Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center, partially credits the increase in liver transplants to the use of machine perfusion, a technology that circulates oxygen-rich, nutrient-rich, blood-based solution through donor organs until transplantation. Machine perfusion reduces graft dysfunction, allowing organs to be viable longer and improving physicians’ assessments of the organs ahead of transplantation—all of which has served to increase donor organ availability, Kim said.

A willingness to take on the most complex cases also helped drive the increase in lung transplants, according to Kim, as Cedars-Sinai is known for accepting high-risk cases that had been previously turned away by other institutions.

“We are committed to staying on the leading edge of transplant technology to ensure the best results for our patients, with survival outcomes that continue to meet or exceed the national average,” Kim said. “The more organs we can transplant, the more patients can receive a second chance at life. It’s a privilege to not only help these patients, but also to honor the donors who gave the ultimate gift of life.”

According to published data from the Organ Procurement and Transplantation Network (OPTN), 49,065 transplants occurred in the U.S. in 2025—more than in any other year. With records continuing to be set year over year, the OPTN has set an ambitious nationwide goal of 60,000 deceased donor transplants annually by the end of 2026.

New Records in Liver and Lung Transplants, Living Kidney Donors

The Department of Cardiac Surgery in the Smidt Heart Institute is the largest heart transplant center by volume in California, with clinical and surgical teams performing 114 adult heart transplants in 2025. The team, led by Joanna Chikwe, MD, chair of the Department of Cardiac Surgery, Fardad Esmailian, MD, surgical director of the Heart Transplant Program, and Jon Kobashigawa, MD, director of the Heart Transplant Program in the Department of Cardiology, has maintained an average of more than 100 heart transplants each year for the last 13 years, a current record in the U.S.

Surgical Director Dominick Megna, MD, and Medical Director Reinaldo Rampolla, MD, led the lung transplant team to perform 93 lung transplants in 2025—the most ever at Cedars-Sinai—surpassing its previous record of 88 in 2024. The Lung Transplant Program in the Smidt Heart Institute at Cedars-Sinai continues to be the largest by volume in California and, in 2025, earned a place as a top 10 center by volume in the U.S.

The Liver Transplant Program also reached new milestones. The team, led by Kim, as surgical director, and Alexander Kuo, MD, professor of Medicine and medical director of the Liver Transplant Program, performed 145 liver transplants in 2025, exceeding the 2024 record of 136 transplants.

The Kidney Transplant Program team, led by Stanley Jordan, MD, medical director of the Comprehensive Transplant Center’s Human Leukocyte Antigen and Transplant Immunology Laboratory, and Tsuyoshi Todo, MD, surgical director, completed 324 transplants in 2025, including one pancreas-kidney transplant.

Notably, the team performed 80 living donor kidney transplants in 2025, setting a record for the number of living donor kidney transplants performed at Cedars-Sinai, with a more than 15% increase over the previously held record volume of 69 in 2013. This program, led by Steven Wisel, MD, and Reiad Najjar, MD, has transformed into a completely robotic surgical program.

“These achievements are a testament to the hardworking team at the Cedars-Sinai Comprehensive Transplant Center,” said Kim, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine. “But none of these lifesaving procedures would be possible without the altruism of organ donors and their families. We are tremendously grateful to those who give the gift of life through organ donation.”

Read more from Cedars-Sinai Stories and Insights: After Lung Transplant, a Return to Running

Reid had been diagnosed with heart failure at Cedars-Sinai after experiencing fatigue and shortness of breath. The condition occurs when the heart is too weak to pump enough blood throughout the body, causing fluid to build up.

Reid told Good Morning America co-anchor Michael Strahan he initially dismissed his symptoms. He urged others—especially people of color—to seek medical care when something feels wrong.

“A lot of times, we don’t go because we don’t want the bad news, or we’re too busy just hustling, trying to make it from day to day,” Reid said. “And we … feel like we don’t got time, or we’ll get over it. Well, you might not.”

Jones told Good Morning America that during a follow-up visit, it was clear medications were no longer controlling Reid’s condition.

“He came in very swollen again,” she said, “and that is a little unusual in somebody who’s been started on treatment.”

DiChiacchio told Good Morning America that bloodwork revealed the condition was worsening and Reid needed an immediate heart transplant.

“So when we think about status for a heart transplant,” DiChiacchio said, “he was very high on that list because of how ill he was and really dealing with a kind of life or death situation.”

Days later a donor heart became available, and DiChiacchio and team successfully completed the transplant.

 Reid told Strahan he is grateful for a second chance at life.

“This thing is … a beautiful life,” he said. “And, you know, I wanna be around for it.”

According to the Centers for Disease Control and Prevention, 6.7 million U.S. adults have heart failure. Risk factors include high blood pressure, diabetes and coronary artery disease, though regular exercise, adequate sleep and proper nutrition can lower risk.

Click here to watch the entire segment of Good Morning America.

“We continue to expand the number of clinicians, surgeons and physician-scientists coming together to address the most challenging heart conditions,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute. “As our program grows, we remain committed to delivering care guided by extensive research.”

Fetal Cardiology

Mark Sklansky, MD, is a leader in fetal echocardiography, the detailed evaluation of the heart prior to delivery. He is medical director of Pediatric and Fetal Cardiology Outreach in the Smidt Heart Institute and Guerin Children's, where he uses ultrasound to identify heart conditions before birth and brings his expertise to the broader community.

Prenatal detection of heart problems allows fetal cardiologists, in partnership with obstetricians, maternal-fetal medicine specialists and neonatologists, to create a treatment plan for when the baby is born. In some cases, pediatric cardiac interventionalists, working with maternal-fetal medicine specialists, can perform a minimally invasive procedure to correct the heart defect before birth. In other cases, newborns can undergo lifesaving surgery or catheter-based therapies within hours after delivery.

