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Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - "Early and long-term results". | LitMetric

Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - "Early and long-term results".

Int J Cardiol

Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Munich Heart Alliance (MHA) - DZHK, Ludwig Maximilians University Munich, Department for Epidemiology and Prevention of Cardiovascular Diseases, Pettenkoferstr. 8a & 9, D- 80336 Munich, Germany. Electronic address:

Published: June 2022

AI Article Synopsis

  • - The study analyzed the early and long-term survival rates of children under 3 years old who underwent ABO-compatible heart transplantation between 1991 and 2021, focusing on serious adverse events linked to mortality.
  • - Out of 46 patients, 94% survived the first 30 days, while survival rates dropped to 63% after 15 years, with higher mortality observed in those younger than 3 months and those with single ventricle physiology.
  • - The findings suggest that pediatric heart transplantation remains the best treatment for end-stage cardiac failure despite challenges, with better long-term outcomes in patients with cardiomyopathy compared to congenital heart disease.

Article Abstract

Objectives: We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation.

Patients And Methods: 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time.

Results: Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality.

Conclusion: Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.

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Source
http://dx.doi.org/10.1016/j.ijcard.2022.04.002DOI Listing

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