SickKids doctors implant the first total artificial heart for a child in Canada

Posted on July 18, 2022

Summary:

SickKids teams came together to urgently perform an innovative procedure to bridge Mariam to a second heart transplant after she went into heart failure for a second time.

Last year, when Mariam Tannous’ first heart transplant started failing and other medical interventions were no longer working, her clinical team at The Hospital for Sick Children (SickKids) had to quickly think outside the box for an innovative treatment. With time ticking away and an urgent need to bridge Mariam to a second heart transplant, the team decided to try something that had never been done before at SickKids or in Canada – a total artificial heart implant for a paediatric patient.

Mariam’s team at SickKids consulted with colleagues in the United States and received training on the technology, and within two weeks, 11-year-old Mariam became the first paediatric patient in Canada to receive a total artificial heart. She was also one of the smallest patients, and youngest, in the world to have the device implanted.

[Music]

[SickKids logo appears on a white background]

[Linda, mom, and Mariam, patient, sit on a hospital bed in a patient room]

Linda Antouan Adwar: When they come in, they say the surgery is done and be happy, be proud for your daughter because she is the first kid in Canada to do the surgery and she's doing well. You know, it's, it's not easy. I don't know how can I explain it, but I feel my heart go like higher and higher from the from the happy to see my daughter go back to me.

[Text on screen: Linda Antouan Adwar, Mariam’s mom]

Linda Antouan Adwar: So the doctors at SickKids hospital, they do amazing things. They consult a lot and they come with good ideas for us to survive our daughter’s life.

[Text on screen: Dr. Aamir Jeewa, Cardiologist and Medical Director of the Ventricular Assist Device Program, SickKids]

Dr. Jeewa: Mariam had undergone a heart transplant about five years ago for end stage heart failure. Unfortunately, her transplanted heart began to fail about a year ago, and this resulted in her having a cardiac arrest and being admitted to our Cardiac Critical Care unit.

[Text on screen: Dr. Osami Honjo, Cardiovascular Surgeon and Surgical Director of Heart Transplantation and Mechanical Circulatory Support, SickKids]

Dr. Honjo: Her transplanted heart was no longer functioning. The option of re- transplantation is quite limited due to a very active immune system that she has. So that means that it's highly likely that her body is going to reject the new organ. So, that is why removing the organ that's been rejected and implanting essentially the artificial heart was the only option.

[Linda, Mariam and SickKids staff standing around Mariam’s bed and talking]

Linda Antouan Adwar: They told us about the total artificial heart. I know it's new in Canada and it's hard. It's hard when you listen for something and this is the first time. But all these things, when they speak to us, we say yes, we need to survive our daughter life.

[Dr. Jeewa sitting in an office]

Dr. Jeewa: The total artificial heart is a surgically implanted device that replaces the right and left side of the heart with mechanical pulsatile pumps. This is a great example of how we can apply innovative therapies right at the bedside for children with heart failure to help bridge them to heart transplantation.

[Photos of Mariam in hospital]

Dr. Honjo: First of all, we have never done this.

[Dr. Honjo sitting in an office]

Dr. Honjo: Just because, you know, we didn't have a right patient in need for this particular procedure. This procedure is also very limited for certain body size.

[Mariam in her hospital bed]

Dr. Honjo: Mariam was one of the smallest patient in the world to have this device. So, there's a technical challenge as well.

[Mariam sticking a paper heart to Dr. Jeewa’s shirt, SickKids staff stand around her bed]

Dr. Jeewa: In the beginning, we really had to know if this was absolutely going to fit inside her chest. And so we reached out to our colleagues at Cincinnati Children's Hospital and they applied a novel imaging technique to look at the virtual 3-D fit of the device before we did the surgery. We also had the total artificial heart team fly out from Arizona to help with training and surgical guidance, and this collaboration really helped to make this a successful process.

[SickKids department hallway]

Linda Antouan Adwar: When she woke up, she say, did you take my heart and you give me the machine to make me survive? We say, yes. She said, I am okay now, I can go home? We say, yes, you can go home. You are okay now.

[Mariam working with two SickKids staff members]

Dr. Jeewa: This is truly a great example of how at SickKids, the Heart Center could come together and apply innovative technology to really help children with severe heart failure.

[Mariam playing guitar on her bed]

Dr. Honjo: SickKids transplant team and ventricular assist team has been evolved over the years and we have done a number of innovative procedures and new strategies.

