Pediatric and Congenital Heart Transplant: Twenty-year Experience in a Terciary Brazilian Hospital

Abstract

IntroductionCardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients.ObjectiveThis study aims to report on 20 years of experience since the first case and evaluate our results.MethodsWe conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to 21 years with a mean of 8.8±5.7 years and a median of 5.2 years. The underlying diagnosis was dilated cardiomyopathy in 61.5%, congenital heart disease in 26.6% and restrictive cardiomyopathy in 11.9%. All patients above 17 years old had congenital heart disease.ResultsSurvival rate at 30 days, 1, 5, 10, 15, and 20 years were 90.4%, 81.3%, 70.9%, 60.5%, 44.4% and 26.7%, respectively. Mean cold ischemic time was 187.9 minutes and it did not correlate with mortality (P>0.05). Infectious complications and rejection episodes were the most common complications (P<0.0001), occurring, respectively, in 66% and 57.4% of the survivors after 10 years. There was no incidence of graft vascular disease and lymphoproliferative disease at year one, but they affected, respectively, 7.4% and 11% of patients within 10 years.ConclusionTwenty-year pediatric heart transplant results at our institution were quite satisfactory and complication rates were acceptable.

Mechanical circulatory support in paediatric population

“…They report a significant reduction in the number of patients who have failed to be weaned from extra-corporeal membrane oxygenation (25 versus 85%) and greater discharge rates in hospitals where extra-corporeal membrane oxygenation programmes have been implemented (5.5 versus 45%). 29 Khorsandi et al support the findings of Ge et al, by demonstrating a survival to discharge rate of 47% in patients where extra-corporeal membrane oxygenation was instituted in the operating theatre versus 37.5% in patients who failed maximal medical therapy and required extra-corporeal membrane oxygenation during their ward stay. 30 In these patients, survival was poorest in younger patients (<6 months) and in those with prolonged extra-corporeal membrane oxygenation duration.…”

The Report of the First 12 Cases of Heart Transplantation among Children at Shahid Rajaei Heart Center

“…Because of the difference in the learning curves of the two pointed groups, the statistics on mortality and survival of the patients in the two groups can be very discrepant. In surveys by Groetzner et al, 8 and by Miana et al, 9 the most prevalent reason for long-term death was postoperative infections and graft rejection. Given that most studies focused on long-term follow up of patients and also employed new immunosuppressive therapies as well as used new and quick diagnostic techniques for postoperative complications, we expected lower mortality as well as higher improvement rates following heart transplantation in children that was also revealed in our observation in a short-term follow-up time.…”

Pediatric Mechanical Circulatory Support Systems in Latin America

“…The Heart Institute at the University of São Paulo Medical School HTX program began in 1992, and since then we have performed an average of six pediatric HTX per year up to 2010 . In the last 5 years, we have averaged 17 transplants annually due to the improvements in the state funding for the long‐distance organ procurement with air transportation.…”