Pediatric interventional cardiology has had meaningful advances over the past decade that are changing how children with congenital heart disease are treated at

Congenital heart defects, which arise from abnormal or incomplete formation of the heart, valves and blood vessels, are among the most common birth defects worldwide. The condition affects approximately 40,000 babies each year in the United States.

From less invasive, catheter-based procedures to improved imaging and emerging technologies, innovations are helping reduce risk, shorten recovery times and expand treatment options for the smallest patients with heart problems.

The Cedars-Sinai Newsroom recently spoke with Stephen Nageotte, MD, MBA, an interventional cardiologist and director of the Congenital Catheterization Laboratory at Cedars-Sinai Guerin Children’s and the Smidt Heart Institute. Nageotte treats children and adults using minimally invasive procedures. He shared what’s new in the field and what families need to know:

What are the most significant advances you’ve seen in pediatric interventional cardiology in recent years?

Over the past five years, there have been major advances in three key areas:

• Premature patent ductus arteriosus [PDA] closure. It’s a congenital heart condition in which a connection between two blood vessels in an infant fails to close after birth. This can cause abnormal blood flow to the lungs and breathing difficulties, particularly in premature infants.
• Transcatheter pulmonary valve replacement, which is a minimally invasive procedure in which we replace a faulty heart valve using a catheter instead of surgery.
• PDA stenting. Sometimes babies have heart problems that limit blood flow to the lungs. We can keep a small vessel called the ductus arteriosus open by placing a tiny tube, or stent, inside it to improve blood flow.

All three procedures have evolved significantly and are allowing us to treat patients in less invasive ways, often replacing or delaying the need for surgery.

How has transcatheter PDA closure changed care for premature infants?

Transcatheter PDA closure has become an important option for premature infants with a hemodynamically significant PDA—meaning the vessel is causing strain on the heart and lungs. In fact, Evan Zahn, MD, of the Smidt Heart Institute, helped develop the device cardiologists use to close a PDA during a transcatheter procedure.

The procedure is quick and can be done at the bedside in the Neonatal Intensive Care Unit [NICU], which helps us avoid transporting fragile infants. Research also suggests many babies show respiratory improvement after closure, which may reduce complications associated with long‑term ventilation.

Who is typically a candidate for the transcatheter PDA closure?

These procedures are generally for premature infants who are showing signs that the PDA is affecting their health, such as needing increased respiratory support or showing enlargement of the heart. There’s no strict minimum weight requirement, and the focus is really on whether the PDA is having a meaningful impact on the baby’s heart and lungs. Transcatheter PDA closure is also performed on older kids and adults.

What impact has new device technology had on how these procedures are performed?

One recent advancement is an improved delivery system for PDA closure devices. The device, known as the Amplatzer Piccolo Delivery System, recently received FDA [Food and Drug Administration] clearance to treat premature infants with PDA, including babies weighing as little as 2 pounds. Previously, the procedure required exchanging multiple catheters during the case, which could introduce instability; the newer system allows physicians to navigate and deliver the device using a single, shorter, softer catheter, potentially improving patient stability and precision.

How has transcatheter pulmonary valve replacement expanded treatment options for patients?

The development of newer self‑expanding valves has significantly increased the number of patients who can receive pulmonary valve replacement through a catheter instead of surgery. These procedures are typically considered from late childhood through adulthood and are used for patients with pulmonary valve disease related to congenital heart conditions. Early outcomes have shown good durability and high success rates.

Imaging plays a big role in heart care. What improvements are making the biggest difference?

There have been significant advances in cardiac CT and MRIs. Imaging is faster, clearer and uses lower radiation doses than in the past. These tools help us better understand heart anatomy, blood flow and timing for interventions. There’s also growing interest in using virtual or augmented reality to create 3D heart models for procedure planning, allowing teams to better visualize anatomy before a procedure.

What should families know as they navigate a congenital heart diagnosis?

