UPMC Heart & Vascular Institute Welcomes New Surgical Director of Advanced Heart Failure Center David J. Kaczorowski, MD

On November 1, David J. Kaczorowski, MD, joined the UPMC Heart and Vascular Institute (HVI) as the new surgical director of the Advanced Heart Failure Center.

Dr. Kaczorowski joined UPMC after previously holding faculty positions at the University of Maryland School of Medicine. He was director of cardiac transplantation and mechanical circulatory support and the United Network for Organ Sharing (UNOS) primary transplant surgeon for heart and lung transplant programs at the University of Maryland Medical System. Dr. Kaczorowski also served as Program Director of the Thoracic Surgery Residency Programs at the University of Maryland.

Dr. Kaczorowski's medical training began at Johns Hopkins University School of Medicine, where he earned his medical degree, followed by a general surgery residency at the University of Pittsburgh School of Medicine. He then completed a cardiothoracic surgery residency and fellowship in heart failure, cardiothoracic transplantation, and advanced adult cardiac surgery at the University of Pennsylvania School of Medicine.

“I grew up in Pittsburgh and did part of my residency training at the University of Pittsburgh and UPMC. I’m intimately familiar with the system and its long history as a national and international leader in transplant medicine. I’m excited to return to my hometown and join the expanding Heart and Vascular Institute at UPMC, where I can apply my training and experience in improving outcomes and quality of care for our heart failure patients,” says Dr. Kaczorowski.

Clinical Areas of Focus

Dr. Kaczorowski's clinical work is devoted mainly to treating patients with advanced heart failure and cardiogenic shock through the use of temporary mechanical support modalities such as extracorporeal membrane oxygenation (ECMO) and durable strategies, including left ventricular assist devices (LVAD) and cardiac transplantation (CT). 

Minimally Invasive LVAD Approach

Dr. Kaczorowski’s surgical practice with LVADs is primarily dedicated to the use of minimally invasive implantation approaches. As device generations have advanced and become smaller in size, this has led to advances in minimally invasive implantation techniques.

"There is a growing body of evidence and our own experiences with minimally invasive techniques to support wider adoption. We have realized excellent clinical outcomes with our patients with demonstrably significant improvements in overall survival, length of hospital stay, and postoperative bleeding,” says Dr. Kaczorowski.

Additionally, Dr. Kaczorowski's clinical experience and other studies have shown that minimally invasive LVAD approaches can reduce right ventricular failure, which is a major concern with LVAD use and carries with it very high rates of mortality and morbidity.

For cardiothoracic patients that have LVADs placed as a bridge to transplantation, there appear to exist additional benefits to having LVADs placed using minimally invasive approaches versus the standard approach using a full median sternotomy. Dr. Kaczorowski and colleagues have examined the influence of minimally invasive LVAD insertion on outcomes at the time of the subsequent transplant operation. A new paper will be published soon that outlines some of the benefits of minimally invasive LVAD in CT from their surgical experience.

"Our research points to several benefits for these patients. It appears that length of stay (LOS) can be reduced, as well as the need for transfusions. Minimally invasive implantation approaches also appear to facilitate re-entry to remove the device, and we have seen improved outcomes in these patients at the time of transplantation,” says Dr. Kaczorowski. “I’m looking forward to continuing this line of research at UPMC.”

ECMO for Mechanical Circulatory Support and as Access Point for Diagnostic and Therapeutic Procedures

Extracorporeal membrane oxygenation (ECMO) for critically ill patients has become an important tool in the management of cardiogenic shock since its first application in adult patients in 1972. ECMO allows for the short-term stabilization and support of patients with cardiac or pulmonary failure, giving them time for their organ systems to recover or for other procedures to be performed to stabilize or repair the causative factors associated with their condition.

Dr. Kaczorowski has an extensive clinical and research background with ECMO, treating nearly 200 patients a year with the treatment modality. He brings his expertise and clinical acumen to an ECMO program at UPMC with its own long and successful use of the therapy for patients in cardiopulmonary failure.

Dr. Kaczorowski also brings to UPMC his work developing a unique adaptor system that can be inserted into an ECMO circuit to allow for endovascular access through which diagnostic or therapeutic interventions or procedures can be accomplished while maintaining ECMO support.

Dr. Kaczorowski developed and patented the novel device prior to joining the University of Maryland. The device can be installed and removed without disturbing or otherwise altering the already-in-place ECMO circuit.

“Traditionally, it has been difficult to gain vascular access in ECMO patients to perform procedures. Our idea involves using the ECMO circuit as a means to gain access to the patient's cardiovascular system to perform procedures or diagnostics," says Dr. Kaczorowski. “Our device could greatly expand how ECMO is used, moving outside of its traditional supportive role and into one of intervention. We have a good deal more research and testing to do with the device, but all of our initial work has shown great promise to advance the ECMO field into new territory.”

Research and Teaching Priorities

Dr. Kaczorowski’s research interests closely align with his clinical areas of focus. His research has focused on studying minimally invasive LVAD implantation and how minimally invasive techniques may benefit patients in terms of outcomes and complications.

Another avenue of research Dr. Kaczorowski has been involved in recently with colleagues at the University of Maryland is developing and testing xenotransplantation models and pathways using genetically modified porcine hearts.

Further Reading

1. Pasrija C, Bittle GJ, Zhang J, Morales D, Tran D, Deatrick KB, Gammie JS, Wu Z, Griffith BP, Kon ZN, Kaczorowski DJ. A Novel Adaptor System Enables Endovascular Access Through Extracorporeal Life Support Circuits. J Thorac Cardiovasc Surg. 2019; 158(5): 1359-1366.

2. Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant. In peer review.