Current Topics and Controversies in Pediatric Heart Transplantation: Proceedings of the Pediatric Heart Transplantation Summit 2017

Abstract

In October 2017, a pediatric heart transplant summit was held in Seattle-the first of its kind internationally-which focused solely upon controversies in pediatric end-stage heart failure management and pediatric heart transplantation. We selected five of the most popular and contentious topics and asked the speakers to provide a position paper. Worldwide, the vast majority of programs perform only a handful of pediatric heart transplants a year. Because of this, these "orphan" areas of investigation provide an opportunity for us as a community to aggregate our collective knowledge, which may represent the only viable way that we might sort through these complex and controversial issues in the field. We hope this represents the first of many such conferences and that this initial selection of papers encourages us to begin this collaborative process.

Surgical strategies for the management of end‐stage heart failure in infants and children: A 15‐year experience with a patient‐tailored approach

“…With the aim of delaying or, if possible, avoiding the need for HT, we propose a novel, integrated surgical program, comprising PAB for LV rehabilitation and long‐term MCS. Our experience shows that selected patients can benefit from such a patient‐tailored protocol, which can provide satisfactory early and medium‐term results, with an overall 5‐year survival rate of 74.1% (Figure 3), which is similar to the international standard of care 5‐11 . Noticeably, PAB strategy permitted survival without MCS and myocardial recovery avoiding HT in selected infants.…”

“…*Of note that, although survival rate for PAB was 100%, this strategy failed in two over six patients, and these two patients survived by conventional VAD therapy which is similar to the international standard of care. [5][6][7][8][9][10][11] Noticeably, PAB strategy permitted survival without MCS and myocardial recovery avoiding HT in selected infants.…”

“…Heart transplantation (HT) is the ultimate treatment for these patients, but its long‐term outcomes in children are still suboptimal. In fact, 25‐year survival is <40%, 5 worsened by cumulative morbidities related to immunosuppressive therapy, graft rejection, and social issues 4‐6 . All these factors, together with the constant lack of adequate donors, contribute to make HT a not appealing option, especially in infants.…”

“…In fact, 25‐year survival is <40%, 5 worsened by cumulative morbidities related to immunosuppressive therapy, graft rejection, and social issues. 4 , 5 , 6 All these factors, together with the constant lack of adequate donors, contribute to make HT a not appealing option, especially in infants.…”

A 4D flow MRI evaluation of the impact of shear-dependent fluid viscosity on in vitro Fontan circulation flow

“…In completing the total cavopulmonary connection (TCPC), the Fontan procedure by its very design results in low-shear nonpulsatile pulmonary blood flow and central venous hypertension (18). Interestingly, although all patients have the same fundamentally abnormal circulation, the variability in timing and presentation of Fontan failure is currently unexplained (9). Many patient-specific factors such as blood vessel sizes, position and shape of surgical anastomoses, and pulmonary blood flow distribution affect the energetic efficiency of the circulation (36).…”