Dr. Evan Zahn performs surgery on a patient. Photo courtesy of Cedars-Sinai Heart Institute.

Dr. Evan Zahn at Cedars-Sinai continues to innovate for infants with heart defects

The large desk inside Dr. Evan Zahn’s Cedars-Sinai Medical Center office overlooking Beverly Boulevard has a 3-D printed model of a human chest, revealing veins, arteries and, of course, a human heart — the primary focus of his work for more than 30 years.

“It’s a model of an actual patient,” he said.

Zahn, 57, showed how a small metal device could be inserted into the heart through a catheter that would unsheathe once inside, replace a faulty pulmonary valve and improve blood flow.

“It can last 10 or 15 years, and maybe we just put in another valve then, kind of like a Russian [nesting] doll,” he said. “We can save many patients open-heart surgery.”

One patient he helped save was Jimmy Kimmel’s infant son, Billy, whose heart defect was first diagnosed at Cedars-Sinai. In an emotional monologue on his late-night show in May, Kimmel thanked Zahn by name and used the episode to argue for making the same high-quality medical care available for all Americans.

A native of Long Island, N.Y., Zahn has been the director of pediatric cardiology at Cedars-Sinai’s Heart Institute since 2012. He’s one of the world’s pre-eminent experts at treating structural heart problems with minimally invasive procedures, particularly in children.

During a nearly 20-year stint as chief of cardiology at Miami Children’s Hospital in Florida before coming to Cedars-Sinai, Zahn rose to prominence, performing the world’s first nonsurgical tricuspid valve replacement via catheter on a 9-year-old boy.

Five years ago, it seemed like the right time for Zahn to take on a new professional challenge offered by Cedars-Sinai. He, his wife and four children moved from Miami to Pacific Palisades, where they’ve become members at Kehillat Israel, a Reconstructionist temple. He’s an avid runner and cyclist.

“I love it here,” he said. “When people ask me about the traffic in Los Angeles, I say there’s a reason so many people want to live here.”

Zahn was lured to Cedars-Sinai to head up a new Congenital Heart Disease Program and develop more minimally invasive treatments.

“Cedars is a household name, a widely respected place for treating heart disease,” he said. “There’s tremendous support here for doing new, creative and innovative things. I don’t think there’s a place anywhere that rivals this institution for that.”

One of the main attractions for Zahn in coming to Cedars-Sinai was the prospect of forming a congenital heart disease program in an adult medical center. Children’s hospitals, by nature of their charters, can’t treat patients over the age of 18. In many cases, Zahn had patients born with heart defects requiring lifelong medical attention and complex procedures age out of his care.

“I was having to send my patients away, and I hated it, but not half as much as they hated it,” he said. “So, one of the things that really drew me here was being able to take care of patients who need a lifetime of care at one institution with one singular team, from fetal diagnosis until old age.”

Cheryl Davis, 48, a lighting artist at Walt Disney Animation Studios in Burbank, is one of Zahn’s adult patients. She was diagnosed with a severe pulmonary valve regurgitation, or leaky valve, as a 9-year-old. Leaks in the pulmonary valve allow blood to flow back into the heart chamber before it gets to the lungs for oxygen.

Davis had open-heart surgery as a child to correct it but still had complications throughout adulthood, including a murmur and fatigue. After consulting numerous cardiologists, she was referred to Zahn. In late August, he performed a valve replacement on Davis, just as he demonstrated on the model in his office. She was back at work a few weeks later.

“I’m still taking things a little slow, but I don’t feel my murmur and my heart feels normal for the first time in my life,” she said. “[Zahn] has been amazing. On top everything, he’s just a really nice man and one of the most humble people I’ve ever met.”

Still, Zahn’s primary focus at Cedars-Sinai has been treating newborns, particularly premature babies, with structural heart problems. He estimated that as many as 15,000 premature babies are born each year with life-threatening congenital heart defects. These are babies born up to four months early that sometimes weigh as little as 1 pound and fit in a cupped adult hand. Zahn said doctors currently have two main treatment options, which work less than half the time and have significant side effects or complications linked to severe outcomes like blindness, deafness and mental disability.

At Cedars-Sinai, Zahn has made great strides in this area, dedicating time to research and development with colleagues and outside biomedical engineers. So far, he has treated 40 premature babies using a catheter to insert a small metal clamp that plugs harmful blood flow to a baby’s lungs, which causes disease in lungs, bowels and the brain.

“For premature babies, no one does that,” he said. “No one has gone into their hearts via catheterization.”

Zahn said he has a 90 percent success rate so far. No one has died, and babies he treated three years ago now look like other kids their age. In the remaining 10 percent of cases, he said additional conventional surgery was required. 

“There have been other people who have done other work in other countries, and some of that was very useful, but ultimately, I think the solution came from here,” he said.

Zahn almost feels guilty about how much personal satisfaction he gets out of saving lives.

“It’s almost a selfish thing that I do,” he said. “I get so much joy out of knowing that a baby, who without immediate medical care won’t survive, will be fine because I’ve seen their course so many times. Now that I’ve done this for nearly three decades, I’ve seen these babies grow up to play T-ball, play high school sports, get married and have kids. It’s remarkably gratifying.”

Cedars-Sinai is working with an industry partner to develop a clamp device uniquely designed for premature babies with heart problems and to get federal approval for it. The device, Zahn said, will be a self-expanding plug, fashioned to fit inside a catheter and made out of a metal called nitinol, or nickel titanium. The device used in the initial 40 cases was designed for other purposes.

Zahn, who recently spoke to a colleague in Japan whose hospital just treated its first premature baby, said he is confident that his efforts at Cedars-Sinai will have wide-reaching impact.

