Partial heart transplantation can ameliorate donor organ utilization

Sherard, Curry; Atteya, Miriam M; Vogel, Andrew D.; Bisbee, Cora; Kang, Lillian; Turek, Joseph W.; Rajab, Taufiek Konrad

doi:10.1111/jocs.17050

Cited by 16 publications

(13 citation statements)

References 33 publications

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“…Partial heart transplantation can be performed using donor hearts with poor ventricular function and slow progression to donation after cardiac death. This should ameliorate donor heart utilization and avoid both primary orthotopic heart transplantation in children with unrepairable heart valve dysfunction and progression of these children to end-stage heart failure [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Partial heart transplantation for pediatric heart valve dysfunction: A clinical trial protocol

et al. 2023

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Congenital heart defects are the most common type of birth defects in humans and frequently involve heart valve dysfunction. The current treatment for unrepairable heart valves involves valve replacement with an implant, Ross pulmonary autotransplantation, or conventional orthotopic heart transplantation. Although these treatments are appropriate for older children and adults, they do not result in the same efficacy and durability in infants and young children for several reasons. Heart valve implants do not grow with the. Ross pulmonary autotransplants have a high mortality rate in neonates and are not feasible if the pulmonary valve is dysfunctional or absent. Furthermore, orthotopic heart transplants invariably fail from ventricular dysfunction over time. Therefore, the treatment of irreparable heart valves in infants and young children remains an unsolved problem. The objective of this single-arm, prospective study is to offer an alternative solution based on a new type of transplant, which we call “partial heart transplantation.” Partial heart transplantation differs from conventional orthotopic heart transplantation because only the part of the heart containing the heart valve is transplanted. Similar to Ross pulmonary autotransplants and conventional orthotopic heart transplants, partial heart transplants contain live cells that should allow it to grow with the recipient child. Therefore, partial heart transplants will require immunosuppression. The risks from immunosuppression can be managed, as seen in conventional orthotopic heart transplant recipients. Stopping immunosuppression will simply turn the growing partial heart transplant into a non-growing homovital homograft. Once this homograft deteriorates, it can be replaced with a durable adult-sized mechanical implant. The protocol for our single-arm trial is described. The ClinicalTrials.gov trial registration number is NCT05372757.

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Section: Discussionmentioning

confidence: 99%

Partial heart transplantation for pediatric heart valve dysfunction: A clinical trial protocol

et al. 2023

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“…Additionally, transplantation of only the heart valve allows for procurement from diseased hearts with healthy valves that are not candidates for orthotopic transplantation. Thus, PHT would increase the number of heart donor candidates and help alleviate the current shortage of donor hearts for conventional heart transplants [63].…”

Section: Partial Heart Transplantmentioning

confidence: 99%

Growing Heart Valve Implants for Children

Konsek

Sherard

Bisbee

et al. 2023

JCDD

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The current standard of care for pediatric patients with unrepairable congenital valvular disease is a heart valve implant. However, current heart valve implants are unable to accommodate the somatic growth of the recipient, preventing long-term clinical success in these patients. Therefore, there is an urgent need for a growing heart valve implant for children. This article reviews recent studies investigating tissue-engineered heart valves and partial heart transplantation as potential growing heart valve implants in large animal and clinical translational research. In vitro and in situ designs of tissue engineered heart valves are discussed, as well as the barriers to clinical translation.

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“…Due to the scarcity of donor organs, transplantation will not always be feasible. 42 Recently, surgeons have corrected truncus arteriosus with severe truncal valve insufficiency by performing a partial heart transplantation, 43,44 wherein the pulmonary and aortic roots of a donor heart otherwise unsuitable for orthotopic heart transplantation were used to perform the primary repair. The patient remained alive after over 6 months, and echocardiographic measurements show that the transplanted valves have grown with the patient.…”

Section: Late Mortality and Reinterventionmentioning

confidence: 99%

Outcomes of truncal valve replacement in neonates and infants: a meta-analysis

et al. 2023

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Background: Infants with truncus arteriosus typically undergo repair by repurposing the truncal valve as the neo-aortic valve and using a valved conduit homograft for the neo-pulmonary valve. In cases where the native truncal valve is too insufficient for repair, it is replaced, but this is a rare occurrence with a paucity of data, especially in the infant population. Here, we conduct a meta-analysis to better understand the outcomes of infant truncal valve replacement during the primary repair of truncus arteriosus. Methods: We systematically reviewed PubMed, Scopus, and CINAHL for all studies reporting infant (<12 months) truncus arteriosus outcomes between 1974 and 2021. Exclusion criteria were studies which did not report truncal valve replacement outcomes separately. Data extracted included valve replacement type, mortality, and reintervention. Our primary outcome was early mortality, and our secondary outcomes were late mortality and reintervention rates. Results: Sixteen studies with 41 infants who underwent truncal valve replacement were included. The truncal valve replacement types were homografts (68.8%), mechanical valves (28.1%), and bioprosthetic valves (3.1%). Overall early mortality was 49.4% (95% CI: 28.4–70.5). The pooled late mortality rate was 15.3%/year (95% CI: 5.8–40.7). The overall rate of truncal valve reintervention was 21.7%/year (95% CI: 8.4–55.7). Conclusions: Infant truncal valve replacement has poor early and late mortality as well as high rates of reintervention. Truncal valve replacement therefore remains an unsolved problem in congenital cardiac surgery. Innovations in congenital cardiac surgery, such as partial heart transplantation, are required to address this.

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Partial heart transplantation can ameliorate donor organ utilization

Cited by 16 publications

References 33 publications

Partial heart transplantation for pediatric heart valve dysfunction: A clinical trial protocol

Partial heart transplantation for pediatric heart valve dysfunction: A clinical trial protocol

Growing Heart Valve Implants for Children

Outcomes of truncal valve replacement in neonates and infants: a meta-analysis

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