Heart transplantation in children who have undergone previous heart surgery: is it safe?

As heart transplantation becomes more commonly applied to the pediatric population, it is important to determine if previous palliative or reparative operations increase the risk of transplantation. Since 1988, 13 children aged 23 months to 14 years (mean 9.5 years) who had undergone previous heart operations underwent orthotopic heart transplantation. These children had undergone an average of 3.2 previous operations (range 1 to 7):1.9 sternotomies (range 0 to 5) and 1.2 thoracotomies (range 0 to 3). Three children had undergone only palliative operations (Norwood procedure, Waterston shunt, and transthoracic pacemaker); the remaining 10 had undergone at least one "corrective" operation: four valve replacements or repairs (three mitral and one aortic), three Fontan procedures, one Rastelli procedure, one double-outlet right ventricle repair, and one ventricular septal defect repair. At the time of transplantation, seven patients (54%) were on inotropic support, two with mechanical ventilation. Three patients (23%) had significant levels of preformed antibodies necessitating a prospective cross-match, which significantly delayed transplantation. The transplant procedure was complicated by the need for pulmonary arterial reconstruction in six patients (46%), transposition of the great arteries in three patients (23%), and atrial baffling to redirect anomalous venous drainage in one patient (8%). There was one death 4 days after surgery from sepsis in a patient who had undergone a previous Konno procedure who required 24 hours of mechanical right ventricular assistance after transplantation. Two children (15%) required mediastinal exploration for bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)