Author + information
- Received March 25, 1994
- Revision received December 27, 1994
- Accepted May 1, 1995
- Published online September 1, 1995.
- Daphne T. Hsu, MD, FACC*,
- Jan M. Quaegebeur, MD,
- Robert E. Michler, MD, FACC,
- Craig R. Smith, MD, FACC,
- Eric A. Rose, MD, FACC,
- Maryanne R. Kichuk, MD,
- Welton M. Gersony, MD, FACC,
- Judith F. Douglas, RN and
- Linda J. Addonizio, MD, FACC
- ↵*Address for correspondence: Dr. Daphne T. Hsu, College of Physicians and Surgeons, Columbia University, Babies Hospital, 2 North, 3959 Broadway, New York, New York 10032, USA
Objectives The aim of this study was to describe heart transplantation in children with congenital heart disease and to compare the results with those in children undergoing transplantation for other cardiac diseases.
Background Reports describe decreased survival after heart transplantation in children with congenital heart disease compared with those with cardiomyopathy. However, transplantation is increasingly being considered in the surgical management of children with complex congenital heart disease. Present-day results from this group require reassessment.
Methods The diagnoses, previous operations and indications for transplantation were characterized in children with congenital heart disease. Pretransplant course, graft ischemia time, posttransplant survival and outcome (rejection frequency, infection rate, length of hospital stay) were compared with those in children undergoing transplantation for other reasons (n = 47).
Results Thirty-seven children (mean [±SD] age 9 ± 6 years) with congenital heart disease underwent transplantation; 86% had undergone one or more previous operations. Repair of extracardiac defects at transplantation was necessary in 23 patients. Causes of death after transplantation were donor failure in two patients, surgical bleeding in two, pulmonary hemorrhage in one, infection in four, rejection in three and graft atherosclerosis in one. No difference in 1- and 5-year survival rates (70% vs. 77% and 64% vs. 65%, respectively), rejection frequency or length of hospital stay was seen between children with and without congenital heart disease. Cardiopulmonary bypass and donor ischemia time were significantly longer in patients with congenital heart disease. Serious infections were more common in children with than without congenital heart disease (13 of 37 vs. 6 of 47, respectively, p = 0.01).
Conclusions Despite the more complex cardiac surgery required at implantation and longer donor ischemic time, heart transplantation can be performed in children with complex congenital heart disease with success similar to that in patients with other cardiac diseases.
- Received March 25, 1994.
- Revision received December 27, 1994.
- Accepted May 1, 1995.
- American College of Cardiology