 |
|
| Over Two Decades of Pediatric Heart Transplantation |
|
Back to 86th Annual Meeting Back to Program Outline Objective: In 1984, the first successful pediatric heart transplant was performed at our center. This is a review of over twenty-one years of experience with pediatric heart transplantation. Methods: Between 11/1/1984-10/3/2005, 165 consecutive orthotopic heart transplants were performed on 155 patients. Characteristics: mean age: 7.2 ± 6.0 years (20 days-21 years), mean BSA 0.8 ± 0.5 m2. Diagnosis at transplant: cardiomyopathy 54.0% (89), congenital heart defect 38.8% (64), retransplant 7.3% (12). 34 potential risk factors for death were analyzed by univariate and multivariate analysis. Results: Mean follow-up was 5.5 ± 4.4 years. Overall actuarial survival was 81.6% at 1 year, 64.1% at 5 years, and 42.3% at 10 years. Overall hospital survival was 88.3% (144). Prior to 1995, actuarial survival was 73.0% at 1 year, 60.0% at 5 years, and 39.8% at 10 years; with a hospital survival of 82.1 % (64). Actuarial survival after 1995 was 88.6% at 1 year, 63.8% at 5 years, and 42.6% at 8 years; with a hospital survival of 95.3% (81). Hospital and 1-yr survival were improved in the post-1995 era compared to the pre-1995 era (p<0.001, p<0.001). 96 patients are alive to date, and at last follow-up, 90% are in NYHA class I. Risk factors for mortality by multivariate analysis were 1) prolonged intubation, 2) African-American ethnicity, 3) receiving blood products post-operatively, 4) post-operative mechanical circulatory support, and 5) post-operative renal failure. Using continuous variable analysis, pulmonary vascular resistance (PVR) did not become a risk factor for mortality at any level. 20 patients in the series had a PVR > 5 Wood units (11 were irreversible). Conclusions: Pediatric heart transplantation remains a safe and effective therapy. In the past 21 years, significant improvements have been made in hospital and short-term survival. However, long-term survival remains unchanged after more than 20 years. New therapies are needed to treat the ever-growing number of children with end-stage heart failure. Back to 86th Annual Meeting Back to Program Outline |
We Model Excellence |
 |
Copyright © American Association for Thoracic Surgery. All rights reserved.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.