Pediatric heart transplantation for congenital heart disease and cardiomyopathy

• Published in: The Annals of thoracic surgery Vol. 52; no. 1; pp. 112 - 117
• Main Authors: Hehrlein, F.W., Netz, H., Moosdorf, R., Dapper, F., Scheld, H.H., Bauer, J., Boldt, J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1991; Elsevier Science
• Subjects: Biological and medical sciences; Cardiomyopathy, Dilated - surgery; Child, Preschool; Female; Follow-Up Studies; Graft Rejection; Heart Defects, Congenital - surgery; Heart Transplantation - mortality; Humans; Infant; Infant, Newborn; Male; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Human; Newborn; Treatment; Congenital; Cardiomyopathy; Heart disease; Cardiovascular disease; Transplantation
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(91)91430-4

Orthotopic heart transplantation has become an accepted therapy for adult patients with end-stage heart disease. In newborns and infants, this procedure is still controversial because of the unknown long-term results and the lack of donor organs. Since March 1988, we have performed orthotopic heart transplantation in 11 infants and children with hypoplastic left heart syndrome (n = 6), cardiomyopathy (n = 4), or congenital endocardial fibroelastosis (n = 1). The smallest infant was 3 days old and weighed 2,650 g. Four of 15 potential donors had to be refused for various medical reasons, and 4 were transferred to our hospital for organ retrieval. Seven hearts were procured remotely. We accepted weight mismatches up to 105% between donor and recipient. There were three perioperative deaths, two in patients 5 and 17 days old with hypoplastic left heart syndrome and 1 in a 2-year-old patient with a dilated cardiomyopathy. All 3 patients had drug-resistant right heart failure. A 2-year-old girl with a dilated cardiomyopathy died 2 months after transplantation owing to severe pulmonary embolism originating from the superior vena cava. The remaining 7 patients are alive and well between 1 month and 31 months after transplantation. Angiographic follow-up has not revealed signs of graft atherosclerosis at 2 years.