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Medium-term results of pediatric patients undergoing orthotopic heart transplantation
N R Doelling1, K R Kanter, K M Sullivan
1Children's Heart Center, Atlanta, GA 30322, USA.
Insights
Pediatric heart transplantation is a viable option for end-stage heart disease. Survival rates were similar for children with and without prior heart surgery, indicating successful outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Orthotopic heart transplantation (OHT) is a critical intervention for pediatric patients with end-stage heart disease.
- Evaluating outcomes in pediatric OHT, particularly comparing those with and without prior cardiac surgery, is essential for refining treatment strategies.
Purpose of the Study:
- To assess the medium-term results of orthotopic heart transplantation in a pediatric cohort.
- To compare outcomes between pediatric heart transplant recipients with and without previous cardiac surgery.
Main Methods:
- Retrospective review of 51 consecutive pediatric patients undergoing OHT between July 1988 and April 1995.
- Patients were divided into two groups: Group A (no prior surgery) and Group B (prior surgery).
- Analysis of early and late survival rates, causes of death, and morbidity.
Main Results:
- No significant difference in early or late survival rates was observed between the two groups.
- Age at transplantation and sex were not predictive of survival.
- Leading causes of late death included graft coronary artery disease and acute coronary vasculitis; early deaths were linked to pre-transplant ventilation and hemodynamic instability.
- Infection caused significant morbidity but no late deaths, though sepsis contributed to early mortality in critically ill patients.
Conclusions:
- Orthotopic heart transplantation is a viable treatment for pediatric end-stage heart disease, including in patients with prior cardiac surgery.
- The procedure offers a life-saving option when other surgical interventions have a high mortality risk.
- Careful management of pre-transplant conditions and post-transplant complications like graft vasculopathy is crucial for long-term success.
Abstract:
To establish the medium-term results of our transplant population, we retrospectively reviewed the charts of 51 consecutive patients who underwent orthotopic heart transplantation between July 1988 and April 1995. These patients comprised two groups: group A consists of 26 patients (age 6 days to 16.4 years, median 1.4 years) with no previous heart surgery, and group B consists of 25 patients (ages 0.1 to 14.3 years, median 8.3 years), all of whom had heart surgery before undergoing transplantation. There was no difference between these groups in early or late survival rates, and neither age at transplantation nor sex was an indicator of survival. There have been 14 deaths, six early (before hospital discharge) and eight late. Early deaths have predominantly been attributed to long-term ventilation and hemodynamic instability before transplantation, and late deaths to graft coronary artery disease (n = 4), acute coronary vasculitis (n = 3), and acute cellular rejection (n = 1). Although infection has resulted in significant morbidity (57 hospital admissions), there have been no late deaths resulting from infection. Sepsis accounts for four early deaths in chronically ill patients. Orthotopic heart transplantation in the pediatric patient with and without previous heart surgery is a viable option for those with end-stage heart disease and those in whom other surgical options carry a prohibitively high mortality rate.