Dr. Mauchley is a cardiac surgeon. He joined Seattle Children’s Heart Center in February 2020.
What drew you to Seattle Children’s?
David Mauchley
Dr. Mauchley: I grew up in the Pacific Northwest in Moscow, Idaho, and went to medical school at the University of Washington. My wife is also from Washington state, and we met in medical school. We always hoped there would be an opportunity to move back to Seattle to be closer to family.
Do you have a specialty area at the Heart Center?
Dr. Mauchley: Congenital heart surgery is my specialty, with what you might call a “niche” in adult congenital heart surgery.
I’m also our “mobile surgeon,” seeing patients one day a week each at Mary Bridge and UW Medical Center (UWMC). At Mary Bridge, I’m the interim cardiac surgery director. I’m also the surgical director of the adult congenital heart program at UWMC. About 75% of my practice is at Seattle Children’s and Mary Bridge and 25% is with adults at UWMC.
Why would an adult patient need a pediatric cardiac surgeon?
Dr. Mauchley: Pediatric cardiac surgeons are used to dealing with congenitally abnormal hearts. We operate on them all the time and have experience with a wide variety of conditions. Adult cardiac surgeons are trained on normal hearts. They may never have seen a heart with the kinds of congenital anomalies we are used to operating on. An ideal situation for an adult with congenital heart disease is to seek care at a facility that has both an adult cardiac surgeon and pediatric cardiac surgeon who can work together. There are many situations where the expertise of each type of surgeon is helpful in this population.
Do Seattle Children’s and UWMC work together for congenital heart disease (CHD) patients?
Dr. Mauchley: Yes, absolutely. Seattle Children’s has always had a relationship with the adult congenital program at UWMC. Previously all surgeries for adults were done at the UWMC hospital by adult cardiac surgeons who had extra training in congenital heart disease.
Now Seattle Children’s has taken the leap into being more closely involved with their adult program. I’m at UWMC once a week for clinic and surgery. Most of our CHD surgeries for adults are still done at UWMC because Seattle Children’s only offers surgery for patients up to age 21.
The kind of relationship we have with UWMC (i.e., pediatric congenital heart surgeons having a formal relationship with the adult congenital cardiology program) is typical in bigger cities. I’m really excited about the work we are doing together.
Another way we’re working together is through the Adult Congenital Heart Defect (ACHD) Program shared by Seattle Children’s and UWMC. As part of that program, two adult congenital cardiologists from UWMC come to see Seattle Children’s patients in clinic twice a week. We help pediatric patients prepare to meet their long-term health needs as they start to transition to adulthood.
What do you expect for CHD treatment in the future?
Dr. Mauchley: The percentage of babies born with CHD stays roughly the same each year. What’s changing is the number who are surviving to adulthood and living longer lives, thanks to the good outcomes we can deliver today. UWMC’s group of five congenital cardiologists, which is exceptionally large, is busy now and will get busier over time, given their national reputation and how many patients will need their services in coming years.
What facets of your partnership with UWMC interest you most?
Dr. Mauchley: I really enjoy the unique partnership I have with UWMC surgeon Chris Burke. We both evaluate every patient who is referred for adult CHD surgery. Chris did his training here at UWMC and specializes in complex aortic surgery. A lot of issues in adult congenital surgery revolve around the aorta and aortic valve. Chris knows more about some aspects of surgery than I do, while I know more about complex congenital anatomy. Patients are getting the best of both worlds because each of us lends a different perspective to their management and we are working together. Chris and I have had excellent outcomes that can’t be found in other programs in WWAMI.
We have something special here. Nationwide, every big medical center with a pediatric heart program has some form of adult congenital presence, but I haven’t been to many that have this kind of partnership where adult and pediatric surgeons work really well together. It will be the new paradigm going forward.
Why do prospective CHD patients choose Seattle Children’s and UWMC?
Dr. Mauchley: It’s the team’s experience and outcomes, most importantly. Our surgeons have more advanced training and experience operating on pediatric patients with a wide range of heart conditions than any other children’s hospital in the Pacific Northwest. What we offer to patients with CHD can’t be matched in many other places; we have some of the best outcomes and survival rates in the country. Parents bring their kids here for those reasons.
What advances can kids with CHD look forward to in the future?
Dr. Mauchley: Helping young patients with aortic valve disease is something Chris and I are really interested in and where we will grow the most. Needing aortic valve surgery as a child or young adult is complicated because there are not a lot of good options for valve replacement. The most common replacement options include a mechanical valve, which requires lifelong anticoagulation therapy, or a tissue valve. Tissue valves don’t require the lifelong anticoagulation but they wear out with time and require additional surgery to replace them.
Chris and I can offer some of these young patients valve-sparing surgery. Instead of replacing the dysfunctional valve, we can repair it so that it functions better. This is an important skill to have when operating on younger patients to give them the option of having a functional valve without the need for lifelong anticoagulation, which can significantly limit the types of activities they can enjoy (contact sports, rock climbing, etc.).
We can also offer the Ross procedure, which replaces the dysfunctional aortic valve with the patient’s pulmonary valve. This gives young patients a completely normal valve that is composed of their own tissue. It has the potential to grow with the patient and never wear out. It’s a complicated operation, and not many surgeons do it.
Research continues to bring new advances for CHD. Just two weeks ago, the FDA approved the first in the world nonsurgical heart valve for pediatric and adult patients with congenital heart disease. The Harmony TPV valve expands our ability to replace the pulmonary valve without surgery. Seattle Children’s was a top-enrolling site for the clinical study. It’s exciting to be part of breakthrough innovations like this for CHD patients.
Has the number of surgeries declined during the pandemic?
Dr. Mauchley: No, the number and type of cases we see in cardiac surgery at Seattle Children’s have held steady over the last year.
Who are Seattle Children’s other heart surgeons?
Dr. Mauchley: Dr. Michael McMullan is our division chief of congenital cardiac surgery and has been at Seattle Children’s since 2007. Dr. Lester Permut has been operating at Seattle Children’s for almost 20 years. More recently arrived is our outstanding new surgeon, Dr. Lyubomyr Bohuta, who has been at Seattle Children’s for three months.
Any other big news?
Dr. Mauchley: We are looking forward to having two new dedicated heart operating rooms when our new building on the main campus is completed in spring 2022 (Building Care).