[Dr. Honjo sitting in an office]

Dr. Honjo: And certainly, this is the biggest transplant in a mechanical support center in Canada. We were challenged by having this new device first implantation. But in terms of knowledge and skills, we are ready to do that.

[Photo of Mariam on a carousel]

Linda Antouan Adwar: Today, she's amazing. She attends her school in person, she meets her friends, she go to play. Day by day she shows us how much she is strong. Now she is moving around. Thanks God. This is a miracle.

[Screen fades from Mariam, Linda and SickKids staff waving at camera, to white screen with SickKids logo]

Finding an urgent solution to Mariam’s failing heart transplant

Mariam, now 12, was born with two forms of congenital heart disease, Epstein’s Anomaly and cardiomyopathy, which meant her right heart ventricle was not well-formed and the valve was leaking. In 2017, she successfully underwent her first heart transplant at SickKids, and was able to go home and resume her favourite activities like swimming and soccer.

A few years later, Mariam unexpectedly started to go into heart failure again and was admitted to SickKids. Her doctors tried various heart failure medications but Mariam’s condition only got worse. She would need a second transplant and the clinical team had to buy her time until a heart became available. As both ventricles of Mariam’s transplanted heart were showing signs of failure, the only option was a total artificial heart – device that can effectively replace an entire human heart for a limited period of time to help bridge patients to a transplant.

Two photos. In one a girl stands out of a wheelchair, in the second she stands next to a large machine.

Mariam relearning how to walk and move while attached to the total artificial heart.

“Total artificial hearts are rarely used in paediatric patients due to their size and limitations,” explains Mariam’s cardiologist, Dr. Aamir Jeewa, Medical Director of the Ventricular Assist Device Program at SickKids. “The device, intended for larger adults, has a large set of mechanical pumps that are surgically connected to vessels inside the chest and are driven by connections, outside of the body, to a large controller unit that is almost as tall as Mariam herself and runs 24 hours a day.”

The total artificial heart would provide Mariam with time until she could receive a second transplant, but she could not be connected to the device indefinitely. A number of factors such as potential infection risks, device failure and other health complications make the device a time-limited option, especially for a young person like Mariam.

It was a hard decision, but SickKids saved her life in the beginning, so we believed they would save her life again.

Since this was a first-of-its-kind procedure at SickKids, Mariam’s parents had a difficult decision to make. “We had a meeting and they told us about the total artificial heart. They explained to us all the risks and what would happen in the surgery and after,” says Linda Antouan Adwar, Mariam’s mom.

SickKids team embarks on innovative surgical procedure

Jeewa and Dr. Osami Honjo, Mariam’s cardiovascular surgeon, Surgical Director of Heart Transplantation and Mechanical Circulatory Support and Watson Family Chair in Cardiovascular Sciences at SickKids, quickly started to collaborate with American colleagues to train SickKids staff on the device, the surgical procedure and post-surgical care.

“Although we often manage other types of assistive devices, everything about the total artificial heart was new for the team. The fact that Mariam was one of the smallest patients in the world to have this device also presented a significant technical challenge,” explains Honjo.

Dr. Aamir Jeewa

Dr. Osami Honjo

On July 8, 2021, the surgery was successfully completed and Mariam began her recovery. With the support of her multidisciplinary team, she had to relearn how to walk, drink and eat while being attached to a large machine and tubes that kept her artificial heart pumping.

Watch Cincinnati Children’s Hospital Medical Center’s video on how the total artificial heart surgery works

“Mariam always needs to do everything fast, and sometimes she would forget she has the machine attached to her. I would have to tell her ‘Wait, slow down, you have a machine with you’ and she just wanted to go,” recalls Linda.

A couple months later, Mariam received her second heart transplant and third surgery with Honjo. He says, “Mariam and her family have gone through a lot and it’s been my honour to join them on this journey. I’m so happy to see her thrive and go back to her life once again. It’s fantastic.”

While Mariam still faces ongoing challenges with her health, she is enjoying being at home, playing with her brother and returning to school with her friends. “I’m so happy and we are so proud of her,” says Linda. “Her journey is not easy, but day by day she shows us how strong she is now.”

Two images of the same child. In one she wears a hoodie and a mask, in the other she wears a dress and poses with hands on hips.

Left: Mariam attending school after receiving her second heart transplant.

Right: Mariam today.