Infant orthotopic cardiac transplantation

Mavroudis, Constantine; Harrison, H.; Klein, Jon B.; Gray, Laman A.; Ganzel, Brian L.; Wellhausen, Samuel R.; Elbl, Francisco; Cook, Larry N.

doi:10.1016/s0022-5223(19)35159-1

Cited by 71 publications

(8 citation statements)

References 13 publications

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“…Our analysis of the UNOS database shows a significant decrease in the acceptance of grafts with DRWR 0.5–0.8 after the year of 1999 (Table 6). The concerns are of cardiac output being inadequate for a larger individual (3), negative correlations between the DRWR and resting heart rate and ventricular filling pressure (10), and the inability of a smaller heart to overcome the PVR (11). There are two adult patient studies (9, 12) that showed a trend toward survival benefit when the DRWR were >0.8.…”

Section: Discussionmentioning

confidence: 99%

Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients

Tang¹,

Du²,

Delius³

et al. 2010

Pediatric Transplantation

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A major limitation to success in pediatric heart transplantation is donor organ shortage. While the use of allografts from donors larger than the recipient is accepted, the use of undersized donor grafts is generally discouraged. Using the UNOS database, we wanted to evaluate whether using smaller donor hearts affects the short- and long-term survival of pediatric heart transplant patients. A retrospective analysis of data entered into the UNOS database from April 1994 to May 2008 was performed. Pediatric heart transplant recipients (ages 0-18 yr) with DRWR <2.0 were identified and divided into two groups: Low-DRWR (<0.8) and Ideal-DRWR (0.8-2.0). Patients' demographics, pretransplant diagnoses, age at transplantation, severity of pretransplant condition, and rate of complications prior to hospital discharge after transplantation were noted. Fisher's exact, chi-square, and Wilcoxon rank sum tests were used to compare patients' baseline characteristics. Kaplan-Meier curves and Cox proportional hazard regression were used to compare patients' survival and to identify independent risk factors for outcomes. There were 3048 patients (204 with Low- and 2844 with Ideal-DRWR). The Low-ratio group patients were older (8.3 vs. 6.9 yr; p = 0.001), there was a slight male predominance in the Low-DRWR group (p = 0.055). The Low-DRWR group had longer transplant wait time than the Ideal-DRWR group (97 vs. 85 days; p = 0.04). The groups did not differ in race, primary diagnoses, severity of pretransplant condition (medical urgency status, need for ventilation, inotropic support, ECMO, nitric oxide, or dialysis, the PVR for those with bi-ventricular anatomy), or post-transplant complications (length of stay, need for inotropic support, dialysis, and rate of infections). The Low-DRWR patients had less episodes of acute rejection during the first-post-transplant month. Infants with DRWR 0.5-0.59 had lower 30-day survival rate (p = 0.045). There was no difference in short- and long-term survival between the patients with DRWR 0.6-0.79 and DRWR 0.8-2.0. Use of smaller allografts (DRWR 0.6-0.8) has no negative impact on the short- and long-term survival of pediatric heart transplant patients.

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Section: Discussionmentioning

confidence: 99%

Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients

Tang¹,

Du²,

Delius³

et al. 2010

Pediatric Transplantation

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“…For this reason, some authors have had to perform orthotopic cardiac transplantation in infants with severely damaged LV function. 34,35 Taking into consideration that implantation of the anomalous LCA to the aorta leads to the recovery of global LV function in patients in whom it is severely depressed, heart transplantation is difficult to recommend for these patients. One such patient in this study, a lO-month-old infant with severe LV dysfunction who was initially considered for cardiac transplantation, underwent reimplantation of the anomalous LCA.…”

Section: Discussionmentioning

confidence: 99%

Anomalous origin of the left coronary artery from the pulmonary artery: Early results with direct aortic reimplantation

