Alberta Innovates- Health Solutions

He claims he is like a mechanic in a garage retooling engines for higher performance.

Dr. Ivan Rebeyka spends hours in his research lab developing surgical techniques and technology he can use to enhance the outcome of complex operations performed on hearts, some no bigger than a golf ball.

The renowned pediatric heart surgeon is the head of the only program in the province that surgically treats children, and some adults, who are born with congenital heart defects. Virtually all of the babies born in Alberta with heart malformations will be sent to the University of Alberta Hospital for their surgery. Newborns account for 30% of these operations.

Dr. Rebeyka was recruited from Toronto's Hospital for Sick Children 18 months ago to head Pediatric Cardiovascular Surgery at the U of A Hospital.

The most common problems seen in patients admitted to the hospital are holes in the heart, blocked or narrowed heart valves, chambers that are switched around, and abnormal connections between vessels and the heart chambers.

Inventing innovative solutions to problems in treating these conditions is at the heart of Dr. Rebeyka's research. Although his skills as an acclaimed surgeon are in high demand - he performs 350 operations each year - he continues to devote 40% of his time to research.

Determining the safest way to stop an infant's heart during surgery is a current area of interest. It's a situation Dr. Rebeyka encounters on a regular basis.

Just about every time surgeons fix an infant's heart, they must stop the organ while the baby is on a heart/lung machine. Doing so can put the heart at risk for injury that may cause it to function improperly or take longer to heal. It's the first 24 to 48 hours after an operation that are the most critical to a positive outcome, Dr. Rebeyka explains. "It's the time when we want the child's heart to be functioning as well as possible."

Exploring the possibility of fetal cardiac surgery - the ability to repair heart defects while a fetus is still in the womb - is another of Dr. Rebeyka's innovative areas of research. "There is a rationale for believing that some day we will technically be able to repair some heart defects before a fetus is born," he says.

With the aid of ultrasound (fetal echocardiography), doctors are now able to detect heart lesions in a fetus as early as 12 weeks of gestation. But repairs can't be done until the fetus is born. "What may be a very minor problem in the heart of a fetus during the early stages of development may end up becoming a much more severe heart lesion by the time the fetus is born," Dr. Rebeyka says. "If you have a blockage or a narrowing somewhere in the heart of the fetus, it may change the way the blood flows through the heart while it is developing. This may really affect how the chambers develop. If we could do something very early in the development to get that chamber to grow in a more normal fashion, then it is possible that the fetus would be born with a normally functioning heart."

So far, doctors in San Francisco and Philadelphia have been able to successfully treat lung and abdominal problems in fetuses. But new methodology and technology must be developed before doctors will be able to perform similar operations on the hearts of fetuses.

Early intervention is the premise behind Dr. Rebeyka's research on how the lungs of newborns develop during the first few months of life. Accelerating the maturation process of the lungs could allow doctors to perform operations sooner than is currently thought possible. "There are several procedures we do that require us to wait until a baby is six months old when their lungs are more fully developed. Performing these operations earlier would have a lot of advantages in terms of treating an infant's condition." Dr. Rebeyka has shown that heparin, a blood thinner, will help the lungs of a newborn sheep mature at a faster rate. He is currently working on techniques that would allow him to transfer this methodology to human patients.

For more information on pediatric heart disease, please check the following website: http://www.hsfacal.org/

Dr. Rebeyka received an AHFMR Independent Establishment Grant to set up his lab. He also receives support from the Medical Research Council of Canada and the Heart and Stroke Foundation.