Prior to joining Cedars-Sinai, Sklansky founded the Children’s Heart Center at UCLA where he was also chief of Pediatric Cardiology. He has authored or co-authored more than 100 scientific papers, including the American Heart Association’s scientific statement on the diagnosis and treatment of fetal cardiac disease.

Cardiac Surgery

Laura DiChiacchio, MD, PhD, is director of Extracorporeal Membrane Oxygenation, a form of life support that temporarily does the work of a person’s heart or lungs.

DiChiacchio also directs the Ex Situ Perfusion Program. Under DiChiacchio’s leadership, the team uses specialized machines to keep donor organs alive outside of the body and to improve the function of thoracic organs following transplantation. The team also conducts translational research on thoracic organ recovery and reconditioning. 

DiChiacchio is a cardiac surgeon who focuses on adult heart and lung transplantation. DiChiacchio completed a fellowship in thoracic transplantation and mechanical circulatory support in the Smidt Heart Institute Department of Cardiac Surgery and a fellowship in cardiothoracic surgery at the University of Utah.

Organ Preservation

As director of Heart and Lung Protection and Management, Yoshikazu Suzuki, MD, procures donor organs for patients awaiting transplant, ensuring safety and reliability through each step. He uses the latest technologies to ensure organs are well-preserved, and he is tasked with creating an accessible database of donor hearts and lungs.

Previously, Suzuki was clinical associate professor in the Division of Cardiovascular Surgery at the Perelman School of Medicine at the University of Pennsylvania.

Pediatric Interventional Cardiology

Stephen Nageotte, MD, is an interventional cardiologist, an expert in using minimally invasive procedures to diagnose and treat children and adults born with a heart condition. These procedures involve using a thin, flexible tube called a catheter to view the heart and repair anatomical abnormalities, such as narrowed blood vessels or an unclosed hole in the heart. Nageotte directs the Congenital Catheterization Laboratory in the Smidt Heart Institute and Guerin Children’s. 

Nageotte joins Cedars-Sinai from Loma Linda University Children’s Hospital, where he was director of the Pediatric Cardiac Catheterization Laboratory and an associate professor. Nageotte also conducts research and has authored several peer-reviewed papers on congenital heart disease and treatments.

The Smidt Heart Institute’s cardiology, heart and vascular surgery programs are rated in the top 10 in the U.S. and #1 in California by U.S. News & World Report.

Read more from the Cedars-Sinai Blog: Why Accreditation Matters in Choosing a Congenital Heart Program

In an essay published in Variety, Malkin revealed that soon after covering the 2025 Academy Awards, he underwent surgery at Cedars-Sinai for an aortic aneurysm. Malkin, 55, is now back on the red carpet, feeling stronger by the day and advocating for preventive heart health to anyone who asks.

Malkin wants to observe Aortic Disease Awareness Month in September by sharing his story far and wide to encourage people with high risk factors—family history, smoking or muscle disease—to consider seeing a physician for screening.

“I've always said if I can help one person, that makes it worth it,” Malkin said.

An aortic aneurysm is a bulge in the large artery that runs through the center of the body. Aortic aneurysms are often found incidentally, as Malkin’s was. If an aneurysm grows to a certain size, it can tear or rupture—resulting in internal bleeding and even death.

“Marc’s case is an example of how you can be young and healthy and have an aneurysm,” said Dominick Megna, MD, surgical co-director of the Cardiac Surgery Intensive Care Unit and a cardiothoracic surgeon in the Smidt Heart Institute at Cedars-Sinai.

Aneurysms are especially dangerous because they don’t usually cause symptoms.

“Aneurysms can be asymptomatic and undiagnosed until rupture, which is why they’re often referred to as a  ‘silent killer’ or ‘time bomb,’” said Ali Azizzadeh, MD, director of the Division of Vascular Surgery at Cedars-Sinai. “We encourage all patients with risk factors or family history to get screened.”

Malkin had originally made an appointment with cardiologist Erika Jones, MD, to manage his high cholesterol and track his heart health. When Jones discovered an aortic root aneurysm in Malkin’s chest, it caught everyone by surprise.

 “I was really scared,” Malkin said. “But both my cardiologist and surgeon said ‘knowledge is power.

Malkin enrolled in the Aortic Surveillance Clinic in the Smidt Heart Institute and began meeting with surgeons, nurses and cardiologists. He underwent routine imaging and screening to measure the size of his aneurysm, which was growing to the point of requiring surgery.

“When an aneurysm grows to 5.5 centimeters in men or 5 centimeters in women, patients are usually referred for surgery,” Megna said. “Some people choose to get surgery sooner to end their worry. Each patient and their care team can make treatment choices specific to their emotional and physical needs.” 

Malkin, the senior culture and events editor at Variety, was worried the surgery might put an end to the work he loves. 

“I cried,” Malkin said. “And I’ve admitted this before: I asked my surgeon if we could wait until after the Oscars.”

Malkin underwent surgery about a week after the 2025 Academy Awards and today is focused on keeping himself healthy. He works out three times a week at the cardiac rehab center at Cedars-Sinai, where nurses and physical therapists monitor his heart activity. He encourages everyone he meets—celebrities and neighbors alike—to see a cardiologist if they have a family history of heart disease or any cardiac risk factors. 

“I tell patients they won’t feel totally differently physically, but mentally they’ll know they’ve corrected something to prevent future catastrophe,” Megna said.

Read more from Discoveries Magazine: A Pioneering Heart Procedure

Cedars-Sinai cardiologist Erika Jones, MD, discovered that Malkin had an aortic root aneurysm, a weakening of the aortic wall that can rupture and be fatal if left untreated. She referred him to the Smidt Heart Institute Aortic Surveillance Clinic, which monitored the aneurysm as it grew.

