Cardiac transplantation in patients under 16 year of age – single center experience

  • Katarzyna Januszewska, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Edward Malec, Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Julia Birnbaum, Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Alexandra Fuchs, Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Robert Dalla-Poza, Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Christoph Schmitz, Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Ralf Sodian, Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
  • Heinrich Netz, Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany

    • Objective: Cardiac transplantation is nowadays an established last option for treatment of complex congenital hearts defects and cardiomyopathy in end-stage heart failure. The aim of the study was to present single center experience with heart transplantation in patients under 16 year of age.
    Methods: Between March 1992 and September 2008, 72 patients aged from 5 days to 15.9 years (mean, 6.6+/-5.8 years) underwent orthotopic heart transplantation in our center. The preoperative diagnosis was cardiomiopathy in 49 (68.1%) and congenital heart defect in 23 (31.9%) children. 16 (22.2%) patients had history of previous cardiac surgery. 9 children required ventricular assisted device as a bridge to cardiac transplantation. Demographic, clinical perioperative and midterm data were retrospectively analyzed.
    Results: The mean follow-up was 6.6+/-4.6 years (range, 3 months to 16.8 years). The mean waiting for transplant time was 65.5+/-95.7 days. Early (30-days) and late postoperative mortality was 5.6% (N=4) and 10.3% (N=7), respectively. Actuarial 1, 5 and 10 year survival was 89%, 89% and 87.5%. The mean ventilatory support time was 6.1+/-7.3 days, and the mean hospital stay time was 45.4+/-20.4 days. The diagnosis of congenital heart defect had significantly higher incidence among non-survivals in comparison with survivals (p=0.036).
    Conclusions: Heart transplantation in patients below 16 year of age has very good midterm results. The diagnosis of congenital heart defect is a risk factor for death after transplantation in this group of age.