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Lessons learned in pediatric heart transplantation
A Trento1, B P Griffith, F J Fricker
1Department of Thoracic and Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Insights
Pediatric cardiac transplantation showed a 36% 6-year survival due to high perioperative deaths, especially in congenital heart disease patients. Late deaths were primarily due to uncontrollable rejection in cardiomyopathy cases.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Congenital heart disease and cardiomyopathies are leading causes of pediatric heart failure.
- Cardiac transplantation is a potential treatment option for end-stage pediatric heart disease.
Purpose of the Study:
- To evaluate the outcomes of pediatric cardiac transplantation.
- To identify factors contributing to mortality in pediatric heart transplant recipients.
Main Methods:
- Retrospective analysis of 32 children undergoing cardiac transplantation between February 1982 and June 1988.
- Assessment of perioperative and late mortality rates.
- Analysis of causes of death, including rejection and surgical complications.
Main Results:
- Overall 6-year actuarial survival was 36%.
- Perioperative mortality was 37.5% (12/32), with a 60% rate in congenital heart disease patients.
- Late deaths (5/6) were rejection-related in acquired cardiomyopathy cases; donor right ventricle failure was a key issue in congenital heart disease recipients.
Conclusions:
- Pediatric cardiac transplantation during this period had high mortality rates.
- Congenital heart disease poses unique challenges, including donor right ventricle failure.
- Uncontrolled rejection remains a significant cause of late mortality, particularly in acquired cardiomyopathy.
Abstract:
Between February 1, 1982, and June 30, 1988, 32 children underwent cardiac transplantation for treatment of congenital heart disease (10) and other cardiomyopathies (22). The 6-year actuarial survival was a disappointing 36% because of a high perioperative mortality (12 of 32, 37.5%) and because of five late deaths due to uncontrolable rejection. The perioperative mortality was a staggering 60% (6 of 10) for the patients with congenital heart disease. Four of the 6 recipients with congenital heart disease died because of acute failure of the donor right ventricle. This included 2 patients who required reconstruction of the pulmonary arteries for stenosis secondary to previous systemic-to-pulmonary shunts and 2 others in whom the pulmonary vascular resistances were underestimated because of undetected recent pulmonary emboli (1) and complicated pulmonary vascular anatomy (1). Five of the six late deaths were due to rejection-related events, and all were patients with acquired cardiomyopathy.