Eventually, the aneurysm became large enough that it could be dangerous. Dominick Megna, MD, surgical co-director of the Cardiac Surgery Intensive Care Unit, told Malkin he would eventually require a valve-sparing root replacement, a surgical procedure that removes the damaged part of the aorta while preserving the valve. Malkin underwent the procedure in March 2025.

“It was better to be preventive than risk an emergency situation,” Malkin wrote.

After a long surgery and eight days in the hospital, Malkin worried about the impact of his recovery on his career. Would his life ever return to normal?

But thanks to his participation in the cardiac rehabilitation program at Cedars-Sinai three days a week, Malkin is back at work, feeling healthy and resilient.

“I couldn’t look at my scar for at least a month after the surgery,” Malkin said. “Today, I show it to anyone who asks because I am proud of where I’ve been and what I’ve survived.”

Malkin is now spreading awareness about heart health, speaking at American Heart Association events and urging people to see their doctors. He wants to send the message that “if something is feeling off in your body or you have heart disease in your family, please talk to your doctor.”

Click here to read the complete article from Variety.

A CT scan at Pulido’s community hospital revealed a large tumor on Pulido’s right ovary—roughly the size of a small basketball. Surgeons removed the cancerous mass, only to discover a smaller tumor on the left ovary, which was removed three months later. Believing the worst was behind her, Pulido returned to work.

But her sense of normalcy was short-lived. Within a month, sharp pains returned.

“I was getting the worst shoulder pain I could get on my left side,” Pulido said. “I went back to the emergency room, and they did another CT scan. Then they saw another tumor. It was much bigger than the first one.”

The doctors diagnosed Pulido—just 22 years old— with a rare condition known as growing teratoma syndrome. The condition occurs when tumor tissue continues to grow rapidly and uncontrollably, pressing on vital organs like the heart and lungs.

The third and largest tumor, about 14 centimeters, was located near Pulido’s liver. Doctors recommended chemotherapy to shrink the tumor, but it failed, and the mass kept growing at an alarming rate. The tumor had progressed so much in size that it was pressing up against her right lung, shifting her heart to the far-left side, essentially under Pulido’s armpit.

By May 2024, the tumor had reached 27 centimeters, weighed more than 40 pounds, and left her wheelchair-bound and dependent on oxygen.

Opting for High-Stakes Surgery Despite the Risks

When chemotherapy failed, surgically removing the tumor was the inevitable choice. After multiple surgery delays and six failed attempts to put Pulido under anesthesia, her original care team halted the procedure altogether.

“The doctors came out of the surgery and told my mom they couldn’t move forward with the surgery because I couldn’t go under anesthesia without flatlining,” Pulido said. “They said the next best step for me would be hospice care.”

Still, Pulido and her family refused to give up.

In their last push for hope, her family sought several opinions from various institutions, but ultimately chose to seek care from Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.

Ferrone quickly assembled a team of experienced anesthesiologists and 13 surgeons from various specialties, including cardiothoracic and liver transplant teams, to perform the complex surgery.

“The tumor was so large and heavy, and it involved such essential blood vessels that if you injure them, it would be very, very difficult to repair them. And an injury like that could quickly lead to death on the operating room table,” Ferrone said.

Yet, Pulido was willing to take her chances.

“The only one that could decide if I do go or stay on that surgery table would be God,” Pulido said. “And I just had really high hopes and faith that I was going to make it through.”

Awake on the Operating Table

The surgical team included Tyler Gunn, MD, an assistant professor of Cardiac Surgery at Smidt Heart Institute at Cedars-Sinai. During the first half of the surgery, Gunn performed a critical procedure called preoperative extracorporeal membrane oxygenation, or ECMO, using only local anesthesia while Pulido was still awake in order to keep her respiration and heartbeat stable and to stop her from flatlining.

“When someone goes to sleep for surgery, their muscle tone decreases and the blood flow to the heart can decrease as well. And they can have trouble with their blood pressure, breathing and heart rate,” Gunn said.

Furthermore, as Pulido’s heart was unstable, lying flat on the operating table was not an option. To work around this, the team placed Pulido on an incline for the first half of the surgery.

“In my mind, I just kept saying, ‘You got this, just keep fighting, keep pushing,’” Pulido said.

The long, arduous surgery was a success.

“In the end, we spent over 14 hours operating with all of the different teams working together,” Ferrone said. “It’s a testament to the working environment of Cedars-Sinai. It is an incredibly collaborative institution and patient care comes first, no matter what.”

Within a week after the tumor removal, Pulido’s lungs were able to fully expand, and her heart was back in its rightful place. She was able to breathe on her own for the first time in six months. 

From Wheelchair to Walking Down the Aisle

Amid her harrowing healthcare journey, Pulido found a few uplifting moments, including an important life milestone. Last year, during the halftime show on Super Bowl Sunday, her longtime boyfriend, Jeffrey Chavez, who had stood by her through every challenge, surprised her with a proposal.

“He was always there every day with me, whether it was before work, after work, he was there and visiting me all the time at my mom's house,” Pulido said.

For Ferrone, watching Pulido through her demanding recovery process has been incredibly gratifying.

“When she returned to the clinic a month later, the entire staff and I were amazed. Just six weeks earlier, she had been wheeled in, in a wheelchair. Now she walked through the doors,” Ferrone said. “She's an incredibly strong young woman and has a wonderfully supportive family.”

On June 21, a little over a year after her life-changing surgery, Pulido walked down the aisle and tied the knot with Chavez in front of her close family and friends. While Pulido will need to continue to monitor her health closely, the newlywed is hopeful and looks forward to the next phase of life.  

“I feel really good. I feel like a new person. I see the world differently,” Pulido said. “Every day is a positive day.”

