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Updated: Jun 12, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Establishing a nationwide pediatric heart transplantation program with mid-term results comparable to worldwide data
Karel Koubský1, Roman Gebauer1, Rudolf Poruban1
1Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
Insights
Czech Republic
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Heart transplantation (HTx) is a vital treatment for pediatric end-stage heart failure.
- A comprehensive nationwide pediatric HTx program was established in the Czech Republic in 2014.
- Evaluating the program's mid-term outcomes and comparing them internationally is crucial.
Purpose of the Study:
- To assess the mid-term characteristics and outcomes of the Czech nationwide pediatric HTx program.
- To compare the program's results with international data.
- To validate the feasibility of establishing a successful national pediatric HTx program.
Main Methods:
- Retrospective observational study.
- Inclusion of all pediatric patients undergoing HTx from June 2014 to December 2022.
- Data analysis using institutional databases for descriptive statistics and survival analysis.
Main Results:
- 30 HTx procedures performed in 29 pediatric patients (15 with congenital heart disease, 14 with cardiomyopathy).
- 10 patients received durable left ventricular assist devices (LVADs) as a bridge to HTx.
- 5-year survival probability was 93%, with 1 early and 1 late death; 76% rejection-free survival at 1 year.
Conclusions:
- The Czech pediatric HTx program successfully manages complex cases, including congenital heart disease and LVAD support.
- Mid-term outcomes are comparable to global benchmarks.
- The program demonstrates the viability of establishing a successful nationwide pediatric HTx initiative in smaller countries.
Background:
Heart transplantation (HTx) is an established therapeutic option for children with end-stage heart failure. Comprehensive pediatric nationwide HTx program was introduced in 2014 in the Czech Republic. The aim of this study was to evaluate its mid-term characteristics and outcomes and to compare them with international data.
Methods:
Retrospective observational study, including all patients who underwent HTx from June 2014 till December 2022. Data from the institutional database were used for descriptive statistics and survival analyses.
Results:
A total of 30 HTx were performed in 29 patients with congenital heart disease (CHD, N = 15, single ventricular physiology in 10 patients) and cardiomyopathy (CMP, N = 14). Ten patients were bridged to HTx by durable left ventricular assist devices (LVADs) for a mean duration of 104 (SD 89) days. There was one early and one late death during median follow-up of 3.3 (IQR 1.3-6.1) years. Survival probability at 5 years after HTx was 93%. Two patients underwent re-transplantation (one of them in an adult center). Significant rejection-free survival at 1, 3, and 6 years after HTx was 76%, 63%, and 63%, respectively.
Conclusions:
The introduced pediatric HTx program reflects the complexity of the treated population, with half of the patients having complex CHD and one-third being bridged to HTx by LVADs. Mid-term results are comparable to worldwide data. The data confirm the possibility of establishing a successful nationwide pediatric HTx program in a relatively small population country with well-developed pediatric cardiovascular care and other transplantation programs.
