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Heart transplantation in children with congenital heart disease
D T Hsu1, J M Quaegebeur, R E Michler
1Department of Pediatrics, College of Physicians and Surgeons, Columbia University, Babies Hospital, New York, New York 10032, USA.
Insights
Pediatric heart transplantation for congenital heart disease shows similar survival rates to other cardiac conditions. However, children with congenital heart disease experienced longer surgery and more infections, requiring careful management.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Congenital heart disease (CHD) historically shows lower survival post-heart transplantation compared to cardiomyopathy.
- Transplantation is increasingly considered for complex CHD, necessitating updated outcome data.
- Previous reports suggest poorer outcomes for CHD patients, warranting reassessment of current results.
Purpose of the Study:
- To describe heart transplantation outcomes in pediatric patients with congenital heart disease.
- To compare these outcomes with pediatric patients undergoing heart transplantation for other cardiac conditions.
Main Methods:
- Characterized diagnoses, prior surgeries, and indications for transplantation in CHD patients.
- Compared pre-transplant course, graft ischemia time, survival, rejection, infection rates, and hospital stay.
- Utilized a control group of 47 children transplanted for non-CHD reasons.
Main Results:
- Thirty-seven children with CHD underwent transplantation; 86% had prior operations.
- No significant differences in 1- and 5-year survival rates or rejection frequency were observed between CHD and non-CHD groups.
- Patients with CHD had longer cardiopulmonary bypass and donor ischemia times, and a higher incidence of serious infections (p=0.01).
Conclusions:
- Heart transplantation in children with complex CHD is feasible and achieves success rates comparable to other pediatric cardiac diseases.
- Despite challenges like complex surgery and longer ischemia times, outcomes are similar.
- Increased infection rates in CHD patients require vigilant post-transplant monitoring and management.
Objectives:
The aim of this study was to describe heart transplantation in children with congenital heart disease and to compare the results with those in children undergoing transplantation for other cardiac diseases.
Background:
Reports describe decreased survival after heart transplantation in children with congenital heart disease compared with those with cardiomyopathy. However, transplantation is increasingly being considered in the surgical management of children with complex congenital heart disease. Present-day results from this group require reassessment.
Methods:
The diagnoses, previous operations and indications for transplantation were characterized in children with congenital heart disease. Pretransplant course, graft ischemia time, post-transplant survival and outcome (rejection frequency, infection rate, length of hospital stay) were compared with those in children undergoing transplantation for other reasons (n = 47).
Results:
Thirty-seven children (mean [+/- SD] age 9 +/- 6 years) with congenital heart disease underwent transplantation; 86% had undergone one or more previous operations. Repair of extracardiac defects at transplantation was necessary in 23 patients. Causes of death after transplantation were donor failure in two patients, surgical bleeding in two, pulmonary hemorrhage in one, infection in four, rejection in three and graft atherosclerosis in one. No difference in 1- and 5-year survival rates (70% vs. 77% and 64% vs. 65%, respectively), rejection frequency or length of hospital stay was seen between children with and without congenital heart disease. Cardiopulmonary bypass and donor ischemia time were significantly longer in patients with congenital heart disease. Serious infections were more common in children with than without congenital heart disease (13 of 37 vs. 6 of 47, respectively, p = 0.01).
Conclusions:
Despite the more complex cardiac surgery required at implantation and longer donor ischemic time, heart transplantation can be performed in children with complex congenital heart disease with success similar to that in patients with other cardiac diseases.