Read more on the Cedars-Sinai Blog: Women in Surgery at Cedars-Sinai.

The three-star quality rating from the Society of Thoracic Surgeons is the organization’s highest rating and recognizes Cedars-Sinai’s cardiac surgery team for its outstanding patient care and low rates of surgical and post-surgical complications.

“Our team has long held the highest recognitions for outcomes in coronary bypass, heart valve and transplant surgery,” said Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery at Cedars-Sinai and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery. “This new rating is testament to our program’s quality and safety record across the entire spectrum of cardiac surgery.”

The Society of Thoracic Surgeons established a database in 1989 to track quality and patient safety. The database includes information voluntarily reported by most hospitals that perform heart surgery in the U.S.

The three-star rating for Cedars-Sinai is based on 1,567 adult cardiac surgery procedures performed between Jan. 1, 2022, and Dec. 31, 2024. These include coronary artery bypass grafting, aortic valve replacement, mitral valve repair and replacement, and combinations of these procedures. The metrics used to create the score apply to any heart surgery done at Cedars-Sinai during that time period, including patients who had multiple surgeries such as a coronary artery bypass grafting and aortic valve repair.

“The growth of the cardiac surgery team is truly remarkable,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty. “The team melds cutting-edge research and surgical skill to ensure the finest patient care outcomes.”   

The Smidt Heart Institute’s cardiology, heart and vascular surgery programs are rated in the top 10 in the U.S. and #1 in California by U.S. News & World Report.

Read more from the Cedars-Sinai Blog: After Heart Surgery, More to Love

A former pack-a-day smoker, Shaw fits the profile of someone at risk for an aneurysm, even though he quit smoking more than two decades ago. That’s because current and former smokers are significantly more likely to develop an aortic aneurysm than nonsmokers. High blood pressure and family history are also risk factors.

The danger can go hidden because aneurysms don’t typically cause symptoms, although they can sometimes lead to indigestion, as was the case for Shaw, or more subtle issues. If an aneurysm keeps growing, it can burst—most people in whom this happens die from internal bleeding. That’s why vascular surgeons urge people like Shaw to get imaging tests that can help physicians find an aneurysm.

“If you have a family history of an aortic aneurysm, or you are a smoker, you should be screened,” said Cedars-Sinai vascular surgeon Elizabeth Chou, MD.

Chou explained that people at risk can see a primary care doctor, a cardiologist or a vascular surgeon for an imaging test such as an ultrasound or CT scan. Studies report that among people who get screened, about 3%-8% are diagnosed with abdominal aortic aneurysm.

An electrician and handyman who likes to stay active, Shaw had choices to make to prevent life-threatening rupture: minimally invasive catheter-based surgery or open surgery through an incision?

When Shaw met Chou, he learned his best option for his condition and lifestyle was an open surgery, where Chou and team would create an incision in the abdomen, sew a tube to the healthy parts of the aorta, and remove the aneurysm.

For people who have a smaller aortic aneurysm, a vascular surgeon will recommend an annual CT scan to see if it grows.

“Some aneurysms do not grow for many years,” said Chou, who is also assistant professor of Vascular Surgery in the Smidt Heart Institute at Cedars-Sinai. “Some people may never need surgery or any sort of repair, only routine monitoring.” She added that research is underway to help physicians understand why some aneurysms grow and some stay the same.

If an aneurysm reaches a certain size—about 5 ½ centimeters in men and 5 centimeters in women—a vascular surgeon typically recommends surgery.

Some patients may benefit from a minimally invasive surgery, during which a catheter is threaded through an incision in a patient’s groin until it reaches the aneurysm. The surgeon positions a tube in the area of the aneurysm and relines the aorta and aneurysm to divert blood flow into the relined aorta and away from the aneurysm. This option is usually recommended for patients who are older, frail, and generally wouldn’t recover well from an open surgery.  Some people also choose this option because they prefer a less invasive approach and are willing to undergo annual follow-ups to make sure the relining remains intact.

Shaw felt confident in Chou’s recommendation for an open surgery

“I live on a ranch,” he said. “I toss around bales of hay and 50-pound bags of horse feed. I need to be totally well. Anything other than a completely replaced artery was not acceptable because of my lifestyle.”

Chou said the most important part of the process is for patients to understand what the aneurysm is and how it affects their life.

“There are pros and cons to open surgery, minimally invasive surgery, and watching and waiting,” she said. “Our utmost priority is ensuring that each patient is comfortable with their decision. What we want people to know is that they need to be screened, and we will take the next steps together.”

After almost a week of recovery in the hospital and four weeks of recovery with light activity at home, Shaw returned to horseback riding on his ranch in Santa Maria, California.

“This could have ruptured at any time,” he said. “I was a walking time bomb. Now I’m totally healthy.”

Read more on the Cedars-Sinai Newsroom: Smidt Heart Institute Opens Aortic Surveillance Clinic

At home in Puerto Rico during college breaks, she perfected her rowing technique in the island’s familiar waters.

Less than a decade later she was in Japan, rowing the Sea Forest Waterway in the Tokyo 2020 Summer Olympic Games as the first-ever female rower to represent Puerto Rico.

With the 2024 Summer Olympics now underway in Paris, Veronica Toro Arana, MD, a Cedars-Sinai cardiothoracic surgery resident, is reflecting on what she learned from the elite sports world and how those lessons are helping fuel her surgical training.

“Rigorous and deliberate practice, the ability to handle high-pressure situations, technical expertise, an openness to coaching and a continuous pursuit of improvement were all important parts of training for the Tokyo Olympics,” Toro Arana said. “And now I’m applying those learnings as I train to be a heart surgeon.”

Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai, is Toro Arana’s mentor.

