Meet Dr. Pedro Catarino, the new director of Aortic Surgery within the Smidt Heart Institute at Cedars-Sinai. Dr. Catarino joined Cedars-Sinai this summer from Royal Papworth Hospital and Cambridge University in Cambridge, England, where he served as the director of transplantation. While his focus will be on aortic surgery, he also brings his extensive experience of cardio-thoracic transplantation to the institute.

We talked to Dr. Catarino about why he's excited to contribute to the transplant program at Cedars-Sinai, recent innovations in heart and lung transplant that help save patient's lives, and what he likes about living in Los Angeles compared to Cambridge.

Dr. Pedro Catarino: I always wanted to be a doctor. I trained in England, where you go into medical school straight out of high school, so you have to make the decision to become a doctor early on.

I love my job, and it's a real privilege to do this sort of work. With cardiac and transplant surgery, it's very challenging, but it's not just about operating on a particular part of the body and fixing something that's wrong. 

Surgery addresses the mechanical issues, but you also have to think about the physiology of the patient: How is the heart working? How is the circulation supported? It's that combination of managing the anatomy and the physiology, which is unique to cardiac surgery, that I really enjoy.

PC: I worked as an attending physician in England for 12 years and was the director of transplant in my unit for a number of years. My career was progressing in a steady manner, but the things I wanted to innovate were quite difficult to introduce in England.

In transplantation, you can be limited by the number of donors you have. In the U.S., there are 35 to 40 organ donors per million, whereas in the United Kingdom there are 20 organ donors per million. These figures are even more dramatic if you just look at heart donors. In the U.S., surgeons perform four times the number of heart transplants per million than in the U.K.

With the National Health Service in England, there are also barriers to innovations and offering specialty therapies. In the U.S., there is a "can do" attitude which helps clinicians drive innovations forward. 

At Cedars-Sinai, there is strong institutional support for innovation. As the world-leading heart transplant program, we're now looking to do the same thing on the lung side and achieve a similar level of success in our lung transplant program. That's the big attraction.

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PC: A heart-lung transplant is quite a rare opportunity. There are only about 50 heart-lung transplants performed in the world every year. This surgery is for patients who have heart failure and lung failure and need both organs replaced.

With this type of transplant, you don't separate the heart and lungs, you take the heart and lung out as a block. For DCD, we knew that standard organ preservation on ice would be inadequate, so we needed a completely novel approach to keeping the heart-lung bloc viable. We used a portable device to perfuse the heart with blood to enable the beating heart to perfuse the lungs, keeping both organs healthy during transport between the donor and our hospital. This heart-lung block was perfused for eight hours, which is quite a long time. 

My patient was 23 years old and he'd had a congenital heart defect operated on as a baby. He'd been experiencing pulmonary hypertension for the past eight years, which had gradually gotten worse, and he'd had several cardiac arrests. In this case, the heart and lung he received from the donor worked very well. After surgery the patient did very well, he was a very lucky guy. 

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PC: One newer surgical advancement is what we in the field call a "mini-thoracotomy." Normally, a lung transplant operation is done with a big, 20- to 24-inch incision that comes across the breastbone and goes from one armpit to the other armpit.

What I've been doing is a lung surgery with a much smaller, 3-4 inch incision just under each nipple. By making a less invasive incision, the patient can start breathing much sooner on their own and recover more quickly.

I'm also in the process of developing a portable version of the ex vivo normothermic machine perfusion (NMP) machine for the lung. For transplant, this machine helps improve preservation of the lung from donor to recipient. Before we remove the lung from the donor, we give the lung one breath that stays in the lung during transport and then we use the machine to control blood flow through the lung during this process.

The aim of our work is to increase the length of time we can perfuse the lung, as right now we're only able to preserve the lung for six to eight hours. Using this new technology, if we can perfuse the lung for 24 hours or even longer, we can introduce some new therapies which might actually improve rather than just preserve the donor lungs.

Read: 7 Myths About Organ Donation

PC: I love L.A.! I have a teenage son who says that L.A. is the exact opposite of Cambridge, England. Cambridge is a small old town, with a university that has been around for more than 800 years. The university dominates life, and the town feels very studious and reserved.

Now we've come to this enormous, diverse, multicultural city, which is loud and glamorous and where the weather is terrific. The biggest difference we've noticed in our lives is that we spend a lot more time outdoors. We eat outside at home here in L.A., which would have been impossible in England.

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PC: I'd say that arguing about politics over a jigsaw puzzle is a typical pandemic evening in our household. I am also a keen cyclist and have been discovering new routes in the hills and along the coast.

Also, we have been trying to bring the vast range of cuisines in L.A. into our home until we can enjoy the restaurant scene L.A. is so famous for.