Early detection and screening are incredibly important, ideally before birth, so families can meet the care team and understand what to expect. At Cedars-Sinai we can identify a defect while a baby is still in the womb and will continue to care for the baby at birth, during childhood, and all the way through adulthood, so the patient never needs to transfer to another institution.

Congenital heart care is lifelong and truly a team effort. Families aren’t expected to understand every technical detail—our role is to guide them, answer questions and be there every step of the way. Building long‑term relationships with patients and families is one of the most meaningful parts of this work.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

Led by interventional cardiologist Raj Makkar, MD, the six-and-a-half-year award from the Patient-Centered Outcomes Research Institute (PCORI) will fund a multi-center clinical trial of patients 50 and older who were born with a bicuspid aortic valve, a condition in which the aortic heart valve has two flaps regulating the flow of blood rather than the normal three. People with this condition typically develop aortic stenosis, when the aortic valve becomes so narrow that it impedes blood flow out of the heart.

Bicuspid aortic valve is the most common congenital heart condition, affecting approximately 2% of people, but little data exists comparing current treatments.

Heart valve disease can cause subtle symptoms at first but progress to heart failure if not diagnosed and treated early. Both surgery and transcatheter procedures are currently used to treat aortic stenosis. Transcatheter procedures use a thin, flexible tube called a catheter to reach the damaged valve. They are considered minimally invasive and are often recommended for patients who are at high risk for complications during surgery.

“Transcatheter aortic valve replacement has changed the paradigm for nonsurgical treatment of aortic stenosis, but it needs to be studied more rigorously in patients with bicuspid aortic valves,” said Makkar, a principal investigator of the study and vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai. “We look forward to addressing this important evidence gap with this PCORI-funded randomized controlled trial in collaboration with our esteemed co-investigators.”

Patients with bicuspid aortic valve stenosis enrolled in the clinical trial will be randomly assigned to have their aortic valve replaced via open-heart surgery or by a transcatheter procedure. Investigators will review results from both groups to understand which option results in better health outcomes.  

The inaugural director of the Karsh Division of Interventional Cardiology, Makkar is an authority in minimally invasive approaches to treating heart valve disease.

“The Smidt Heart Institute at Cedars-Sinai is a leader in both heart surgery and minimally invasive heart procedures,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai and the Mark S. Siegel Family Foundation Distinguished Professor. “This study reflects our commitment to advancing heart research and care.”

“This research is a prime example of how Cedars-Sinai fosters innovation and brings leading-edge and clinically effective research directly to patient care,” said Shlomo Melmed, MB, ChB, Cedars-Sinai's executive vice president of Medicine and Health Sciences and dean of the Medical Faculty. “The findings from this clinical trial will help doctors globally advise their patients born with a bicuspid aortic valve on the best and safest approach for treating their cardiac condition.”

The award has been approved pending completion of a business and programmatic review by PCORI and issuance of a formal award contract. PCORI is a non-profit organization with a mission to fund research designed to provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.

Read more on the Cedars-Sinai Newsroom: $35M Gift Creates Karsh Division of Interventional Cardiology

The Karsh family’s contribution will advance care and research across the field of interventional cardiology at the medical center. Interventional cardiology is a branch of medicine focusing specifically on minimally invasive, catheter-based procedures to correct structural heart problems such as leaking valves. The gift is in honor of Martha’s mother, Sybil Lubin, a now-healthy and active 94-year-old who experienced a catastrophic mitral valve rupture two years ago. She credits Raj Makkar, MD, and the interventional cardiology team at Cedars-Sinai with saving her life.

Makkar is the inaugural director of the Karsh Division of Interventional Cardiology and will also serve as the Karsh Distinguished Chair in Interventional Cardiology. An authority in advanced catheter-based therapies, Makkar’s team of experts treat more than 10,000 patients annually. Makkar says his mission is to perform and teach other physicians how to perform these advanced therapies so that many more patients can and will benefit.