“Exceptional surgical residents like Dr. Toro Arana are recruited for their intellect, passion for the medical profession and commitment to saving lives,” Chikwe said. “They also are recruited because they are well-rounded individuals who enrich Cedars-Sinai with their valuable life lessons, experiences and accomplishments.”

A Competitive Path

In the medical residency application she submitted to Cedars-Sinai, Toro Arana wrote: “It took me nine years of daily practice to make it to the Olympics, and I could spend many more years in search of the most powerful stroke that causes the least disruption to the velocity and balance of the boat.

“Similarly, the cardiothoracic surgeons I have worked with are constantly searching for more effective techniques to operate on the heart and its vasculature, limiting the intrinsic damage caused by their intervention. This pursuit of precision and excellence, combined with a constant push towards innovation, drove me to surgery from an early age.”

Growing up, Toro Arana dabbled in sports. But academics were her sweet spot.

“The only Olympics I thought about were the Math Olympics,” she said, “which I competed in every year, starting in seventh grade.”

When the local hospital’s chief of Trauma Surgery came to speak at Toro Arana’s school when she was 15, she quizzed him about experiences in the operating room.

“What do you do when one of your patients dies in your OR?” she asked, unintimidated. A few days later she was watching him operate on a patient with a gunshot wound, attempting a new lifesaving procedure. She took that experience to MIT, determined to join the ranks of people pushing the boundaries of medical innovation.

No Room for Intimidation

Although Toro Arana didn’t learn to row until college, she was not intimidated by teammates who had been recruited to join the team. She was motivated by them, driven to work even harder.

When she learned about opportunities to represent Puerto Rico at national and international rowing competitions, motivation kicked in again. Coaches told her she should consider training for the 2020 Tokyo Olympics. She was excited, but medical school also was on her agenda. She would need to balance both.

After two years of medical school at Stanford University, Toro Arana put education on a three-year hold to train full time with premier coaches—training that would get her to the Olympics.

“The opportunity to compete as the first woman to row in the Olympics for Puerto Rico was a big incentive for me, and I made many sacrifices to make that happen,” she said.

Important Takeaways

Toro Arana placed 21st out of 32 competitors; what she won was priceless.  

As she wrote in her residency application: “I envision standing on the right side of my patient, my scalpel poised on the skin over their sternum, feeling the same way that I felt when I heard the announcer at the start line of my first Olympic race: confident that I have planned and prepared to the extent of what was possible, humbled by the uncertainty of what truly awaits, standing on my toes ready to respond to whatever may arise down the course, with absolute commitment to perform my best at the task at hand.”

Toro Arana has a packed schedule these days—12-hour shifts at Cedars-Sinai, six days a week—but she still rows and competes when she has time. Next month she will participate in the World Rowing Beach Sprints Finals in Italy.

“I don’t want to lose that part of myself,” she said.

At dawn on a recent weekday, Toro Arana was at the water’s edge in Marina del Rey, just off a night shift. Oars in hand, she sat down in her boat and rowed. 

Read more on the Cedars-Sinai Blog: Navy Veteran Gets Lifesaving Heart Surgery

Barr’s death at 39 from sudden cardiac arrest was caused by mitral valve prolapse—a heart valve defect that can affect the heart’s ability to pump blood. It can, in some cases, lead to death.

Now, thanks to the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act—legislation named in honor of Barr that allocates funding through the National Heart, Lung, and Blood Institute to study heart valve disease and risk factors that may lead to sudden cardiac arrest—the lives of millions of Americans with the condition could be saved.

The Smidt Heart Institute recently received CAROL Act funding to study the connection between ventricular arrhythmias—abnormal heartbeats that start in the heart’s two lower chambers—and an elevated risk of sudden cardiac death in patients with mitral valve disease.

This sub-study of the National Institutes of Health-sponsored PRIMARY clinical trial is led by Smidt Heart Institute cardiologist and Chair of the Department of Cardiology Christine Albert, MD, MPH. Albert, the Lee and Harold Kapelovitz Distinguished Chair in Cardiology at the Smidt Heart Institute and past president of the Heart Rhythm Society, is noted for her pioneering contributions to cardiac electrophysiology research.

The PRIMARY trial is directed by Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at Cedars-Sinai. The randomized trial—across 60 sites in six countries—compares transcatheter edge-to-edge mitral repair (using a clip) to surgical repair for patients with severe mitral regurgitation caused by mitral valve prolapse.

The PRIMARY trial is co-chaired by interventional cardiologist Raj Makkar, MD, Cedars-Sinai’s vice president of Cardiovascular Innovation and Intervention, associate director of the Smidt Heart Institute and a professor of Cardiology in the Department of Cardiology.

To kick off Heart Month, the Cedars-Sinai Newsroom sat down with Chikwe and Makkar—experts in robotic and minimally invasive surgical techniques and transcatheter edge-to-edge repair—to discuss mitral valve disease and advancements in treatment approaches.  

What should we know about mitral valve disease and treatment?

Chikwe: The symptoms—rapid heartbeat, fatigue, cough and shortness of breath—are subtle and can be difficult to detect. Many patients don’t have any symptoms and have no idea there is a problem with their heart. The condition is often discovered when physicians pick up on a heart murmur during a routine physical exam or when the patient is receiving care for something else. Untreated, it can sometimes lead to sudden and unexpected death, as was the case with Carol Barr. In the past, heart surgeons corrected a faulty mitral valve by replacing it with an artificial one during open-heart surgery. But today, we can repair, rather than replace, the valve through minimally invasive, low-risk, extremely safe and effective surgery or by using a clip. 

What makes the Smidt Heart Institute’s mitral valve program unique?

Chikwe: We combine the highest levels of surgical, nonsurgical and imaging expertise available in the U.S. Few centers are strong in both surgery and transcatheter repair, and very few match our level of experience and results with transcatheter and robotic mitral repair. Patients come to us from all over the U.S. and overseas for our expertise.