“We think we can make a big difference around the world with this,” he said. “It’s a very in-need population, and there’s not a lot made in general for premature babies. They don’t vote. They don’t get the attention they need. We think this is going to be a game changer.”

My son is too young to be vaccinated

I remember when I read the news on January 5th about measles being linked to Disneyland visits between December 15-20, 2014. I frantically googled how long someone can be exposed to measles before the disease manifests. I found out that at the longest, it’s three weeks. I was relieved, and then I was angry.

My son isn’t vaccinated.

I was relieved because it had been just about three weeks since my family, including my then 2-month-old son, were at Disneyland. And I was angry that measles, a preventable disease, was spreading through southern California.

Even though we were safe from the initial outbreak at Disneyland, we live just a few minutes away from other places where the outbreak is just beginning to show up.

My son wasn’t vaccinated because he’s too young.

I believe in vaccines. I am also a baby-wearing, breastfeeding, co-sleeping, and organic-eating mommy (or try my best to be.) I’m not super “crunchy,” but some would argue I have a lot in common with the stereotypical “anti-vaxxer.” My son is lucky; he did not get measles. He has passive immunity because he is breastfed, and I have been fully vaccinated.

I am a “vaxxer.” I believe vaccines not only help my own child, but are our social responsibility to others who are medically unable to vaccinate to protect themselves. While pregnant, I had my entire family (30 people) get their TDaP booster because I was not risking my son getting whooping cough. He can’t protect himself yet, so it’s our responsibility to protect him. Likewise, the people of society should do so for each other. We might not be family, but we must live together.

Those who are medically able to withstand the minimal risks/ effects of a vaccine should be vaccinated.  I know vaccines aren’t 100% effective in preventing a disease, but they do a great job of arming the body with immunity to fight against the disease. So, if someone were to contract the disease, that person is less likely to pass the disease to another and is better able to fight it, making the duration of the symptoms shorter and less intense than if that person had no immunity whatsoever. 

Furthermore, even IF vaccines caused autism (which they don’t), I’d rather have a living autistic child than a deceased non-autistic child from a preventable disease like measles.

Having most members of a community, 95% vaccinated, creates herd immunity. People who are immunocompromised, or severely allergic, or too young  (like my son) to receive vaccinations depend upon that immunity. It's what keeps preventable diseases at bay and keeps diseases from mutating. It is because so many have been vaccinated that this measles outbreak isn't worse.

That’s why the measles vaccine has been so effective. The strain has remained relatively the same for the past five decades. However, with so many anti-vaxxer clusters, communities have created a sort of petrie dish allowing the virus room to mutate. We see how readily viruses mutate each year with the flu. And measles is much more contagious than the flu.

Do you wonder why we see mothers in poorer countries walking miles to vaccinate their young children? It's because they have seen death first–hand from preventable diseases. There is a reason why we see so few deaths in the US from measles and other preventable diseases. It is because of our access to vaccines and healthcare.

I would hate for children too young to receive a vaccine to die because of another parent’s selfish choice to not vaccinate their child.  It’s selfish because that choice affects others. The scariest thought is if the disease is allowed to mutate, then no one, not even the vaccinated, will have immunity.

Germany’s Jews won’t be punished for circumcisions

Germany’s Jews and Muslims will not be punished for breaking the law if they carry out circumcisions on young boys, Chancellor Angela Merkel’s spokesman said.

“For everyone in the government it is absolutely clear that we want to have Jewish and Muslim religious life in Germany,” Merkel’s spokesman, Steffen Seibert, said Friday according to Reuters. “Circumcision carried out in a responsible manner must be possible in this country without punishment.”

Earlier this week Europe’s main Orthodox rabbinical body held an emergency meeting in Berlin after a Cologne court ruling that said the religious ritual could be considered a criminal act. Regardless, the rabbis urged Jews in Germany to uphold the commandment to circumcise newborn sons.

The decision came in the ruling in the case of a Muslim boy taken to a doctor with bleeding after circumcision. The Cologne court said the practice inflicts bodily harm and should not be carried out on young boys, but could be practiced on older males who give consent. The ruling by the Cologne Regional Court applies to the city and surrounding districts.

In a press conference held Thursday at the Amano Hotel in central Berlin, Rabbi Pinchas Goldschmidt, president of the Conference of European Rabbis, said his organization was ready to back Jews in challenging the May ruling by a Cologne district court, which Jewish groups see as symptomatic of a trend across Europe against some Jewish rituals.  Rabbi Goldschmidt did not give details about what actions his group could take.

The rabbinical conference also announced that it is joining with the Orthodox Rabbinical Conference of Germany to create an association of mohels, or ritual circumcisers, to be supervised by the Association of Jewish Doctors and Psychologists

Goldschmidt, who is chief rabbi of Moscow, told JTA he didn’t think “that 70 years after the Holocaust a German court would put a parent or a mohel in jail for performing a Jewish religious commandment.”

The Central Council of Jews in Germany has condemned the court’s decision and promised to work with German lawmakers to reverse the ruling. Muslim groups also have proposed bringing a test case to German courts.

Goldschmidt said his rabbinical group applauded the Central Council’s action and wanted to back it with moral and religious encouragement on a European level. He also said that the rabbinical conference had received assurances from Germany’s ambassador to Israel, Andreas Michaelis, that the German government will work on legislation to rectify the legal situation.

Seibert, according to Reuters, said that Merkel’s office would continue to work to resolve the legal issues.

The German Medical Association has advised doctors to not perform circumcisions until the legal questions are resolved, according to Reuters.