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Stanford heart team combines two highly complex specialties in a novel PARplant procedure
Santana Renchie takes on life as if she knows—at the tender age of 2—that she’s lucky to be alive. She’s sassy, full of joy, and determined to not miss a single moment of fun.
“There’s nothing stopping her. She’s relentless. If she wants something, she just goes for it,” says her dad, Sebron.
That wasn’t the case until last fall, when she received a lifesaving, novel surgical procedure at Stanford Medicine Children’s Health, one that has never been performed elsewhere in the world. The nearly 16-hour operation took a huge multidisciplinary team of heart experts to pull off, but the result likely means a brighter, better future for Santana.
“Historically, patients like Santana don’t have many options. She was not a candidate for a heart transplant because her lung vessels were very small. Blood would not be able to flow easily through them, and her new heart would likely struggle trying to pump blood to the lungs,” says Chiu-Yu Chen, MD, pediatric cardiologist. “The only other solution for her would have been a heart-lung transplant.”
While heart-lung transplantation is a remarkable option, survival rates are often significantly lower than for heart transplants alone. According to a journal article written by the Stanford Medicine Children’s Health doctors who invented Santana’s unique surgery, the median survival for heart-lung transplant is 5.9 years, while the survival for heart transplant is 15.9 years for a 10-year-old child.
A rough start for little Santana
Santana was born with two incredibly complex conditions—a single ventricle congenital heart defect and diffuse pulmonary artery stenosis. Her heart defect meant she had just one pumping chamber in her heart, rather than two. The defect makes it difficult for blood to flow from the heart to the lungs and the rest of the body. If that was not enough, her pulmonary artery stenosis—a narrowing of the pulmonary artery—further decreased her blood flow.
“We believed that performing two procedures at once was her best option, one we could offer because of our rare expertise in both heart transplantation and pulmonary artery reconstruction—two recognized strengths of our Betty Irene Moore Children’s Heart Center,” Dr. Chen says. “It’s the perfect opportunity for us to care for these very unique and very sick children.”
The doctors who invented the two-in-one procedure named it PARplant—a combination of PAR, which stands for “pulmonary artery reconstruction,” a repair of damaged arteries in the lungs, and plant—an abbreviated form of the word “transplant.” While it makes for a long operation, it addressed Santana’s heart and lung problems all at once.
Pushing the limits for a better outcome
By the time Santana turned 1, she had undergone three surgeries to improve her heart and lung function. Yet, she didn’t improve. She got sicker—losing her energy and her appetite—and her heart began to fail. That was when doctors in her Southern hometown referred her family to the Betty Irene Moore Children’s Heart Center for pulmonary artery reconstruction (PAR). Yet when they arrived, they were told that performing PAR alone was not an option.
“We determined her heart would not progress well if we just addressed her lung issues, so we decided to fix everything at once. I had watched Michael Ma, MD, perform the first PARplant, and I do both of these surgeries on a weekly basis, so I figured all I had to do is bring them together. It felt challenging, but it felt comfortable, too,” says Elisabeth Martin, MD, pediatric cardiovascular surgeon.
The new PARplant operation takes an extensive amount of coordination. As Santana received care in the Cardiovascular Intensive Care Unit (CVICU), the cardiology care team helped her gain strength so that she could endure her pending reconstruction and heart transplant. Specialists from pediatric cardiac anesthesia, cardiac imaging, interventional cardiology, transplant, cardiac nursing, and social services supported the Pulmonary Artery Reconstruction team, the cardiothoracic surgery team, and the Pediatric Advanced Cardiac Therapies (PACT) team, which provided vital input on Santana’s heart failure and heart transplant.
“A deep expertise in heart transplant and PAR, coupled with an incredible spirit of collaboration, allows us to think outside the box and cautiously but confidently pursue novel therapies like this,” Dr. Chen says.
The day of surgery
The big day came on Aug. 19, 2021, after a three-month hospital stay. Heart transplants always demand precise timing, but with a PARplant, the need for good timing is doubled. When a donor heart is identified, things move quickly to ensure that the heart stays healthy in transit and that it’s placed in the body quickly. The quicker the heart is placed, the less chance that it will struggle to restart or work properly, and the less time a child has to spend on a heart-lung bypass machine.
“The PARplant went really well. I performed her pulmonary artery reconstruction first without any concerns, so when the heart arrived, we were able to place it without delay,” Dr. Martin says. “Then, there was a long period of intraoperative management while we made sure Santana’s heart and lungs were working well.”
The family waited on pins and needles, receiving updates every few hours on how the operation was going. With each of the 16 long hours that passed, their worry increased.
“It was really hard sitting there wondering and hoping everything was going as planned, so when Dr. Martin came out and told us it went well, we felt terribly relieved,” Sebron says. “To be able to do something like this for her, without complications, is just amazing.”
The collective teams’ intricate planning and deep expertise in two highly complex procedures added up to a successful outcome. Santana recovered well without transplant rejection, and her follow-up studies showed no narrowing of her pulmonary arteries.
“We don’t have follow-up data on this new therapy or a crystal ball to see into Santana’s future health, but the heart transplant survival data tells us she likely gained several more years than she would’ve had with a heart-lung transplant,” Dr. Martin says.
Santana stayed in the hospital less than a month, a typical stay for a heart transplant. After a few months of living nearby and receiving follow-up care, the family returned home to Dallas—just in time for the holidays.
“Santana was always smiling and wanting to interact with providers even when she was sick. She’s got a strong spirit,” Dr. Chen says. “After she left the hospital, we had a telehealth visit, and I saw her running around in the background, which was wonderful to see. It’s why we do what we do.”
A happy ending
Today, Santana spends her days playing games with her family, snuggling with mom Tamela, dancing around the house, and following her big sister, Sanvier, around. Dad says she’s bossy and opinionated, but it’s that feisty spirit that helped her get through her rough start.
“It is like night and day. She has so much energy now. She runs around all day and she is a lot happier,” Sebron says. “She hasn’t had to return to the hospital once since we’ve been home.”
Families often come to Stanford Medicine Children’s Health when they have no other options. Other pediatric heart centers across the world refer children for pulmonary artery reconstruction and heart transplants—two hallmarks of the Moore Children’s Heart Center. PARplant was a remarkable yet logical next step.
“We’re making history. We have all of the elements needed to make PARplant successful,” Dr. Martin says. “We’ve completed two now, and both children are doing really well. Without this therapy, they would have been struggling, and now, both are thriving. There’s no better reward than that.”
Learn more about our Betty Irene Moore Children’s Heart Center services >
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- Lynn Nichols
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