Alexi-Meskishvili¹,

Hetzer²,

Weng³

et al. 1994

The Journal of Thoracic and Cardiovascular Surgery

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Anomalous origin of the left coronary artery from the pulmonary artery Early results with direct aortic reimplantationBetween January 1991 and June 1993, eleven children with anomalous origin of the left coronary artery from the pulmonary artery underwent direct aortic reimplantation of the left coronary artery at the German Heart Institute Berlin. The patients' ages ranged from 2.5 months to 10.5 years; six were infants. Three infants were intubated and their lungs ventilated before the operation, and one was resuscitated 2 days before the operation. The electrocardiograms of eight patients indicated deep Q waves. All but three of these patients had insufficient collaterals between the right and left coronary arteries. The entire group exhibited reduced left ventricular ejection fraction (minimum 15 %) including mitral valve incompetence, which was moderate in six patients and severe in three. AU six infants underwent emergency operations, and the remaining children, who were older, underwent elective operations involving moderate hypothermic perfusion and cold crystalloid cardioplegia. Aortic crossclamping time ranged from 22 to 79 minutes (mean 54 minutes). A two-coronary artery system was established in all patients by direct reimplantation of the anomalous left coronary artery into the ascending aorta. Three patients who also exhibited severe mitral valve incompetence underwent modified Kay mitral valve annuloplasty. A delayed sternal closure procedure (closure performed 1 to 10 days after the operation) was used on eight patients. A 10-month-old patient was successfully treated after the operation with a centrifugal left heart assist device and a 9-year-old patient receivedextracorporeal membrane oxygenation because of severe heart failure. No postoperative deaths occurred. Left ventricular end-diastolic volume decreased dramatically after the operation and returned to near normal values 1 to 9 months postoperatively. At the same time, the preoperatively depressed left ventricular ejection fraction returned to normal and mitral valve incompetence decreased or vanished in eight patients. Color Doppler echocardiograms (eleven patients) and coronary angiograms (three patients) indicated that the reimplanted left coronary artery was patent in all eleven patients during the follow-up period. Reimplantation of the left coronary artery into the ascending aorta is an effective

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“…Grafts came from northern Italy (16). from central and southern Italy (14, ofwhich 6 came from Bambino Gesh Hospital, where 7 were taken with a "domino" procedure), and from Europe (17, namely, 9 from Spain, 1 from France, and 1 each from Austria, Germany, Holland, and Great Britain).…”

Section: Methodsmentioning

confidence: 99%

Intermediate and long-term results after pediatric heart transplantation: incidence and role of pretransplant diagnosis

et al. 1998

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From November 1985 to 31 July 1997, 65 pediatric patients underwent heart transplantation at Bambino Gesù Hospital in Rome. Two of them underwent retransplantation, both 6 years after the first transplant. The 67 transplant patients had a mean age of 59 months; 11 were under 1 year of age. Their indications for transplantation were cardiomyopathies (38), lymphocytic myocarditis (8), and congenital heart diseases (19). Two patients of the first group successfully received a combined heart and kidney transplant. The 1-, 5-, and 11-year actuarial survival rates for the 65 patients who underwent heart transplantation were 68%, 62%, and 42%, respectively. In the 1st postoperative year in patients who had had cardiomyopathy, a total of 50 episodes of acute rejection (AR), with one death, occurred (mean 1.7 AR/patient per year +/- 1.5) and, in patients who had had congenital heart diseases, 19 ARs (one death) occurred with a mean of 1.58 AR/patient per year +/- 1.4. The incidence of AR was significantly higher in patients who had had myocarditis with a total of 26 episodes (mean 3.7 AR/patient per year +/- 2) and one death. Rehabilitation of heart transplanted children and infants was complete (NYHA class 1) in 52% of patients of this series. We conclude that heart transplantation may give a good intermediate and long-term survival in selected patients; the extension of indications to desperately ill patients, or patients with systemic diseases or complex congenital heart diseases may bring less encouraging results, but should not be definitely excluded. Scarcity of donors remains the main limit, being still the first cause of death for patients on our waiting list. Our limited experience seems to suggest that, as described in adults, the cellular amplification of the immune response might affect the post-heart transplant follow up of pediatric patients with myocarditis resulting in a poor outcome for this population.

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Infant orthotopic cardiac transplantation

Cited by 71 publications

References 13 publications

Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients

Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients

Anomalous origin of the left coronary artery from the pulmonary artery: Early results with direct aortic reimplantation

Intermediate and long-term results after pediatric heart transplantation: incidence and role of pretransplant diagnosis

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