Advancing Predictive Care in Pediatric Cardiology: The Research of Avihu Z. Gazit, MD, Inaugural Patrick Dick Memorial Chair
August 14, 2025
Avihu Z. Gazit, MD, Chief of the Pediatric Cardiac Critical Care Division, Department of Critical Care Medicine and co-director of the Heart Institute at UPMC Children’s Hospital of Pittsburgh, was recently appointed as the inaugural holder of the Patrick Dick Memorial Chair in Pediatric Cardiology. His appointment reflects both his leadership role within the Heart Institute and his commitment to advancing research in pediatric cardiology, with a particular focus on improving care for medically fragile children in the cardiac intensive care unit — whether due to congenital heart disease or other complex conditions. His appointment also honors the enduring institutional legacy of Douglas Dick and his family, whose longstanding philanthropic commitment has helped advance care and research at UPMC Children’s and the broader UPMC system for more than three decades.
The Dick Family Legacy and Endowed Chair
Douglas Dick, chairman and CEO of Dick Building Company, has maintained an extensive leadership and philanthropic relationship with UPMC Children’s Hospital and the broader UPMC system for nearly 30 years. He currently serves as chair of the Board of Trustees of UPMC Children’s Hospital and as a member of the Board of Trustees of UPMC Children’s Hospital of Pittsburgh Foundation, where he has previously served on the Executive Committee, Strategic Planning and Board Engagement Task Forces, and Affiliation Oversight and Bylaws Committee. In addition to his involvement with UPMC Children’s, Douglas has served on governance boards across multiple affiliated organizations, including the Eye & Ear Foundation of Pittsburgh, the University of Pittsburgh Cancer Institute, and UPMC’s parent company where he currently chairs the International and Enterprises committee.
His personal connection to pediatric cardiology and UPMC Children’s began with the birth of his son, Patrick, who was born with the congenital cardiac condition of transposition of the great arteries (TGA). At that time, Patrick underwent surgical treatment at UPMC Children’s using the most advanced procedures available during that era. His care was led by several of UPMC Children’s Heart Institute pioneering leaders in pediatric cardiac surgery and cardiology, including Ralph Siewers, MD, who performed Patrick’s surgery, and cardiologists William Neches, MD, Sang Park, MD, James Zuberbuhler, MD, and Bartley Griffith, MD. While these interventions offered the best available care at the time, Patrick unfortunately passed away at 13 months of age due to the complexity of his condition.
In the years that followed, Douglas established the Patrick Dick Memorial Endowment Fund to support pediatric cardiology research at UPMC Children’s, which was later converted into an endowed chair to help recruit and retain physician-scientists dedicated to advancing the field of pediatric cardiology.
“It is a tremendous honor to be named to this chair,” says Dr. Gazit. “Gifts like Douglas’ provide institutions like ours with the resources and flexibility to support research and innovation that ultimately benefit the most vulnerable children we care for.”
The Evolution of Pediatric Cardiac Critical Care
The trajectory of Douglas Dick’s philanthropy parallels the broader evolution of pediatric congenital heart care. In the era when Patrick Dick underwent treatment, the Mustard procedure, an atrial switch operation that redirected blood flow inside the heart, was the surgical standard for TGA. Although it offered palliation, this approach did not fully restore normal circulatory physiology and carried long-term risks for arrhythmias and ventricular dysfunction.
Over the past several decades, the arterial switch operation replaced the atrial switch as the definitive surgical repair for TGA. This complex procedure anatomically corrects the great arteries and coronary arteries, creating near-normal physiology and dramatically improving both survival and quality of life for children born TGA.
“The arterial switch operation has significantly improved survival and long-term outcomes for these patients,” says Dr. Gazit. “Today, these children recover more quickly, develop more normally, and integrate more fully into life than they could have in previous eras. It’s the type of advancement in medical science and techniques that have been driven by philanthropic support like that of Douglas and his family but also from entities like the National Institutes of Health that have quite literally shaped the trajectory of medicine for the greater good, not just here in Pittsburgh or the United States, but globally. This cannot be overstated.”
Alongside surgical advances, the structure of pediatric cardiac critical care has also undergone a major transformation. Thirty years ago, most congenital heart patients were managed in general pediatric intensive care units by clinicians without specialized training in cardiology. Today, dedicated cardiac ICUs staffed by dually-trained cardiac intensivists with expertise in pediatric cardiology and critical care medicine have become the standard.
“This dual training allows us to approach these patients with a much deeper understanding of both their cardiovascular physiology and their critical care needs,” says Dr. Gazit. “The field has become increasingly multidisciplinary, with surgeons, intensivists, anesthesiologists, advanced practice providers, respiratory therapists, and nurses working together as fully integrated team of teams.”
