Perioperative Management in Pediatric Heart Transplantation

Abstract

Peri- and early postoperative mortality significantly influences the probability of survival following heart transplantation in children. Main causes of death early after transplantation are rejection, non specific graft failure and RV failure due to pulmonary hypertension. Optimal therapy of pulmonary hypertension and aggressive use of assist devices as a bridge to recovery will substantially improve survival in the early period after transplantation. Furthermore, the use of marginal donor organs will be more acceptable because transient myocardial insufficiency may recover during extracorporeal life support.

Key words

Heart transplantation - early mortality - pulmonary hypertension - graft failure - assist device

References

• 1 Bailey L L, Nehlsen-Cannarella S L, Doroshow R W, Jacobson J G, Martin R D, Allard M W. et al . Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome.  N Engl J Med. 1986;  315 949-951
• 2 Boucek M M, Edwards L B, Keck B M, Trulock E P, Taylor D O, Mohacsi P J. et al . The Registry of the International Society for Heart and Lung Transplantation: sixth official pediatric report 2003.  J Heart Lung Transplant. 2003;  22 636-652
• 3 Burch M, Aurora P. Current status of paediatric heart, lung, and heart-lung transplantation.  Arch Dis Child. 2004;  89 386-389
• 4 De Santo L S, Amarelli C, Romano G, Della C A, Torella M, Mastroianni C. et al . Evolving practice patterns in heart transplantation: a single-center experience over 15 years.  Transplant Proc. 2004;  36 627-630
• 5 Boucek M M, Edwards L B, Keck B M, Trulock E P, Taylor D O, Mohacsi P J. et al . The Registry of the International Society for Heart and Lung Transplantation: sixth official pediatric report 2003.  J Heart Lung Transplant. 2003;  22 636-652
• 6 Kirklin J K, Naftel D C, Bourge R C, McGiffin D C, Hill J A, Rodeheffer R J. et al . Evolving trends in risk profiles and causes of death after heart transplantation: a ten-year multi-institutional study.  J Thorac Cardiovasc Surg. 2003;  125 881-890
• 7 Bauer J, Dapper F, Demirakca S, Knothe C, Thul J, Hagel K J. Perioperative management of pulmonary hypertension after heart transplantation in childhood.  J Heart Lung Transplant. 1997;  16 1238-1247
• 8 Stobierska-Dzierzek B, Awad H, Michler R E. The evolving management of acute right-sided heart failure in cardiac transplant recipients.  J Am Coll Cardiol. 2001;  38 923-931
• 9 Gajarski R J, Mosca R S, Ohye R G, Bove E L, Crowley D C, Custer J R. et al . Use of extracorporeal life support as a bridge to pediatric cardiac transplantation.  J Heart Lung Transplant. 2003;  22 28-34
• 10 Fiser W P, Yetman A T, Gunselman R J, Fasules J W, Baker L L, Chipman C W. et al . Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation.  J Heart Lung Transplant. 2003;  22 770-777
• 11 Stiller B, Hetzer R, Weng Y, Hummel M, Hennig E, Nagdyman N. et al . Heart transplantation in children after mechanical circulatory support with pulsatile pneumatic assist device.  J Heart Lung Transplant. 2003;  22 1201-1208
• 12 Dellgren G, Koirala B, Sakopoulus A, Botta A, Joseph J, Benson L. et al . Pediatric heart transplantation: improving results in high-risk patients.  J Thorac Cardiovasc Surg. 2001;  121 782-791
• 13 Taghavi S, Ankersmit J, Zuckermann A, Roth G A, Wieselthaler G, Rajek A. et al . A retrospective analysis of extracorporeal membrane oxygenation versus right ventricular assist device in acute great failure after heart transplantation.  Transplant Proc. 2003;  35 2805-2807
• 14 Kavarana M N, Sinha P, Naka Y, Oz M C, Edwards N M. Mechanical support for the failing cardiac allograft: a single-center experience.  J Heart Lung Transplant. 2003;  22 542-547
• 15 Kirshbom P M, Bridges N D, Myung R J, Gaynor J W, Clark B J, Spray T L. Use of extracorporeal membrane oxygenation in pediatric thoracic organ transplantation.  J Thorac Cardiovasc Surg. 2002;  123 130-136
• 16 Fenton K N, Webber S A, Danford D A, Gandhi S K, Periera J, Pigula F A. Long-term survival after pediatric cardiac transplantation and postoperative ECMO support.  Ann Thorac Surg. 2003;  76 843-846
• 17 Mitchell M B, Campbell D N, Bielefeld M R, Doremus T. Utility of extracorporeal membrane oxygenation for early graft failure following heart transplantation in infancy.  J Heart Lung Transplant. 2000;  19 834-839
• 18 Hoffman T M, Spray T L, Gaynor J W, Clark III B J, Bridges N D. Survival after acute graft failure in pediatric thoracic organ transplant recipients.  Pediatr Transplant. 2000;  4 112-117