Makkar: Also, patients have earlier access to the most innovative treatments because we are often leading clinical trials and using new devices and novel approaches. We treat the most complex patient cases. And we help people who have had misdiagnoses elsewhere or who may have been told they needed a different procedure than we might recommend. We can help inform the patient’s decision-making by presenting all their options and discussing what might work best for them. This individualized approach is unique.

What excites you about the future of heart valve disease study?

Makkar: The PRIMARY trial is very exciting. Because the mitral valve represents a challenging frontier between surgical and nonsurgical treatment options, I believe the results, whichever way the evidence shows, will transform patient care. If a transcatheter approach turns out to be better for patients long term, that might give another option to patients who currently don’t have access to it. Alternatively, trial results may demonstrate that minimally invasive surgery is by far the safest and most effective way to treat mitral valve prolapse.

Chikwe: I completely agree with Dr. Makkar around excitement about the PRIMARY trial’s potential to transform future mitral valve patient care. He mentioned that it is essential for a discussion between the heart team and a patient deciding between surgery or interventional approaches. We need randomized clinical trials with robust evidence to help us better inform these important decisions.

What does it mean for the PRIMARY trial to receive additional funding as a result of the CAROL Act?

Chikwe: It reflects Cedars-Sinai’s unique expertise in arrhythmia management, imaging and treatment for mitral valve conditions. To be at the forefront of an effort to get to the bottom of why people with mitral prolapse may die suddenly and unexpectedly, even when they’re quite young, as Carol Barr was, is particularly impactful. Without the additional funding, we wouldn’t have the opportunity to better understand how to identify people at high risk of mitral valve disease and how to help prevent a potentially catastrophic outcome.

Makkar: Cedars-Sinai’s pioneering mitral valve program has been further validated thanks to this additional funding, and that is significant. Although the CAROL Act was born from tragedy, our goal is to prevent similar tragedies in the future through new discoveries that could one day improve outcomes for many people, perhaps even beyond those with mitral prolapse.  

Read more on the Cedars-Sinai Blog: Options in Treating Mitral Valve Disease

In the summer of 2022, an overwhelmed Jon Anderson was nervously preparing for a big moment—having robotic coronary artery bypass surgery. Just over a year later, in the fall of 2023, Anderson was staring down another major life event. This one: finishing a grueling five-day, 26-mile hike through the Andes Mountains to the ruins of Machu Picchu, the fabled “lost city of the Incas.” Again, there were nerves and feelings of overwhelm.

And when he finally entered the Sun Gate last month, nearly 9,000 feet high with a breathtaking view of Machu Picchu, Anderson was tearful—at the enormity of the site, the view and all that he and his heart had accomplished.

“To not only get through it, but with no health issues and feeling strong and good about my heart being up to the task, it was quite emotional,” Anderson said. “I thank the team at Cedars-Sinai for saving my life and giving me the ability to take on a huge physical and mental challenge.”

Anderson’s care team at the Smidt Heart Institute at Cedars-Sinai included cardiac surgeons Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery, and Dominic Emerson, MD, associate professor and director of Robotic Cardiac Surgery. The two performed robotic bypass surgery to improve blood flow to Anderson’s heart after learning his left main artery was 70% blocked. Robotic techniques facilitate heart surgery through keyhole incisions instead of opening the breastbone, allowing for a faster recovery.

Now back home in Australia, the former Los Angeles resident recently shared the story of his heart surgery and subsequent goal of hiking the Inca Trail to Machu Picchu. He also told the Cedars-Sinai Newsroom how the climb of a lifetime reminded him that bypass surgery had not slowed him down.

How were you feeling on the hike to Machu Picchu? It’s known for being quite steep.

I had trained for eight months with almost daily hikes. But even so, our group of eight (ranging from late 20s to me—the oldest—at age 65) felt the pressure on days when we were climbing uphill. Because of the altitude, it took a lot of concentration on breathing and enormous stamina to get through those sections. We were normally rewarded by a lengthy downhill hike immediately after, but even those were challenging, as the steps are uneven and put a lot of pressure on the knees. But my recovery time was quick after each big day, which was probably a result of my training. So, while it was draining mentally and physically, I had a great sense of accomplishment at the end of each day.

Were there moments during the trek where you questioned why you’d decided to set this goal? 

No, although I did think many times, “It is going to feel so good when I finish!”

Describe some of the more challenging parts of the hike.

Dead Woman’s Pass, on day two, stands out. We started from our camp at Wayllabamba and hiked up 3,658 feet to Ayapata (about 90 minutes), then another two hours to Llulluchapampa (12,589 feet). Then we began another steep ascent (1,148 feet) for two hours to Dead Woman’s Pass, which sits at 13,828 feet—the highest elevation on the trail. The steep climb on stone stairs of inconsistent height means you have to continually watch your foot placement. It took a lot of concentration to focus on moving upward for that entire hike. I concentrated on the shoes of the person in front of me, which helped because if you start looking at where the path is going, the sight of it extending ever upward could really impact your enthusiasm. Getting to the top was exhilarating, and almost immediately, the stress of the climb disappeared as we all took in the view. Once I got through that portion, I knew I could do anything. It signaled that my heart was in great condition, and it gave me a huge confidence boost to know that I had managed to get through what would be the most difficult day of the hike.

How did you feel when you reached Machu Picchu?  

The hikers get the best entrance to Machu Picchu because they enter through the Sun Gate at a higher part of Machu Picchu Mountain and see the lost city laid out in all its glory. I was overwhelmed by the sight, and I burst into tears. The view is spectacular and, having been obsessed with the stories of the Inca Empire as a kid, to realize this dream over 60 years later was a very moving experience. I think I had been holding in a lot of fear about whether I was ready for this hike, and whether I could make it.

