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Heart transplantation and the Batista operation for children with refractory heart failure
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Republic of China.
Insights
Pediatric heart transplantation offers satisfactory outcomes for medically refractory heart failure in children with cardiomyopathy or complex congenital heart disease. The Batista operation serves as a viable bridge to transplant when donor hearts are scarce.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Immunology
Background:
- Medically refractory heart failure in children often stems from cardiomyopathy (CMP) or complex congenital heart disease (CHD).
- Established adult surgical options include heart transplantation and the Batista operation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of cardiac transplantation in pediatric patients with medically refractory heart failure.
- To assess the role of the Batista operation as a bridge to transplantation in this population.
Main Methods:
- A cohort of 6 children (aged 1-16 years) with medically refractory heart failure underwent cardiac transplantation between March 1995 and January 2000.
- One patient received the Batista operation as a bridge to subsequent transplantation.
- Immunosuppressive regimens and post-operative complications were monitored.
Main Results:
- Five of the six patients were discharged with satisfactory hemodynamics post-transplantation.
- One patient experienced fatal sepsis, while others managed rejection and lymphoproliferative disease with medication.
- Long-term follow-up showed normal cardiac function, with remodeled left ventricular mass and no need for anticongestive medications.
- The patient undergoing the Batista operation showed improved ejection fraction and was successfully bridged to transplant.
Conclusions:
- Cardiac transplantation is a satisfactory surgical treatment for medically refractory heart failure in pediatric patients.
- The Batista operation can be a valuable bridge strategy to heart transplantation, particularly given donor heart limitations.
Abstract:
Medically refractory heart failure may be present in children with cardiomyopathy (CMP) or complex congenital heart disease (CHD). In adults, the surgical management of this condition is either heart transplantation or the Batista operation. From March 1995 to January 2000, a total of 6 children, aged from 1 to 16 years, with medically refractory heart failure associated with CMP or complex CHD underwent cardiac transplantation and one of them also had the Batista operation as a bridge to transplantation. One of the 6 patients died of intractable sepsis 17 days after the operation, but the other 5 were discharged with satisfactory hemodynamics. Immunosuppressive agents, including azathioprine, cyclosporin or FK-506, were given. One patient experienced moderate acute rejection, but it was controlled by FK-506, OKT-3 and solumedrol. However, another suffered from lymphoproliferative disease 8 months after transplant, but it was controlled by intravenous immunoglubulin, alpha-interferon and acyclovir. Cardiac function during serial follow-up (range, 1 month to 5 years) revealed normal systolic and diastolic function and none received any anticongestive medications. Almost all patients received an oversized donor heart. The left ventricle (LV) mass was remodeled, initially as an decrease and later as an increase. The patient who underwent the Batista operation was discharged 1 month after the operation with an increased LV ejection fraction (from 10% to 22%). She was successfully bridged to heart transplantation 7 months after the Batista operation. The results of cardiac transplantation in growing children are satisfactory and remain the mainstay of surgical treatment for medically refractory heart failure in these patients. However, with a shortage of donor hearts, the Batista operation may be adopted as a bridge to heart transplant with a fair response.