better understand their condition, meet people who are going through the same thing and help them deal with some of the difficult social interactions they might have growing up.”

Christy Hernandez, a registered nurse with Texas Children’s Outcomes and Impact Service, has been helping organize the camp since its inception and said it is amazing to watch the campers open up to one another over the weekend while participating in super fun activities.

“It’s life changing for many of them,” she said. “It’s a time when they can forget about their medical condition and just be kids.”

Roy participated in the camp for the first time this year as its counselor coordinator and saw firsthand what a great opportunity it is for children with cleft lips and palates to gain confidence in themselves, and meet and build relationships with people who look and often feel the same way they do.

“Camp Keep Smiling is a very valuable experience for these children to have,” she said. “I feel blessed to be a part of it and to let them know there’s a bright future ahead of them.”

Click here to watch ABC-13’s story about Camp Keep Smiling.

November 8, 2016

11916drhollierpressganeyinside640Improving the experience for every patient and family who comes to Texas Children’s Hospital for surgery is a top priority for Dr. Larry Hollier, associate surgeon-in-chief for clinical affairs and chief of plastic surgery at Texas Children’s. Over the past two years, he has led the charge at the hospital to ensure every family feels there is no better place for their children to receive surgical care.

To honor him for his work in improving the patient experience at Texas Children’s, Press Ganey, a leading provider of patient experience management solutions, presented Hollier with the 2016 Physician of the Year award at the annual Press Ganey National Client Conference.

Members of the Ambulatory Surgery Patient Experience Workgroup and leaders throughout Texas Children’s nominated him for the award.

“Dr. Hollier is very passionate about the patient experience, and he embraces all of the different touch points that comprise a patient and family’s care experience,” said Sarah Maytum, assistant vice president of patient and family services at Texas Children’s. “In leading the Ambulatory Surgery Team, he not only sought input from front line staff, he listened, acted on their input and empowered staff members to take ownership of project implementation.”

Hollier has been responsible for leading patient experience innovations within the Department of Surgery including: same-day surgery consultation appointments, standardized pre-surgery materials, the surgery greeter program, direct scheduling for Texas Children’s Pediatrics providers and for Texas Children’s Emergency Center; surgical patient ingress/egress patterns; and a physician communication course, called Breakthrough Communications, aimed at enhancing the conversation between patients, families and caregivers. He has also been instrumental in advancing the hospital’s expertise in caring for patients with a range of complex conditions while simultaneously becoming a leader in outcomes measurement and patient experience.

Recently, the Meds to Beds program, which delivers post-surgery medications to a patient’s bedside before discharge, was highlighted in NEJM Catalyst as a highly innovative program. Meds to Beds not only enhances the surgery experience for patients and families, but has also resulted in improved pharmacist and OR staff satisfaction.

“We in the Department of Surgery are extremely proud of the extraordinary work being done at Texas Children’s to optimize the care experience of our patients and their families,” said Dr. Charles D. Fraser Jr., Texas Children’s surgeon-in-chief. “Dr. Larry Hollier has been an outstanding and visionary leader for the surgery service in partnering with Sarah Maytum and the Patient Relations team. His recognition by Press Ganey is a testimony not only to his enormous contributions, but to the effective team spirit we are so proud of in the Texas Children’s Hospital family.”

Hollier holds the S. Baron Hardy Endowed Chair in Plastic Surgery at Texas Children’s and serves as professor and chief of Plastic Surgery at Baylor College of Medicine. In addition, he is chairman of the Medical Advisory Board of Smile Train, an international children’s charity that provides free cleft repair surgery and comprehensive cleft care worldwide, and serves on the board of the Duke Global Health Institute focusing efforts on reducing health disparities. Hollier has authored more than 190 articles for scholarly and professional publications, written 37 book chapters and sits on the editorial board of numerous journals. His surgical specialties include craniofacial conditions, cleft lip and palate, and microsurgical hand repair.

October 18, 2016

101916easeapp640At Texas Children’s Hospital we understand it’s hard to be a patient and that sometimes it’s even harder to be a loved one of those in our care, especially if they are undergoing surgery.

To help alleviate the anxiety of those sitting in the waiting room while their family member is on one of our operating tables, Texas Children’s Hospital is providing a resource that gives parents and/or guardians real-time status reports from the operating team.

Those updates come in the form of a HIPAA complaint text via an app called EASE or Electronic Access to Surgical Events. EASE allows doctors and nurses to securely communicate with families about their loved one from the surgery suite. Messages disappear within 45 seconds and nothing is saved on any device to insure private information stays that way.

“This application allows our families to leave the waiting room while their child is in surgery but still feel connected to their child’s doctors and nurses, and secure in the knowledge that a member of the OR team can contact them anytime it’s necessary,” said Dr. Larry Hollier, associate surgeon-in-chief for clinical affairs.

Currently, EASE is being used in the West Tower Main OR, the Clinical Care Tower OR and the Pavilion for Women OR. It will soon be used in the West Campus OR and will be available in the Woodlands OR when the community hospital opens next year.

The response from our patients since the application was introduced at Texas Children’s Hospital late last year has been overwhelmingly positive, Hollier said, adding that a nice feature of EASE is the feedback the application provides. At the end of every session, a customizable survey is generated allowing Texas Children’s Hospital to collect valuable patient satisfaction data.

Data collected so far on our patient families shows almost all users had a positive experience. The following comments are from people who used the application in one of our OR waiting rooms:

  • “This program was very nice. Just knowing what is going on really put me at ease.”
  • “Love this program! As a grandmother, it was an added bonus to keep us updated.”
  • “Wonderful way of keeping in touch. The pictures were truly a blessing.”

Director of Perioperative Services Janet Winebar said she is thrilled Texas Children’s Hospital is using EASE to better communicate with our families. She said the application increases their overall experience with the hospital by creating transparency and improving the doctor-patient relationship. It also decreases anxiety, which impacts the overall process for everyone involved.