Pediatric cardiac transplantation – the Innsbruck experience

Abstract

Aims: Cardiac transplantation (HTX) is an accepted treatment of terminal heart failure in adults. In childhood, however, a number of congenital as well as aqcuired diseases may also lead to terminal heart failure. The aim of our study was to investigate the results of pediatric HTX at our department. Methods: We investigated on all pediatric HTX performed in Innsbruck between 1996 and 2007. Demographic aspects, cardiac disease, waiting time, bridging devices as well as outcome were evaluated. Results: From 1996 through 2007, 16 HTX were performed in 15 children at our departement.9 children were male, 6 female. Mean age was 10.3 years with a range from 0.8–18 years. Underlying cardiac disease was a dilative cardiomyopathy in 9 children, restrictive cardiomyopathy in 2. One transplantation was performed for Ebsteins' anomaly, one for virus myocarditis and one for muscular dystrophia. One girl, who was first transplanted in 1996, underwent retransplantation for TX-vasculopathy in 2007. Furthermore, one boy underwent retransplantation, who was first transplanted elsewhere. Mean waiting time was 177 days with a range from 4–652 days. One girl died on first postoperative day due to peracute rejection. No further deaths were encountered in postoperative course so far. Mechanical bridging systems were used in nine children. These include one ECMO, two LVADs and six BVADs. Conclusion: HTX is a good therapeutical option for children suffering from terminal heart failure, leading to good long-term results with acceptable perioperative risk. The waiting time for transplantation is longer in children, thus leading to more mechanical bridging-devices.