Shah the Driving Force Behind Growth, Innovation at VUMC
"The first time I watched a heart transplant, I said, 'This is it.'"
More than 200 hearts transplants later, Ashish S. Shah, MD, chair of the Department of Cardiac Surgery and director of Heart Transplant and Mechanical Circulatory Support at Vanderbilt, is the driving force behind one of the nation's busiest heart transplant programs.
Finding his Place
Raised in Connecticut, Shah received his bachelor of science in biomedical engineering from Duke University before earning his medical degree from the University of Pittsburg School of Medicine. Following an internship at Duke University Medical Center, Shah remained onsite for residencies in general and thoracic surgery.
"I had committed to being a heart surgeon ... and at the time, there were just a few credible places to go if you wanted to be a leader in the field," Shah said of his time in North Carolina. "Duke was a mecca for the training of heart surgeons, and it was demanding; but it helped me understand how to be the best physician and academic surgeon I could be. They taught work, endurance and excellence that I've carried with me."
Shah also was exposed to the school's heart and lung transplant programs, which led to his first job performing aortic surgery, heart and lung transplants at Johns Hopkins University in Baltimore. It was trial by fire for the young surgeon, who diversified his skill set while working with medically complex patients from across the world. He also established a successful academic career focused on end stage heart and lungs and investigated ways to improve organ function.
"Being surrounded by great scientists pushed me to perform better and ask the big questions," Shah noted of his 10 years at Johns Hopkins.
Coming to Nashville
In 2015, Shah relocated to Nashville to serve as medical director of the heart transplant program at Vanderbilt University Medical Center.
"My family and I were looking for a change, but I didn't want to give up an academic environment," said Shah, who continues to perform transplants and teach. "That academic enterprise helps you figure out how to do things better, and Vanderbilt had a long history of excellence with a credible and aggressive transplant program. Their work in mechanical support devices and left ventricular assist devices also was a sign that the organization and people were ambitious and hungry to do bold things."
Since his arrival, Shah has been focused on establishing VUMC's heart transplant program as an international destination for patients with complicated diagnoses. And it's working. By increasing the complexity of surgeries, the program has tripled in size since Shah's arrival, transplanting 100 hearts in 2017 alone. Their success has opened doors for the team, allowing them to participate in even more cutting-edge research.
Thinking Outside the Box
Recent accomplishments for Shah's team include VUMC's trial involvement with novel "heart in a box" technology (see sidebar), which allows organ profusion during transport.
Shah is already working to establish a program for the promising technology, currently undergoing FDA approval. He's also growing VUMC's aortic surgery program, building partnerships and broadening capabilities for patients with rare vascular and aortic conditions. It's a passion that stems from his work with at Johns Hopkins, where he cared for patients that other programs weren't comfortable treating.
Shah also has been instrumental in reestablishing the CORE Research Laboratory for cardiac surgery, which has helped attract those pursuing careers in academic medicine. "We've established some pretty fertile areas of research, and we're bringing ideas and post-doctoral fellows together to fill in the gaps," he said.
Building on his experience performing more than 230 lung transplants in Baltimore, Shah also plans to re-launch a combined heart and lung program at VUMC. It's a rare, complicated procedure that involves transplantation of two connected organs. "My vision is to be a destination center and to be able to offer everything the most desperately ill people need," said Shah, noting the program would make the university one of a few places in the country to offer the combined surgery.
Training the Next Generation
Despite his continued success, the world-class surgeon is quick to give credit where it's due: his mentors. "The longer I'm in cardiac medicine, the more I've appreciated the people who've been examples of excellence and took a personal interest in teaching me to do very tough surgeries," Shah said. "My mission here is to do that for others and help young physicians feel as comfortable tackling difficult problems as I do now. Being a program our size makes you better, and being around smart people who push you and make sure you're at your best is the secret sauce of how programs like this do right by our patients."
VUMC Raises the Bar for Heart Transplantation
Vanderbilt University Medical Center set a new record for total transplants among its five organ specialties in 2018 with more than 500 transplants - of which, more than 20 percent were hearts. The program saw a record 109 adult and pediatric transplants, making VUMC the second largest heart transplant program in the nation by volume for three consecutive years. So what's next for the thriving program?
VUMC recently participated in a clinical trial for technology expected to redefine organ transplantation. The TransMedics Organ Care System's living organ transplant technology allows warm blood perfusion of harvested organs for days or even weeks, giving physicians more time to ensure a perfect match.
The "heart-in-a-box" also relieves the time sensitive component to organ transplant - a particular challenge in rural areas worldwide. "The way we traditionally preserve organs is to pack them in an iced cooler for transport, but that six-hour period without blood supply is a time of vulnerability and a lot of metabolic things can happen," said Ashish Shah, MD, medical director of VUMC's heart transplant program. "Why not pump blood into the organ to maintain blood supply?"
While the idea isn't new, the technology is: Hearts beat, lungs breathe, kidneys produce urine and livers produce bile. In anticipation of the system's pending FDA approval, Shah is assembling a team of advanced heart failure cardiologists in hopes of using the technology as a gateway for repairing damaged organs.
"We're working in partnership to produce a collaborative model involving multiple disciples and perspectives," Shah said. "When you remove the time and distance constraints from transplantation, you can clean it, give it antibiotics, or deliver genes. It becomes a platform to manipulate or repair and prepare it. Vanderbilt has an opportunity because we can ask the big questions and make an impact on the ability to recondition a patient's own organs."
VUMC also is revolutionizing transplantation through "Hep C Hearts" - those harvested from patients with Hepatitis C. "We were approached by liver experts at Vanderbilt who said, 'We have these drugs that now cure people of Hepatitis C, and our liver surgeons are using organs from people with the disease. A lot of these donors have really strong hearts that aren't being used,'" Shah said.
VUMC initially offered the Hep C hearts to patients at imminent risk of dying. Those who tested positive for Hep C following transplantation received the FDA-approved 12-week drug therapy to eliminate the disease. Three years later, VUMC has performed more than 70 Hep C heart transplants - more than anyone else in the nation. "We've learned a lot about the biology of Hep C in these organs, and other teams are looking to us to understand the long-term consequences," Shah said.
While most recipients test positive for the virus within one week, Shah is especially interested to study the biology behind those who never become infected. "It's remarkable to see the quality of organs available, and we're able to get them quickly because no one else is using them," he added.