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Pediatric cardiac transplantation for congenital heart defects: surgical considerations and results
P R Vouhé1, D Tamisier, J Le Bidois
1Department of Cardiovascular Surgery, Laënnec Hospital, Paris, France.
Insights
Pediatric heart transplantation is feasible in children with congenital heart defects, even with prior surgeries. Careful planning ensures successful outcomes, though long-term survival rates and risks like coronary artery disease require monitoring.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Congenital heart defects (CHDs) are a significant challenge in pediatric cardiac surgery.
- Heart transplantation is a potential treatment for end-stage heart failure in children with CHDs.
- Prior surgical interventions are common in pediatric patients with CHDs requiring transplantation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of heart transplantation in pediatric recipients with congenital heart diseases.
- To assess early and late mortality, survival rates, and potential complications in this patient population.
Main Methods:
- Retrospective analysis of 55 heart transplantations in 54 children with CHDs.
- Detailed review of patient demographics, diagnoses, prior surgical history, and additional procedures.
- Assessment of early and late mortality causes and survival rates at 3 years.
- Evaluation of complications such as accelerated coronary artery disease and long-term cardiac symptoms.
Main Results:
- 24 out of 54 children (44%) had CHDs, including single-ventricle variants, hypoplastic left heart syndrome variants, and transposition complex.
- 83% of recipients with CHDs had undergone prior operations.
- Early mortality was 11% (6 deaths), and late mortality was 11% (6 deaths).
- The 3-year survival rate was 43% +/- 12%.
- Accelerated coronary artery disease was observed in 22% of survivors.
- No deaths were attributed to surgical technique.
Conclusions:
- Heart transplantation is a viable option for pediatric patients with complex congenital heart diseases.
- Careful surgical planning and execution are crucial for successful outcomes in this challenging group.
- While survival rates are moderate, long-term complications like accelerated coronary artery disease warrant vigilant follow-up.
Abstract:
Among 54 children who underwent 55 heart transplantations, 24 (44%) (mean age, 4.9 +/- 4.8 years; range, 9 days to 18 years) had congenital defects with the following diagnoses: single-ventricle variants (6), hypoplastic left heart syndrome variants (5), transposition complex (6), and miscellaneous defects (7). Twenty patients (83%) had undergone 43 prior operations. Additional surgical procedures included repositioning of transposed great arteries (11), reconstruction of the aortic pathway (4), reconstruction of the pulmonary pathway (8), correction of situs inversus (1), and correction of anomalous pulmonary (1) or systemic (1) venous drainage. Reconstructive procedures were performed using donor or recipient tissue or both. There were six early deaths (hyperacute rejection, 1 patient; pulmonary hypertension, 1; graft failure, 2 patients; infection, 2) and six late deaths (sudden death, 2; chronic rejection, 2; nonspecific graft dysfunction, 1; lymphoproliferative disease, 1). The survival rate was 43% +/- 12% at 3 years. No deaths were related to surgical technique. Survival was not significantly different in pediatric recipients with cardiomyopathy (67% +/- 9%; p = 0.22). Accelerated coronary artery disease was noted in 4 operative survivors (22%; 70% confidence limits, 12% to 36%). All late survivors were free from cardiac symptoms after a mean follow-up of 34 +/- 24 months (range, 6 to 71 months). Based on this study, we reached three conclusions. (1) Careful planning of both harvesting and transplantation procedures allows heart transplantation in recipients with congenital heart diseases. (2) The surgical technique may be demanding, but the early risk is not increased.(ABSTRACT TRUNCATED AT 250 WORDS)