What are your reflections, a few weeks after summiting Machu Picchu? 

I think the biggest thing was proving to myself that I would not let my heart surgery define me or make me feel incomplete or unable to do things I had done before. I wanted to know that I could make it through a tough physical challenge as if I had never had the operation. It made me realize that I was still the same person. It seems strange to think otherwise, but the realization that I had heart disease played havoc with my confidence. This trek swept that away and helped me see that the “plumbing” had been fixed and the garden was in full bloom again! And I was rewarded with a visit to a place that I had only dreamt of as a child and was now finally seeing after all these years. It was an incredibly emotional experience. The trek was grueling, but completing it was very satisfying. I could not have done it without the team of surgeons, doctors and nurses at Cedars-Sinai. They’ve given me a new lease on life.

Read more on the Cedars-Sinai Blog: Shortness of Breath—When to See Your Doctor

ECMO, once widely viewed by physicians as a last-chance therapy for patients close to death, was prominently employed with success during the COVID-19 pandemic, when the virus was at its peak and many patients arrived at the hospital on the edge of not surviving. 

Cedars-Sinai physicians learned that ECMO—in carefully selected patients—served as a bridge to lung transplantation, or at minimum, an opportunity for a patient’s body to heal their own lungs. Care teams also use ECMO in patients with heart disease to allow for recovery, or even as a bridge to heart transplantation.

The prestigious three-year Gold Level Award of Excellence in Extracorporeal Life Support was given by the Extracorporeal Life Support Organization.

“This achievement is a testament to our dedication to providing exceptional care and promoting excellence in every aspect of our extracorporeal life support program,” said Tyler Gunn, MD, director of the Extracorporeal Membrane Oxygenation Program in the Department of Cardiac Surgery. 

Richard Kim, MD, surgical director of the Guerin Family Congenital Heart Program and director of Pediatric and Congenital Cardiac Surgery, says the award not only signifies a commitment to providing exceptional adult and pediatric care but, “also assures the healthcare community of our adherence to high-quality standards, specialized equipment and supplies, well-defined patient protocols, and advanced education for all our staff members.”

Experts at the Smidt Heart Institute, a designated Center of Excellence, demonstrated superlative patient care by employing the highest-quality measures, evidence-based processes, and well-structured administrative systems. Other findings concluded employees demonstrated excellence in training, education, collaboration and communication, and the institute and medical center were found to foster a healing environment for families, patients and staff.

“Being recognized as a Gold Level Center of Excellence showcases our leadership in extracorporeal life support and highlights our dedication to offering state-of-the-art healthcare services,” said Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at Cedars-Sinai and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery. “Our collective efforts and unwavering commitment to excellence, especially during the challenging times of the COVID-19 pandemic, have culminated in this incredible achievement.”

The institute’s success with ECMO led Smidt investigators to publish novel clinical data that supported wider use of ECMO. The data was published via an analysis in The New England Journal of Medicine, and included data from more than 3,000 lung transplantations that took place in the U.S. between Aug. 1, 2020, and Sept. 30, 2021.

The data showed that during the pandemic, 7% of the nation’s lung transplants were performed to treat severe, irreversible lung damage caused by COVID-19. More than half of these patients needed either ventilators or ECMO before their transplant.

The comprehensive team provided a cumulative total of more than 30,000 patient hours of ECMO support in 2022 alone.

“We extend our heartfelt gratitude to each member of our multidisciplinary ECMO team, including nursing staff, perfusionists, pharmacists, program coordinators and administrators, intensivists, as well as medical and surgical staff,” Gunn said. “This award serves as a reminder of our shared mission to save lives, improve patient outcomes, and continuously advance the field of medical and surgical care.”

Read more from the Cedars-Sinai Blog: Respiratory Revelations

at Cedars-Sinai have found that community-level socioeconomic disparities are associated with worse three-year survival rates for patients with degenerative mitral regurgitation who had valve repair surgery.

The findings, recently published in the Journal of Thoracic and Cardiovascular Surgery, showed that patients from socioeconomically distressed communities had an approximate 20% increased risk of three-year mortality after their mitral valve repair, and an almost 30% increased risk of heart failure readmission.

Previous studies had demonstrated mixed results regarding racial disparities in mitral valve repair rates and short-term outcomes, and little was known about the midterm impact of socioeconomic distress on repair outcomes.

“Our findings add to the growing body of literature highlighting that racial and socioeconomic disparities exist in cardiovascular health and in cardiac surgical outcomes and that they impact overall long-term care,” said Jad Malas, MD, a  cardiothoracic surgery resident in the Smidt Heart Institute and lead author of the study. “Even when narrowing our research to focus on a very specific population of patients undergoing a very specific surgery, disparities still exist.”  

To conduct the study, investigators used data from the Centers for Medicare and Medicaid Services to identify 10,322 patients who were undergoing first-time isolated surgical repair for degenerative mitral regurgitation between 2012 and 2019.

They used the Distressed Communities Index, which has previously predicted poor cardiac surgical outcomes, to classify distressed patients. The Distressed Communities Index incorporates education level, poverty, unemployment, housing security, median income and business growth.

Of the 10,322 patients, 1,003 (9.7%) came from distressed communities and were more often female (55.3% from distressed communities vs. 50.5% from nondistressed communities) and Black (11.6% vs. 2.7%). Additionally, they had mitral valve surgery at lower-volume centers (11 cases per year vs. 16 cases per year) and traveled farther for surgery (40 miles vs. 17 miles).

Post-repair survival rates at three years in patients from socioeconomically distressed communities and nondistressed communities was 85.4% and 89.7%, respectively.

