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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Heart transplantation in children and adults with Down syndrome: A single centre experience
Espeed Khoshbin1, Abbas Khushnood1, Zdenka Reinhardt1
1The Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
Insights
Heart transplantation is viable for individuals with Down syndrome, even with complex heart failure. Patients showed positive long-term outcomes, challenging previous assumptions about post-transplant complications.
Area of Science:
- Cardiology
- Transplantation Medicine
- Genetics
Background:
- Cardiac surgery advances and evolving attitudes enable cardiac transplantation for patients with cognitive disabilities.
- Down syndrome patients are increasingly considered for heart transplantation.
Purpose of the Study:
- To report the experience of heart transplantation in four patients with Down syndrome.
- To evaluate the outcomes and safety of cardiac transplantation in this population.
Main Methods:
- Retrospective case series of four patients with Down syndrome undergoing heart transplantation.
- Analysis of pre-transplant conditions, bridging strategies, and post-transplant outcomes.
Main Results:
- Anthracycline-induced cardiomyopathy was the primary cause of heart failure in 75% of patients.
- Two patients required mechanical circulatory support (ECMO/BIVAD, LVAD) for bridging.
- All four patients survived, with the longest follow-up at 17 years post-transplantation.
- No increased propensity for post-transplant infections or lymphoproliferative disorders was observed.
Conclusions:
- Down syndrome alone should not be a contraindication for heart transplantation.
- Transplantation decisions for Down syndrome patients must be individualized, considering adequate social support.
Background:
In recent years, rapid advances in cardiac surgery and changes in attitude towards patients with cognitive disability have led to these patients receiving cardiac transplantation.
Method:
This is a retrospective report describing the experience of four patients with Down Syndrome who received heart transplantation in a single institution.
Results:
Anthracycline-induced cardiomyopathy was the most common cause of heart failure in this group (3/4). Two patients were bridged to transplantation, one by using a combination of extra-corporeal membrane oxygenation and biventricular assist device and the other by using a durable implantable left ventricular assist device. All the four patients are alive with the longest surviving patient 17 years after transplantation. Against strong hypothetical predictions, we observed no propensity for the development of post-transplant infections or lymphoproliferative disorders.
Conclusion:
Down Syndrome should not be the sole contraindication to heart transplantation. The decision for transplantation should be on a case-by-case basis provided adequate social support is in place.