“Our interventional cardiology programs are available around the clock to provide urgent care to those who need it most,” said Makkar. “Thanks to the incredible generosity of the Karsh family, we not only are able to sustain this critical service but also enhance and grow it. Their gift makes them true partners in our mission, helping us continue to provide the highest level of care, and we are deeply grateful for their support.”

Cardiovascular disease remains the leading cause of death globally, as cited by the World Health Organization. Cedars-Sinai ranked #1 in California and #6 nationally for Cardiology, Heart & Vascular Surgery in U.S. News & World Report’s "Best Hospitals 2024-25" listings. The newly established interventional cardiology division will treat conditions including valvular defects, electrical rhythm disorders, heart muscle dysfunctions and congenital heart disease.

The Karsh family says mindful merging of a common mission is the basis for their partnership with Cedars-Sinai. “’Education, Community, Democracy’ is a motto of our foundation,” the family said. “With this gift, we aim to amplify our commitment to both our community and medical education. Ultimately, what we hope to contribute to the world of medicine on a global scale with Cedars-Sinai is a powerful testament to what results from intention put into action.”

Peter L. Slavin, MD, president and CEO of Cedars-Sinai, expressed his gratitude for the Karsh family’s generosity and commitment to the highest quality care.

“The Karsh family has an enduring commitment to transformative medicine, and they’re building an even more profound legacy of philanthropy with the Karsh Division of Interventional Cardiology,” said Slavin. This new gift adds to their past visionary contribution that birthed the nationally ranked Karsh Division of Gastroenterology and Hepatology. Both enterprises address vital areas primed for innovative, groundbreaking advancements with the resources required for our patients.”

Read more on the Cedars-Sinai Newsroom: Smidt Heart Institute Advances Valve Replacement

Daukayev is a beloved ballet teacher and the owner of Los Angeles-based Marat Daukayev School of Ballet with his wife of 28 years, Pamela. Daukayev also is known around the world for his 20-year career as a leading male dancer in numerous international ballet tours.

Outwardly, the Russian-born dancer seemed the picture of good health. Though he was managing high blood pressure under the care of an interventional cardiologist, Daukayev said he felt healthy and showed no signs of slowing down. 

So, it was a surprise in the early morning of Feb. 6, 2023, when an episode of severe chest pain sent him racing to the Cedars-Sinai Emergency Department. There, he was evaluated by cardiologist Mamoo Nakamura, MD, who immediately whisked Daukayev to the Cardiac Catheterization Laboratory in the Smidt Heart Institute, where Daukayev received two lifesaving stents. A week later, when Daukayev’s electrical heart function became unstable, he returned to the cath lab for a third stent.

“If he came in even two or three hours later, things could be very different,” Nakamura said. “It is very fortunate that he came to us just in time.”

After his hospitalization, Daukayev returned home and adhered closely to doctors’ instructions, walking daily and eating healthfully. Just four weeks later, he was back at his dance studio, teaching daily. By August, when rehearsals began for his studio’s annual production of Pyotr Ilyich Tchaikovsky's “The Nutcracker Suite,” he was fully recovered.

“Marat has made tremendous progress,” Nakamura said. “This is a major success story for the treatment of a heart attack.”

Today, Daukayev reflects on his health journey and says that it’s a strange thing when the body you count on every day of your life suddenly stops working.

“My whole life’s training has been to make the body do the impossible,” he said. “But suddenly, I was forced to put my body completely and fully in someone else’s hands.”

Daukayev will lead four “Nutcracker” performances on Dec. 7 and Dec. 8 at California State University Los Angeles’ The Luckman Theater. Daukayev plans to dance alongside 105 ballet students who have waited all year for this annual performance.

“I am so lucky,” Daukayev said, “and I feel so alive.”

To purchase tickets for “The Nutcracker” this weekend, visit theater.maratdaukayev.org/nutcracker-performances/.

Read more from the Cedars-Sinai Blog: A Better Model of Heart Disease Prediction