Investigators noted that potential ways to address this disparity could include improving access to high-volume centers and earlier referral for mitral valve surgery, before the disease worsens. But, they added that access to high-volume centers alone would likely not be sufficient to resolve the disparity in midterm outcomes, which is influenced by other factors.

“Ultimately, this study demonstrates that socioeconomic status matters,” said senior and corresponding author Michael Bowdish, MD, vice chair of the Department of Cardiac Surgery. “It is important that we continue to recognize that inequities exist among patients undergoing mitral valve repair, and we hope that by understanding these disparities, we can better support these patients and ensure they continue on the right path after surgery.”

Mitral valve regurgitation affects more than 2 million Americans. Historically, heart surgeons corrected a faulty mitral valve by replacing it with an artificial one via open-heart surgery. Today, specialists are able to repair, rather than replace, the valve through minimally invasive surgery. It is low risk and successful in nearly 100% of patients having degenerative mitral valve repair in the United States.

Since 2017, the Smidt Heart Institute has received the highest national ratings for mitral valve surgery from the Society of Thoracic Surgeons, and it was recently designated a Mitral Valve Repair Reference Center by the Mitral Foundation. The institute is highly regarded for its record of superior clinical outcomes resulting from evidence-based, guideline-directed degenerative mitral valve repair.

Study author Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at Cedars-Sinai, noted that the Smidt Heart Institute’s health outcomes research program is working to better understand disparities and how they impact the field and society at large.  

“The findings from the mitral outcomes study are a call to action to consider how we effectively care for patients,” said Chikwe, who also holds the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery. 

“As physicians, we can work to better understand our patients—their background, where they live, the support they have at home. We can remind them about the importance of getting an echocardiogram every year and encourage follow-up visits after surgery. We need to identify factors that can help our patients have better outcomes in the long term.” 

Other Cedars-Sinai investigators involved in the study include Qiudong Chen, MD; Dominic Emerson, MD; George Gill, MD; Georgina Rowe, MD; and Alfredo Trento, MD.

Funding: The study was funded by the National Institutes of Health for advanced heart disease research (award number T32HL116273).

Read more from the Cedars-Sinai Blog: Heart Disease: When to Get a Second Opinion

Staying active on the hiking trails around the southern highlands of Australia, where he retired earlier this year after a career in film marketing, Jon Anderson is feeling there’s little he can’t conquer.

And he gives credit for that to the Smidt Heart Institute team at Cedars-Sinai and his surgeons, Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery, and Dominic Emerson, MD, associate professor and director of Robotic Cardiac Surgery.

During a routine physical last year in Los Angeles, where Anderson was then living, his physician noted that a referral to a cardiologist was in order. Test results had shown that his cholesterol was very high, despite taking medicine to lower it. A stress test and angiogram—a heart scan—at the cardiology appointment revealed heart disease and a 70% blockage in his left main artery.

Anderson was shocked—he felt fine. No pain. No fatigue. Nothing out of the ordinary.

“There’s that classic story about the person who thought they were healthy and then just dropped dead on a hike,” Anderson said. “I could have been one of those people. That was shocking and worrying.”

When the cardiologist advised surgery, Anderson was intent on having it done at Cedars-Sinai. The Department of Cardiac Surgery in the Smidt Heart Institute is known for innovation and expertise in robotic and minimally invasive heart surgery to treat all forms of heart disease. The Smidt Heart Institute also is ranked #1 in California and #3 in the nation for Cardiology and Heart Surgery by U.S. News & World Report’s “Best Hospitals 2022-2023.”  

Chikwe, the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery, is widely recognized for her skill in robotic and minimally invasive surgical techniques. When Anderson met with Chikwe to discuss surgical options that were right for him, he was quickly put at ease.

“She validated the enormity of what I was going through—heart surgery is extremely overwhelming—but she made me feel that I shouldn’t worry about it,” he said. “As she explained the various approaches to surgery, I started to cry. She took my hand and said, ‘I know this is a big deal, but you are going to be fine.’”

Chikwe’s confidence is due to the Smidt Heart Institute’s multidisciplinary care team.  

“We can treat patients using minimally invasive methods, including robotic procedures, or traditional open-heart surgery, depending on things like age, other heart conditions and overall health,” Chikwe said. “Jon was eligible for robotic coronary artery bypass surgery.”

Coronary artery bypass graft surgery, also called bypass surgery, is the most common type of heart surgery. More than 300,000 people have successful bypass surgery in the U.S. each year.

Robotic surgeries may be less invasive than traditional open-heart surgeries and offer faster recovery times and less discomfort during healing, among other benefits.

Just as Chikwe had assured Anderson, he was fine after surgery on June 30, 2022. He did so well that he walked out of the Intensive Care Unit to a regular hospital room the very next day. On July 3, just three days after surgery, Anderson was able to go home, with only minimal discomfort and a few small incision marks.

“I can truly say that I received my freedom in time for Independence Day,” he said. “I had such a great experience that I get emotional talking about it.”

Anderson was back at work about a week after surgery. He was careful not to overexert himself, per doctor’s orders, but slowly he made his way back outside for flat, easy walks.

This October, Anderson will hike Peru’s famed Inca Trail to Machu Picchu on a five-day trek spanning 26 miles across steep mountain ranges. He’s been training with uphill hikes and stair climbs multiple times each week, plus swimming and lifting weights.

Neither the Inca Trail nor the preparation are for the faint of heart. And heart is what it’s all about.

“I’m not the least bit worried and have complete confidence in my health and my heart,” he said. “That feels very liberating.”

Freedom, just in time for his one-year anniversary post-surgery.

“Dr. Chikwe and her team helped me to reach a summit with my health,” he said. “And now, after their help, I can reach the summit of Machu Picchu on my own.”

Read more on the Cedars-Sinai Blog: Robotic and Minimally Invasive Cardiac Surgery | The New Standard