From Clinical Judgment to Predictive Analytics
Despite these advances, the postoperative period following congenital heart surgery remains one of the most physiologically fragile phases of care. Even experienced clinicians face challenges in identifying early signs of deterioration in the CICU.
“Every second these patients are generating huge amounts of data across multiple parameters — blood pressure, heart rate, oxygen saturation, laboratory values, ventilator settings,” says Dr. Gazit. “The problem is not a lack of information. The problem is that even experienced clinicians cannot fully synthesize these immense data streams, and the power locked inside them, in real time to anticipate when a patient may begin to destabilize and require an immediate or preventive adjustment in care.”
To address this challenge, Dr. Gazit has focused much of his career’s research on incorporating real-time predictive analytics into ICU workflows. More recently, central to this work is the Etiometry™ platform and its U. S. Food and Drug Administration (FDA)-approved IDo2 algorithm. The IDo2 index continuously integrates multiple high-frequency physiologic variables to estimate the likelihood that a patient’s oxygen delivery is insufficient, which is used as a surrogate for declining cardiac output and impending clinical decompensation.
Unlike traditional monitoring that relies on intermittent assessments, IDo2 provides clinicians with a dynamic risk estimate that evolves in real time, offering an early signal of physiologic instability before overt clinical signs appear.
Evaluating Decision Support in Vasoactive Weaning
In 2025, Dr. Gazit and colleagues published results from a multicenter prospective clinical trial in the journal Critical Care Medicine1 that tested whether real-time physiologic analytics could help standardize and optimize the weaning of vasoactive medications after congenital heart surgery. Conducted across three major pediatric cardiac ICUs, the study enrolled 775 infants using a staggered before-and-after design.
Vasoactive and inotropic medications are routinely used in the immediate postoperative period to support cardiac function and maintain blood pressure. While necessary in the short term, prolonged use can lead to additional risks, including infections and delays in recovery. Decisions about when to safely reduce or stop these medications often vary widely between clinicians and institutions.
“We identified vasoactive weaning as an ideal clinical target because it is both highly variable and clinically significant,” says Dr. Gazit. “Our hypothesis was that embedding IDo2-based analytics into the decision-making process could help reduce unnecessary exposure to these medications without compromising safety.”
Using the IDo2-informed clinical decision support pathway, clinicians participating in the study were provided with real-time alerts during rounds when patients met physiologic criteria suggesting readiness for weaning. The study found that use of this decision support system was associated with a 29 percent reduction in the duration of vasoactive infusion use, with no increase in adverse events such as cardiac arrest or weaning failure. ICU length of stay was unchanged.
“This was one of the first multicenter studies to demonstrate that predictive analytics can safely and meaningfully influence bedside care in real time,” says Dr. Gazit.
External Validation and Editorial Perspective
The significance of Dr. Gazit and colleague’s study was recognized in an invited editorial published in tandem with the study in Critical Care Medicine. In the editorial, the authors described the work as, “a compelling demonstration of how predictive analytics can meaningfully influence bedside care.” They highlighted the fact that the study moved beyond traditional risk prediction to actively guide de-escalation of care that allowed the clinicians to safely reduce therapy rather than simply identifying high-risk deterioration.
The editorial also emphasized the study’s pragmatic multicenter design, sophisticated statistical modeling, and its demonstration of clinical feasibility.
“This type of external recognition is important because it validates both the methodological rigor we built into the research and the real-world clinical relevance and applicability of this work,” says Dr. Gazit.
Future Directions in Predictive Critical Care
Building on these findings, Dr. Gazit and his colleagues are now working to integrate predictive analytics more deeply into routine care in the CICU at UPMC Children’s. As the hospital and broader UPMC system transitions to a single, unified electronic health record later in 2026, plans are underway to embed the Etiomentry analytic platform directly into the daily clinical workflow of the CICU, enabling real-time risk assessment to be seamlessly incorporated into routine rounds and the clinical decision-making process.
Over time, Dr. Gazit sees the ability to expand these kinds of predictive analytic tools beyond vasoactive weaning to other aspects of cardiac critical care, including early identification of respiratory failure, impending cardiac arrest, and the readiness for extubation.
“Our goal is to create a more predictive model of care that allows us to intervene earlier, anticipate deterioration before it happens, and personalize care in ways that improve outcomes,” says Dr. Gazit. “That is the next phase of our field’s evolution.”
Extending the Legacy
For Douglas Dick, the Patrick Dick Memorial Chair represents a lasting legacy that bridges a profound personal loss with institutional advancement in congenital heart care. For Dr. Gazit, the chair provides critical support to pursue the complex research questions that seek to transform how critically ill children are managed in real time.
“This work builds directly on the mission that Douglas set in motion decades ago,” says Dr. Gazit. “The progress we have made is extraordinary, but there is much more we can do.”
References and Further Reading
