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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.
The Annals of Thoracic Surgery
|November 1, 1989
Summary
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.