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Perioperative anesthetic management in pediatric heart transplantation: a single-center descriptive study involving
Ya-Fei Cheng1, Cong-Li Meng1, Yi-Ru Wang1
1Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital, Beijing, China.
Insights
This study highlights complex anesthesia management for pediatric heart transplants, noting high rates of extracorporeal membrane oxygenation (ECMO) support and significant complications. The findings emphasize the need for multidisciplinary collaboration in managing these high-risk pediatric patients.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Transplant Surgery
Background:
- Orthotopic heart transplantation is the standard treatment for pediatric end-stage heart disease.
- Perioperative anesthesia management is complex due to the wide age range and physiological heterogeneity of pediatric recipients.
- Limited literature exists on real-world perioperative practices for high-risk pediatric heart transplant populations.
Purpose of the Study:
- To summarize perioperative anesthesia management strategies for pediatric heart transplant recipients.
- To report short-term clinical outcomes in a single-center cohort.
- To describe practices for a high-risk pediatric population.
Main Methods:
- Retrospective descriptive study of 27 pediatric heart transplant recipients.
- Data collected on baseline characteristics, intraoperative variables, complications, and outcomes.
- No control group or causal inference performed.
Main Results:
- The cohort included children aged 6 months to 16 years, with dilated cardiomyopathy being the most common diagnosis.
- 55.6% received preoperative ECMO support, and 40.7% required postoperative ECMO.
- Major complications included hypoxic-ischemic encephalopathy (4), acute kidney injury requiring CRRT (5), and peripheral nerve injury (2).
- Overall survival at follow-up was 85.2% (23 alive, 4 deceased).
Conclusions:
- Anesthesia management involved low-dose staged induction, invasive monitoring, and multidisciplinary collaboration for severe pediatric heart transplant cases.
- Pulmonary hypertension, primary graft dysfunction, and multi-organ complications were common.
- Findings require validation in larger, multicenter studies due to the descriptive nature and small sample size.
Background:
Orthotopic heart transplantation is the standard treatment for pediatric end-stage heart disease. Due to the wide age range and high physiological heterogeneity among pediatric recipients, perioperative anesthesia management is particularly complex. Literature describing real-world perioperative practices for high-risk populations remains limited.
Objective:
This descriptive study aims to summarize the perioperative anesthesia management strategies and short-term clinical outcomes for pediatric heart transplant recipients at a single center.
Methods:
This retrospective descriptive study enrolled 27 pediatric patients who underwent orthotopic heart transplantation at a single center from May 2022 to October 2025. Data on baseline characteristics, intraoperative variables, complications, and outcomes were collected. No control group was established, and no causal inference was performed.
Results:
he cohort included 27 patients (13 male, 14 female), aged 6 months to 16 years (weight 7.0-95.0 kg). Dilated cardiomyopathy was the most common diagnosis (20/27, 74.1%). All patients were NYHA class III-IV; median LVEF was 28.5%. Preoperative ECMO support was used in 15 patients (55.6%). No major cardiovascular events occurred during induction or pre-CPB. Mean CPB time was 183.3 ± 55.6 min; mean cold ischemia time was 249.5 ± 101.1 min. Mean postoperative mechanical ventilation was 7.7 ± 9.5 days. Postoperative ECMO was required in 11 patients (40.7%). At follow-up, 23 patients were alive and 4 died (survival 85.2%). Major complications included hypoxic-ischemic encephalopathy (n = 4), AKI requiring CRRT (n = 5), and peripheral nerve injury (n = 2).
Conclusion:
Among the pediatric heart transplant recipients with severe conditions in this cohort (including a high proportion of ECMO bridged cases), the perioperative anesthesia management strategy implemented included low-dose staged induction, invasive monitoring, and multidisciplinary collaboration. Pulmonary hypertension, primary graft dysfunction, and multi-organ complications were commonly observed in this cohort. This study is descriptive and observational; causal relationships cannot be inferred, and the findings require further validation in larger sample sizes or multicenter studies.
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