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Expanding applicability of transplantation after multiple prior palliative procedures. The Paediatric Heart
A H Menkis1, F N McKenzie, R J Novick
1University Hospital, London, Ontario, Canada.
Insights
Pediatric heart transplantation for structural congenital heart disease is increasing. Successful orthotopic heart transplantation is achievable in these complex cases, even after prior palliative repairs, with careful surgical technique.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Heart transplantation numbers have plateaued, but pediatric cases are rising.
- Structural congenital heart disease, not cardiomyopathy, is the main reason for pediatric heart transplants.
- Prior palliative cardiac surgeries are common in children requiring heart transplants.
Purpose of the Study:
- To review the outcomes of orthotopic heart transplantation in children with structural congenital heart disease.
- To evaluate the impact of prior palliative repairs on transplantation success.
- To highlight surgical modifications and donor tissue use in complex pediatric heart transplants.
Main Methods:
- Review of patient cases undergoing orthotopic heart transplantation for structural congenital heart disease.
- Inclusion of patients with and without previous palliative cardiac surgical procedures.
- Analysis of surgical techniques and donor tissue utilization.
Main Results:
- No early deaths were recorded in the study cohort.
- Two late deaths occurred at 8 months and 3 years postoperatively due to transplant rejection.
- Successful orthotopic heart transplantation was achieved in patients with complex congenital heart disease.
Conclusions:
- Orthotopic heart transplantation is a viable option for children with structural congenital heart disease.
- Surgical modifications and extended donor tissue use facilitate successful transplantation in complex pediatric cases.
- Careful patient selection and surgical management are crucial for favorable outcomes in pediatric heart transplantation.
Abstract:
The number of heart transplantations performed over the past 3 years has plateaued. However, the number of pediatric transplantations continues to slowly increase. Unlike adult heart transplantation, for which cardiomyopathy remains the most frequent indication, structural congenital heart disease is the primary indication in children. This report reviews our experience with orthotopic heart transplantation in the presence of structural congenital heart disease with and without prior palliative repair. The diagnoses included transposition of the great arteries, common atrium, left superior vena cava with and without a bridging innominate vein, dextrocardia, and univentricular configurations. The palliative repairs included Blalock-Taussig shunt, bilateral Glenn shunt, Fontan repair, and Mustard and Rastelli procedure. There were no early deaths. Two rejection-related late deaths have occurred at 8 months and at 3 years postoperatively. Extended use of donor tissue and modifications to surgical technique allowed for successful orthotopic heart transplantation in these patients who had structural congenital heart disease with and without prior surgical palliation.