The PACT program (Pediatric Advanced Cardiac Therapies) was established in 2004, and was one of the first such programs for children.  Since its beginning, we have treated more than 2000 children with heart failure from all causes, ranging from genetic cardiomyopathies, to the most complex forms of congenital heart disease.

PACT is a comprehensive patient-centered program for the diagnosis and treatment of children with heart failure.  The overarching goal of PACT is to maintain the health of children with heart failure through the entire spectrum of disease, ranging from screening of asymptomatic children at risk for heart failure, to the treatment of those children who require medications, or who require more advanced therapies including mechanical circulatory support and heart transplantation.  Rather than focusing only on the time of transplantation and beyond, we seek to intervene at an earlier time, to preserve the function of the native heart where possible; and to prepare children and their families for transplantation when that is necessary.  The model of care that is central to the PACT program is to form a partnership with the PACT team, the family, and the community-based physicians in order to optimize access to care and to specialized expertise.

The pediatric heart transplantation program at Stanford has been in continuous operation since 1984 and has transplanted more than 500 children as of 2023.  We serve primarily the population of Northern California, but also have patients from multiple locations in the Western United States including Hawaii.  The transplant program provides service to children with highly complex anatomic and immunologic disease, and is tightly integrated with the mechanical circulatory support program.  We participate actively in the Pediatric Heart Transplant Study, with the goal of collecting data nationally to enhance our ability to treat children after heart transplantation.

Mechanical circulatory support is the use of heart pumps to support the failing heart when medications are no longer sufficient.  In children, mechanical circulatory support is typically used to maintain patients in a stable condition in order to receive a heart transplantation.  Occasionally, mechanical circulatory support is used as a long-term support without the goal of transplantation.  There are a variety of different devices (VADs) which can be used for mechanical circulatory support, depending upon the circumstances.

The mechanical circulatory support program for children, which is a part of the PACT program, has among the highest volume of VAD implantations for children in the United States, and has a long record of innovation and excellent outcomes.  The program currently uses the Berlin Heart EXCOR, Pedimag, Centrimag, Impella and Heartmate III. We are leaders in the ACTION learning network for VAD and HF, with the goal of pooling knowledge about children to accelerate improvement in care.  We have been leaders in supporting the safe discharge from the hospital of pediatric VAD patients, and their re-integration into their communities.  For those children who must remain hospitalized while awaiting transplantation, we have a comprehensive range of support services including physical therapy, and participation in age-appropriate schooling.