Kaiser Permanente Northern California Adult Congenital Heart Disease Program

Director's Description

Northern California Kaiser Permanente is an integrated healthcare organization that serves nearly 5.5 million members in Northern California. Our ACHD program is divided into 3 regions, each led by a board certified ACHD cardiologist. We provide:

-Outpatient care: We provide comprehensive outpatient care to ACHD patients. In addition to general ACHD clinic, we also have clinics focused on transition, high risk pregnancy, single ventricle care, and pacemaker management.
-Imaging and functional testing: In our outpatient clinics, we provide state-of-the-art imaging including echocardiography (including 3D, strain, and stress echo), transesophageal echocardiography, cardiac MRI, cardiac CT, and cardiopulmonary exercise testing.
-Cardiac surgery: We coordinate cardiac surgery for our ACHD patients. The CV surgeon(s) and location of surgery are dependent on the type of surgery required and the patient’s co-morbidities. We are affiliated with Stanford/Lucile Packard Children’s Hospital (LPCH) and use their congenital CV surgeon(s) for our congenital surgeries. The complicated congenital surgeries are performed at LPCH. The simpler congenital surgeries, particularly in patients with complex adult co-morbidities, are performed at Kaiser Permanente in SF (KPSF) by the congenital CV surgeon(s) from LPCH, assisted by KPSF adult CV surgeon(s). Our non-congenital CV surgeries in our ACHD patients; such as coronary artery bypass surgeries, are performed by our adult CV surgeon(s) at KPSF.
-Non-cardiac surgery: We have a team of anesthesiologists (general anesthesia, pediatric anesthesia, and CV anesthesia) who are consulted on a case by case basis to plan for the safest location and anesthetic management of the ACHD patients scheduled for non-cardiac surgery.
-Cardiac catheterization: We coordinate cardiac catheterization for our ACHD patients. The interventionalist(s) and location of the procedure are dependent on the type of procedure requested and/or the complexity of the hemodynamics required. We are affiliated with the University of California San Francisco/Benioff Children’s Hospital (UCSF). They perform most of the complex congenital interventions and complex congenital hemodynamics. Atrial septal defect closures, transcatheter aortic valves, and coronary artery interventions, as well as coronary angiography and simple-moderately complex hemodynamics are performed by our adult interventionalists at KPSF.
-Electrophysiology procedures: We coordinate electrophysiology procedures for our ACHD patients. The interventionalist(s) and location of the procedure are dependent on the type of procedure requested and/or the complexity of the anatomy. We are affiliated with the University of California San Francisco/Benioff Children’s Hospital (UCSF). They perform the electrophysiology procedures in the ACHD patients with complex anatomy and unique rhythm disturbances. Our electrophysiology group at Kaiser Permanente is centralized in Santa Clara (KPSC). They have outstanding experience and results with atrial and ventricular mapping, ablations including pulmonary vein isolation procedures and ventricular tachycardia ablations. One of our ACHD cardiology leads is based at KPSC and oversees these procedures.
-Pacemaker and ICD implantation: We coordinate the implantation of pacemakers and ICDs. Most of the Northern California KP medical centers have cardiologists trained to do these implants. The patients with complex anatomy are sent to UCSF for device implantation (or surgery for epicardial device placement). The ACHD cardiologists are intimately involved in managing device programming in the outpatient setting.
-High-risk obstetrics: Our high-risk obstetrics program consists of ACHD cardiologists, Women’s cardiologists, perinatologists, and OB anesthesiologists from around the region. We join together virtually every other month. We have 2 goals. First, we assess pre-conception risk and emphasize pre-conception counseling. Second, we manage high risk pregnancies and make plans for labor and delivery.
-Inpatient care: When ACHD patients require hospital admission (i.e. heart failure, arrhythmias, labor and delivery, other surgeries, other medical illness), we often manage remotely at their local KP medical center. We work closely with the hospitalists and cardiologists to provide appropriate care. Our integrated system allows real time sharing of data and review of images. If medically necessary, we transfer them to KPSF to manage them directly.