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Updated: Jul 12, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Domino heart transplantation involving infants
T L Astor1, M Galantowicz, A Phillips
1Division of Pulmonary Medicine, Columbus Children's Hospital, OH, USA. astort@pediatrics.ohio-state.edu
Insights
Domino heart transplantation was successfully performed in two infants, offering a novel approach for pediatric heart transplants. This technique provides pre-conditioned donor hearts, improving survival rates in critically ill infants.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Domino heart transplantation, a procedure where a donor heart is transplanted into a second recipient, is established in adult cardiac surgery.
- Its application in infant heart transplantation has not been previously documented.
- Infants requiring heart transplantation often face limited donor availability and unique physiological challenges.
Observation:
- A 3-month-old infant with primary pulmonary hypertension underwent heart-lung transplantation, and their donor heart was subsequently transplanted into another 3-month-old infant with complex congenital heart disease.
- Both infant recipients survived beyond one year post-transplant.
- No significant allograft-related complications were observed in either infant.
Findings:
- The 'domino' heart, transplanted from the first infant to the second, showed stable right ventricular (RV) hypertrophy and interventricular septum thickening.
- Both right and left ventricular function remained robust in the domino heart.
- Echocardiography and cardiac catheterization confirmed the sustained cardiac health of the transplanted organ.
Implications:
- Domino heart transplantation represents a viable and potentially life-saving strategy for infant heart recipients.
- This technique may offer 'pre-conditioned' donor hearts, particularly beneficial for infants with complex congenital heart disease.
- Successful infant domino heart transplantation expands the donor pool and offers a novel therapeutic option in pediatric cardiac surgery.
Abstract:
Domino heart transplantation has been well described in adults, but has not previously been reported in infant patients. We report the successful transplantation of a 'domino' heart from a 3-month-old infant with primary pulmonary hypertension undergoing heart-lung transplantation, into a 3-month-old infant with complex congenital heart disease. Both infants have survived past 1 year post-transplant, and neither infant has experienced any clinically significant allograft-related complications. Echocardiography and cardiac catheterization of the domino heart have consistently demonstrated stable hypertrophy of the right ventricle (RV) and interventricular septum, but good right and left ventricular function. Domino heart transplant surgery may be an effective way to provide 'pre-conditioned' donor hearts to infants urgently in need of heart transplantation.
