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Ann Thorac Surg 1994;58:1664-1669
© 1994 The Society of Thoracic Surgeons

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Articles

Orthotopic heart transplantation in children with congenital heart disease

^a Divisions of Cardiothoracic Surgery and Pediatric Cardiology, University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
^b Department of Medical Statistics and Computing, University of Southampton, Southampton, England

Accepted for publication May 19, 1994.

^_* Address reprint requests to Dr Fricker. Division of Cardiology, Children's Hospital of Pittsburgh, 3705 5th Ave at DeSoto St, Pittsburgh, PA 15213.

The early experience (February 1982 to June 1988) with transplantation for the treatment of congenital heart disease at the University of Pittsburgh was disappointing due to an excessively high perioperative mortality. From July 1988 to June 1992, a further 21 children with congenital heart disease underwent orthotopic transplantation. Thirteen had undergone multiple prior palliative procedures (mean, 2.8 per patient). In 12 of these patients, prior procedures involved the pulmonary arteries on one or more occasions. In contrast to our earlier experience, there were no deaths stemming from inadequate surgical reconstruction or pulmonary hypertension. The actuarial survival was 71% at both 1 and 3 years. This did not differ significantly from the survival among 18 patients who underwent transplantation for the management of cardiomyopathy over the same period (1-year and 3-year survival, 83%). The perioperative mortality and short-term survival are now similar for children undergoing transplantation for the treatment of either congenital heart disease or cardiomyopathy. These improved results probably reflect more careful patient selection and an increasing surgical experience with complex reconstructive procedures.

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