In honor of American Heart Month, we spoke to Dr. Michele Domico, medical director of CHOC’s cardiovascular intensive care unit (CVICU), on the importance of having a cardiac intensivist on a child’s heart surgery team.
Q: What role does the cardiac intensivist play in a patient’s overall care?
A: Heart patients will be seen by several doctors during their stay in CHOC’s CVICU. In addition to their cardiovascular surgeons making rounds in the unit, patients will also be regularly visited by their cardiologists who will also manage their care after they go home. But in addition to that care, pediatric heart patients also need a critical care specialist on hand at all times who can care for any unexpected complications that may arise. CHOC’s CVICU has an attending physician in the unit at all times, day or night, to care for our heart patients, and not all heart programs have that. We are also the only place in Orange County that performs neonatal and pediatric open-heart surgery, and have outcomes above the national averages for overall survival rate and neonatal survival rate.
Q: Why is it important for parents to make sure there is a cardiac intensivist on their child’s heart surgery team?
A: General intensivists have training in treating infections, traumas, cardio-respiratory disorders, and other severe problems that may arise. A cardiac intensivist has additional training in caring for exclusively for the most critically ill cardiac patients with severe and rare heart disorders. Patients benefit from having cardiac intensivists on their care teams because they’re prepared to care for any complication that may occur.
Patients with certain heart conditions may require a series of surgeries throughout their childhood. Since there is a cardiac intensive care specialist on call in the CVICU at all times, we really get to know the families we care for. There’s not a single patient who comes to the CVICU for their second surgery that we don’t remember from their first operation. That continuity of care means peace of mind for parents, knowing their child’s heart team knows everything about them.
Q: Why is it important for children to see a pediatric subspecialist for their heart condition?
A: Adult cardiac doctors are trained on structurally normal hearts, where all the pieces of the heart puzzle are intact and everything is in the right place. But children with congenital or acquired heart conditions may have missing or misplaced pieces of their hearts and need specialized care. As pediatric heart specialists, we see patients every day who have unique and severe heart conditions, so we are especially able to care for them.
- Ella underwent heart surgery at CHOC Children’s when she was just 7 months old to correct her coarctation of the aorta. Today, she’s thriving.
- Veer was born with a hole in his heart, and needed surgery to repair it when he was four years old. Today, he’s thriving.
- T.J.s parents were expecting a healthy baby boy and were shocked when shortly after birth he was diagnosed with transposition of the great arteries.