Hari Mallidi, MD, was drawn to Miami Transplant Institute after hearing about the voluntary pause of its adult heart transplant program.
In March 2023, the Miami Transplant Institute's heart transplant program abruptly halted its adult heart transplant program to undergo review by the United Network for Organ Sharing. Investigators visited the transplant center — which is jointly run by Jackson Health System, a public safety-net system based in Miami, and the University of Miami's UHealth — in April after complaints about poor patient outcomes, including infection and death, following heart transplants, as well as a complaint about poor patient selection for the hospital's left ventricular assist device procedure. In July, the program was cleared of deficiencies and was reactivated .
In September 2023, MTI named Hari Mallidi, MD, a thoracic surgeon who heads cardiac surgery at Brigham and Women's Hospital in Boston, as chief of cardiac surgery and program director of heart transplantation and mechanical circulatory support at MTI, and director of the Jackson Heart Institute in Miami.
Dr. Millidi replaced Matthias Loebe, MD, who was released from his duties in February 2024 after the United Network for Organ Sharing said it would investigate at least one patient death.
Dr. Mallidi said he talked to senior leadership at MTI to get more insight into the program and the system after hearing about the halt. He became intrigued by MTI, which runs one of the largest transplant programs in the country by volume and the opportunity to work at a public safety net hospital system.
"This opportunity offered the chance to manage not just a single program or division within one hospital, but broadly manage cardiovascular care across a large safety net system in Miami," he told Becker's. "This piqued my interest, and the more I explored it, the more interesting it became. The Jackson system is capable of running multiple full trauma operating rooms and transplanting multiple organs simultaneously within a county-based hospital system. This capacity is rare within a safety net system, and I found it remarkable that they could care for the most complex patients, not just one at a time, but multiple patients simultaneously."
Dr. Mallidi officially joined the system in November 2023. Since then, he has worked to improve the heart transplant program, but it has not been easy.
"I think the experience of going through a pause in the heart transplant program left many people hesitant to embrace change and move forward," he said. "They weren't sure what that was going to look like. That was the most striking aspect of me joining the system concerning heart failure and transplant. It was a program in dire need of attention, but I don't think it was ready for rapid change."
Some leadership left the program during the pause, and by the time Dr. Mallidi stepped into his role, the program had only one surgeon left.
"This situation required stabilizing, ensuring that patients with emergencies and in need of heart failure care received it while we tried to rebuild the team," he said. "Part of the reason for the issues with adult cardiac heart failure transplant surgery was the distinct silos within the program. Surgeons specializing in transplant, VAD, and ECMO didn't collaborate much with those in adult cardiac surgery. This lack of cross-communication did not serve the patients' best interests."
He started by restructuring the cardiology team and eliminating the "siloed care."
The work is still ongoing, but Dr. Mallidi said his new priorities for the next few years are to increase capacity across the system, recruit additional surgeons with niche focus in aortic surgery, structural heart disease and end-stage heart failure, and revamp the heart failure program on the surgical and medical sides.