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Alfredo Trento
Bartley P. Griffith
Robert L. Kormos
John Armitage
Robert L. Hardesty
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Ann Thorac Surg 1989;48:617-623
© 1989 The Society of Thoracic Surgeons

Articles

Lessons learned in pediatric heart transplantation

Alfredo Trento, MD*,a,b, Bartley P. Griffith, MDa,b, Frederick J. Fricker, MDa,b, Robert L. Kormos, MDa,b, John Armitage, MDa,b, Robert L. Hardesty, MDa,b

a Department of Thoracic and Cardiovascular Surgery, Cedars-Sinai Medical Center, Los Angeles, California USA
b Departments of Surgery and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA

* Address reprint requests to Dr Trento, Department of Thoracic and Cardiovascular Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 6215, Los Angeles, CA 90048.

Between February 1, 1982, and June 30, 1988, 32 children underwent cardiac transplantation for treatment of congenital heart disease (10) and other cardiomyopathies (22). The 6-year actuarial survival was a disappointing 36% because of a high perioperative mortality (12 of 32, 37.5%) and because of five late deaths due to uncontrollable rejection. The perioperative mortality was a staggering 60% (6 of 10) for the patients with congenital heart disease. Four of the 6 recipients with congenital heart disease died because of acute failure of the donor right ventricle. This included 2 patients who required reconstruction of the pulmonary arteries for stenosis secondary to previous systemic-to-pulmonary shunts and 2 others in whom the pulmonary vascular resistances were underestimated because of undetected recent pulmonary emboli (1) and complicated pulmonary vascular anatomy (1). Five of the six late deaths were due to rejection-related events, and all were patients with acquired cardiomyopathy.




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