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In this major surgical innovation, the living valve from a donor’s heart is implanted in a patient, allowing it to grow with the child. This is an alternative to prosthetic valves that cannot grow as the patient matures. Traditionally used animal-derived and mechanical prosthetic valves deteriorate over time or require daily blood thinners. These non-living valves also need to be replaced over time, leading to additional open-heart surgeries, and are associated with a decreased survival rate after implantation.

This breakthrough procedure was led by Dr. David Kalfa, Chief of Cardiovascular Surgery, Co-director of the Nicklaus Children’s Heart Institute, and Professor and Researcher at the FIU Herbert Wertheim College of Medicine. The partial heart transplant highlights Dr. Kalfa as a pioneer in the development and clinical application of living heart valve implants for children.

“Partial heart transplants are redefining what’s possible in pediatric heart surgery. By transplanting a living valve, we are not just repairing a defect. We are restoring function in a way that allows the heart to grow naturally,” said Dr. Kalfa.

“Our goal is to move beyond temporary solutions like prosthetic materials and provide children with long-lasting, life-changing outcomes.”

Greyson, the 11-year-old patient who underwent the procedure, had two additional heart surgeries as a baby prior to coming to Nicklaus Children’s. His family is hopeful that he will not require another open-heart surgery in the future, thanks to this innovative procedure.

“Going in for a second opinion is what brought me to Nicklaus Children’s and Dr. Kalfa with his years of expertise and research in the field, and I am so grateful for that,” says Piera Archila, Greyson’s mother.

“Greyson underwent open-heart surgery in New York and has since been to a few other children’s hospitals in Florida and outside the state in search for answers for his condition. Nicklaus Children’s offered something unique in that Greyson can now grow up without needing another open-heart surgery.”

Congenital heart defects are the most common birth defects, affecting nearly 1% of newborns in the U.S., or about 40,000 infants. Of those infants born with CHD, half will need an operation to fix or replace a valve.

Dr. Kalfa’s work is supported in part by grants from the National Institutes of Health in collaboration with FIU, advancing research and clinical innovation in partial heart transplantation and pediatric valve preservation techniques.

Nicklaus Children’s Hospital is ranked among the nation’s “Best Children’s Hospitals” by U.S. News & World Report, with seven specialty-ranked programs, including Nicklaus Children’s Heart Institute, ranked the #1 heart program for children in South Florida.

Cardiovascular Surgeons and Interventionists within Nicklaus Children’s Heart Institute have successfully performed the following procedures within Nicklaus Children’s Hospital:

• Partial Heart Valve Transplantation: One of the first in the nation to offer this type of pediatric heart surgery. In this procedure, only a portion of the damaged heart valve is replaced or transplanted with a living heart valve, preserving the remaining functional valve tissue to optimize heart function. The Heart Institute’s Cardiovascular Surgery program is leading the first CHSS-based national registry in pediatric cardiac surgery, the registry is focused on understanding the new technique of partial heart transplant nationwide.

• Pulmonary Embolism Response Team: The Catheterization Lab team within Nicklaus Children’s is the first in Florida to offer a PERT in an effort to quickly and simultaneously engage multiple physician specialists to determine the best course of action and coordinate the clinical care for patients who arrive with Pulmonary Embolisms.

• Biventricular Repair: Designed to avoid long-term issues related to having only one single ventricle, biventricular repairs are a complex procedure aimed at restoring normal blood flow by enabling both ventricles of the heart to function effectively. Nicklaus Children’s is among the few centers in the nation offering the REV operation, in which the cardiac surgical team corrects transposition of the great arteries with ventricular septal defect and pulmonary stenosis by rerouting blood flow and reconstructing the heart’s anatomy.

• Axillary (Armpit) Open-Heart Surgery: Nicklaus Children’s is one of only a few centers nationwide and the only pediatric hospital in Florida offering Axillary (armpit) open-heart surgery. This innovative approach delivers the same lifesaving heart repair with less pain, faster recovery, and minimal visible scarring.

• Transcatheter Fontan Completion: Through the Kawashima procedure, Nicklaus Children’s, being one of the few hospitals in the world to offer it, preps patients for the Transcatheter Fontan Completion. The specialized technique reroutes venous blood directly to the lungs, bypassing the heart, which is an intermediary step before the final stage of placing a stent to ensure Fontan circulation. During this process, Cardiac surgeons and interventionists at Nicklaus Children’s collaborate to save children born with only one working ventricle without the need of open-heart surgery.

• Innovative Valve Repair: Nicklaus Children’s is among a few centers in the U.S. performing innovative valve repairs and replacements using a child’s own living, growing tissue. This includes advanced pulmonary and aortic Ozaki procedures, which use the patient’s own tissue to create durable, growth-accommodating heart valves.

• Norwood Valved Sano: A modification of the Norwood procedure for hypoplastic left heart syndrome, incorporating a valved conduit to improve blood flow from the right ventricle to the pulmonary arteries.

• Virtual Reality/Augmented Reality: Used as a surgical planning tool to design a specialized procedure for patients undergoing intervention, Nicklaus Children’s cardiovascular surgeons and interventionists are the first in Florida to use VR before and during procedures for more precision and accuracy.

• Percutaneous ECMO: A minimally invasive technique used to provide temporary life support for patients with severe cardiac failure. In this procedure, ECMO cannulas are inserted through the skin into large blood vessels without requiring surgery. The ECMO machine takes over the function of the heart and lungs by oxygenating the blood and removing carbon dioxide, allowing the organs to rest and recover. This approach, which is only offered in Florida at Nicklaus Children’s and is the third in the country to do so, allows for shorter procedure time and is less invasive compared to traditional surgical methods.

• Percutaneous Sinus Venosus Defect Closure – Nicklaus Children’s is the first in Florida to offer the technique to repair an abnormal connection between the pulmonary veins and the right atrium without the need for open-heart surgery. Interventional cardiologists use catheter-based technology to place a closure device, restoring normal blood flow and reducing the risks associated with invasive surgery. This approach offers quicker recovery times, fewer complications, and improved overall outcomes.

• Ongoing Research Development: The Nicklaus Children’s Heart Institute is at the forefront of research in Congenital Heart Disorders by expanding its team with world-class leaders in AI, computational modeling, tissue engineering, xenotransplantation, and regenerative therapies such as stem cells and exosomes.

Under the leadership of Nicklaus Children’s Heart Institute co-directors Dr. David M. Kalfa, chief of the Section of Cardiovascular Surgery, and Dr. Shyam Sathanandam, chief of cardiovascular medicine, Nicklaus Children’s is leading the way in pediatric cardiac care. Dr. Kalfa also serves as a professor and researcher at FIU’s Herbert Wertheim College of Medicine, where he is focused on transplant innovation, surgical planning, and robotics within surgery.

“My team and I at the Nicklaus Children’s Heart Institute are redefining the possibilities within pediatric cardiovascular surgery in our tireless mission to save the lives of children born with congenital heart disorders,” says Dr. Kalfa. “The surgical techniques used within our operating rooms are designed to ensure optimal outcomes while reducing the need for additional operations. By tailoring each procedure to the unique needs of our patients, we strive to provide enduring care to families that enhances a child’s quality of life and long-term heart health. We are also expanding our clinical team by hiring engineers who work alongside surgeons at the bedside to continuously advance innovation and improve outcomes for our patients.”

“Building on the foundation of my previous research experience, we are transforming care within the Cath lab at Nicklaus Children’s to deliver the most precise and minimally invasive procedures,” says Dr. Sathanandam. “Our mission is to ensure every patient receives life-saving treatments, giving them the best chance at a healthier future.”