Dr. David Kalfa, a pediatric cardiologist known for his innovative surgical techniques, recently joined the medical community in South Florida as chief of cardiovascular surgery at Nicklaus Children’s Hospital and co-director of the Nicklaus Children’s Heart Institute. He also holds a professorship at the Herbert Wertheim College of Medicine, where he is involved in research on transplant innovation, surgical planning, and robotic surgery.
Kalfa performed the world’s first “domino” infant heart transplant in 2023. In this procedure, a donated heart saves one infant while valves from the recipient’s diseased heart are used to help another child. Describing this experience, Kalfa said, “I also did what we call a split-root domino partial heart transplant. First, a patient received a donor heart. Then, two valves from that patient’s heart were removed and given to two other children with heart conditions. It was unbelievable. You do a heart transplant to save the life of one child and then, using their old heart, you save two more children. All of this happened within 24 hours of non-stop surgery. It was pretty intense, I have to say. I was pretty emotional about it at times. That is a major case that will stay with me for the rest of my life.”
Congenital heart defects affect nearly 1% of newborns in the United States—about 40,000 infants annually—with half requiring operations to repair or replace a valve. Kalfa highlighted ongoing challenges in pediatric valve replacement: “We still don’t have many good options in terms of heart valve replacement for children… Another challenge is that, sometimes, there’s no valve small enough… Lastly, those replacement valves can’t grow with the baby or child.”
To address these needs, Kalfa focuses on living allogenic valve transplantation (LAVT), which involves storing and rehabilitating living donor valves that can grow with pediatric patients and reduce repeated surgeries. His laboratory developed a bioreactor capable of keeping fresh living valves viable for up to seven weeks—a significant improvement over previous methods that preserved tissue for only 48 hours outside the body.
Kalfa received $4.2 million from the National Institutes of Health (NIH) to further develop this bioreactor technology and begin pre-clinical trials.
Discussing future availability for patients needing partial heart transplants, Kalfa explained: “The idea is they would be available essentially ‘off-the-shelf’ for children in need.” This approach could improve access to suitable valves at critical moments.
Kalfa also plans to establish a congenital heart defect research institute that will build on collaborations between Nicklaus Children’s Hospital and Florida International University (FIU), integrating basic science with clinical trials.
In addition to transplantation work, Kalfa has experience launching pediatric cardiac robotic programs—the first formal program was started by him at Columbia University—and aims to introduce similar initiatives at FIU. He emphasized the benefits: “The beauty of robotic surgery is it’s the least invasive type of surgery you can do… There are actually some studies that show the psychological benefit of avoiding that sort of scar.”
Artificial intelligence is another area Kalfa intends to explore further: “One of the projects that I am working on is using AI to try to predict adverse events and cardiac arrests in the ICU and also using AI for risk assessment of patients with borderline left ventricle who need open heart surgery.”
Reflecting on his work’s impact, Kalfa stated: “This is definitely a kind of new frontier and that’s exciting… I wanted to develop innovations that can help improve outcomes for children with congenital heart disease. I think the work we’re doing can really be a gamechanger and transform lives in South Florida, across the country and the world.”
