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Cardiac transplantation for pediatric patients. With inoperable congenital heart disease
K M Shaffer1, S W Denfield, K O Schowengerdt
1Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Pediatric heart transplantation is a viable option for congenital heart disease, showing similar outcomes to cardiomyopathy cases. Survival rates and complications are comparable, supporting its use when surgery isn't possible.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Heart transplantation is increasingly used for pediatric patients with inoperable congenital heart disease.
- Comparing outcomes between congenital heart disease and cardiomyopathy recipients is crucial for treatment decisions.
Purpose of the Study:
- To compare perioperative risk factors and outcomes in pediatric heart transplant recipients with congenital heart disease versus cardiomyopathy.
- To evaluate the safety and efficacy of heart transplantation for congenital heart disease.
Main Methods:
- Retrospective analysis of 40 pediatric heart transplant cases (14 congenital heart disease, 26 cardiomyopathy) from 1990-1995.
- Comparison of donor/recipient factors, ischemic times, cardiopulmonary bypass times, and post-transplant outcomes.
Main Results:
- Cardiopulmonary bypass times were significantly longer for congenital heart disease recipients (102 min vs. 73 min).
- No significant differences were observed in waiting times, donor/recipient weight ratios, ischemic times, infection episodes, hospitalization duration, rejection episodes, or transplant coronary artery disease incidence.
- Forty-month actuarial survival rates were high and similar for both groups (92% for congenital heart disease, 88% for cardiomyopathy).
Conclusions:
- Post-transplantation morbidity and mortality in pediatric congenital heart disease patients are comparable to those with cardiomyopathy.
- Heart transplantation is an acceptable therapeutic option for pediatric patients with inoperable congenital heart disease.
Abstract:
Recent studies have reported the expanding use of transplantation as the definitive option for pediatric patients with inoperable congenital heart disease. This study compares perioperative risk factors and outcomes in pediatric patients who received heart transplants for congenital heart disease with those in pediatric patients who received heart transplants for cardiomyopathy. Retrospective data collected on 40 consecutive pediatric patients undergoing cardiac transplantation from 1 January 1990 through 31 January 1995 provided the following results: 26 patients with cardiomyopathy (mean age, 7.6 years) and 14 patients with congenital heart disease (mean age, 7.2 years) underwent heart transplantation. Between groups, no significant difference was detected in waiting time for a donor heart (cardiomyopathy = 85 days, range = 2 to 409; congenital heart disease = 126 days, range = 9 to 396; P = NS); in donor/recipient weight ratio (1.27 +/- 0.34 vs 1.27 +/- 0.28, P = NS); or in ischemic times (209 +/- 92 minutes vs 248 +/- 70 minutes, P = NS). Cardiopulmonary bypass times accounted for the only significant difference (73 +/- 21 minutes vs 102 +/- 29 minutes, P = 0.003). No significant difference was found in the number of infection episodes, total days hospitalized, rejection episodes, or incidence of transplant coronary artery disease. Forty-month actuarial survival was 88% +/- 6% and 92% +/- 7% for cardiomyopathy and congenital heart disease transplant recipients, respectively (P = NS). We conclude that post-transplantation morbidity and mortality in patients with previous congenital heart disease are not significantly different from morbidity and mortality in patients with cardiomyopathy. Transplantation should be considered an acceptable therapeutic option for patients with congenital heart disease when surgical repair of the native heart is not possible.