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Cardiac transplantation in infants and children
M W Turrentine1, K A Kesler, R Caldwell
1Department of Surgery, Riley Hospital for Children, Indiana University Medical Center, Indianapolis 46202-5125.
Insights
Pediatric cardiac transplantation offers a viable treatment for end-stage heart disease in children. Survival rates vary by condition, with idiopathic cardiomyopathy showing uniform survival.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Cardiac transplantation is an increasingly utilized therapy for pediatric heart conditions.
- Over 30 pediatric patients have undergone orthotopic cardiac transplantation since 1986.
- Indications span idiopathic cardiomyopathy, hypoplastic left heart syndrome, and complex congenital heart disease.
Purpose of the Study:
- To evaluate the efficacy and outcomes of orthotopic cardiac transplantation in pediatric patients.
- To assess survival rates based on the underlying cardiac pathology.
- To determine the feasibility of transplantation in complex pediatric cardiac malformations.
Main Methods:
- Retrospective analysis of 30 pediatric patients undergoing orthotopic cardiac transplantation.
- Categorization of patients by indication: idiopathic cardiomyopathy, hypoplastic left heart syndrome, and other congenital heart diseases.
- Follow-up to assess survival, complications, and causes of mortality.
Main Results:
- Overall cumulative survival is 77% at a mean follow-up of 30 months.
- Uniform survival observed in the idiopathic cardiomyopathy group.
- Survival rates of 78% and 62% in complex congenital heart disease and hypoplastic left heart syndrome groups, respectively.
- Operative deaths linked to pulmonary hypertension/hemorrhage; late deaths to rejection/infection.
Conclusions:
- Orthotopic cardiac transplantation is an acceptable therapy for pediatric end-stage heart disease.
- The procedure is technically feasible even with complex great artery or atrial malformations.
- Further long-term data is needed, but current results are promising for select pediatric populations.
Abstract:
Cardiac transplantation has become a more frequently used therapeutic modality for select cardiac pathology in infants and children. Since June 1986, 30 pediatric patients (19 male and 11 female) ranging in age from 4 days to 15 years (11 < or = 1 month old) have undergone orthotopic cardiac transplantation at our institution. Indications included idiopathic cardiomyopathy (n = 8), hypoplastic left heart syndrome (n = 13), and other forms of complex congenital heart disease (n = 9). There have been four operative and three late deaths only in the groups with hypoplastic left heart syndrome and other forms of complex congenital heart disease. Cumulative survival is 77% after a mean follow-up of 30 months (range, 6 to 77 months). Three operative deaths were attributable to pulmonary hypertension, and the other was due to pulmonary hemorrhage. Two late deaths were secondary to allograft rejection, and the third was due to infection. There has been uniform survival in the group with idiopathic cardiomyopathy, and intermediate-term survival rates are 78% and 62% in the groups with complex congenital heart diseases and hypoplastic left heart syndrome, respectively (p = 0.15). Although longer-term results are necessary, orthotopic cardiac transplantation appears to be an acceptable mode of therapy for endstage heart disease in the pediatric age group and technically can be performed despite complex malformations of the great arteries or atria.