Pediatric Heart Transplantation in a National Pediatric Hospital J.P. Garrahan (Argentina)

Abstract

Purpose This abstract review all patients who underwent orthotopic heart transplantation (OHT) at our program (63 transplants) to describe their diagnostic characteristics and the surgical options for terminal heart failure like heart transplant and mechanical assistance. Methods This is a prospective, retrospective, transversal and observational paper. From July 2000, 129 patients have been listed for heart transplantation. Age from 1 to 230 months, female 52%, male:48 %. Range time in waiting list 1 to 3351 days. Diagnosis Dilated Cardiomiopathy: 93, Congenital heart disease 18, Restrictive 14, pulmonary hypertension:2, retransplant:2. Results Three Patients (16, 32, 7 months old) were transplanted with an ABO INCOMPATIBLE HEART DONOR using the “West Protocol”. (Table 2). Due to the lack of suitable donors and its consequence of high mortality on waiting list, in 2006 we have started to use mechanical assistance to let survive patients in terminal condition, and have a chance for transplantation. Sixty three heart transplants where done in sixty one patients. Fourty nine were assisted with Mechanical Ventricular Assistance (MVA) before transplantation. Berlin Heart® device in: 48 patients and Heart Ware® device: 1 patient. Age: 13 to 198 months; weight: 6 to 90,0 kg.; univentricular (54%) and biventricular (46%). No surgical deaths and no REDO because surgical bleeding in the MVA series. Seven patients where assisted with ECMO after transplantation, due to primary heart failure, with good results in 6 patients after ECMO weaning. One retransplantation dead. The triple scheme used for immunosuppression therapy was: azathioprine, cyclosporine and steroids. (Graph 7). The actuarial survival rate showed a huge survival level with good quality of life. Conclusion A Cardiac Transplant Program in a Pediatric Public Hospital; in Argentina; provides the opportunity for heart transplantation to infants and pediatric population with terminal heart failure. Survival rate and quality of life are satisfactory.