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J Thorac Cardiovasc Surg 1998;116:242-246
© 1998 Mosby, Inc.
Cardiothoracic Transplantation |
From The Department of Surgery, Division of Cardiothoracic Surgery,a The Department of Pediatrics, Division of Cardiology,b The Department of Medicine,c and The Department of Preventive Medicine and Biometrics,d University of Colorado Health Sciences Center and the Children's Hospital, Denver, Colo.
Read at the Twenty-third Annual Meeting of The Western Thoracic Surgical Association, Napa, Calif., June 25-28, 1997.
Received for publication July 8, 1997. Revisions requested Oct. 10, 1997; revisions received Feb. 25, 1998. Accepted for publication April 13, 1998. Address for reprints: Max B. Mitchell, MD, Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Box C-310, Denver, CO 80262.
Objectives: Our objectives were to (1) review our experience with heart transplants in infants (age < 6 months), (2) delineate risk factors for 30-day mortality, and (3) compare outcomes between our early and recent experience.
Methods: Records of all infants listed for transplantation in our center before September 1996 were analyzed. Early and recent comparisons were made between chronologic halves of the accrual period. Univariate analysis was used to analyze potential risk factors for 30-day mortality (categorical variables, Fisher's exact test; continuous variables, nonparametric Wilcoxon rank-sum test). Multivariable analysis included univariate variables with p values 
0.10. Actuarial survivals were estimated (Kaplan-Meier) and compared by the log-rank test.
Results: Fifty-one of the 60 infants listed for transplantation were operated on (waiting list mortality 15%). Thirty-day mortality was 18% overall, 30% in the first 3 years and 10% in the last 3 years (p = 0.07). Sepsis was the commonest cause of early death (4/9). Univariate analysis suggested four potential risk factors for early death: preoperative mechanical ventilation (p = 0.01), prior sternotomy (p = 0.002), preoperative inotropic drugs (p = 0.08), and warm ischemia time (p = 0.08). Multivariable analysis indicated that prior sternotomy (p = 0.01) was an independent risk factor for 30-day mortality. Actuarial survivals were 80%, 78%, and 70% at 1, 2, and 3 years, and these figures improved between early and recent groups (p = 0.05). Late deaths were most commonly due to acute rejection (3/5).
Conclusions: Results of heart transplantation in infancy improve with experience. Prior sternotomy increases initial risk. Intermediate-term survival for infants with end-stage heart disease is excellent.
This article has been cited by other articles:
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  J. H. Artrip, D. N. Campbell, D. D. Ivy, M. C. Almodovar, K.-C. Chan, M. B. Mitchell, D. R. Clarke, and F. Lacour-Gayet Birth Weight and Complexity Are Significant Factors for the Management of Hypoplastic Left Heart Syndrome. Ann. Thorac. Surg., October 1, 2006; 82(4): 1252 - 1259. [Abstract] [Full Text] [PDF]
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 M. B. Mitchell, D. N. Campbell, M. M. Boucek, H. M. Sondheimer, K. C. Chan, D. D. Ivy, B. Pietra, and T. Mackenzie Mechanical limitation of pulmonary blood flow facilitates heart transplantation in older infants with hypoplastic left heart syndrome Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 735 - 742. [Abstract] [Full Text] [PDF]
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 C Wigfield, H C Leonard, J R L Hamilton, A Hasan, and J H Dark Paediatric cardiac transplant surgery has improved BMJ, April 3, 1999; 318(7188): 944 - 944. [Full Text]
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