Intermediate term results of infant orthotopic cardiac transplantation from two centers

C. L. Backer, V. R. Zales, H. L. Harrison, F. S. Idriss, D. W. Benson, Constantine Mavroudis

Research output: Contribution to journalArticle

Abstract

Orthotopic cardiac transplantation has become established for selected infants with severe forms of congenital heart disease. This study reviews the combined experience and intermediate term results of infants undergoing orthotopic cardiac transplantation from Children's Memorial Hospital, Chicago, and Kosair Children's Hospital, Louisville. From June 1986 through December 1989, 20 orthotopic cardiac transplantations were performed in 19 patients. Sixteen patients had variants of hypoplastic left heart syndrome. One infant had anomalous origin of the left coronary artery with severe ischemic cardiomyopathy. Two infants had aortic stenosis with endocardial fibroelastosis, and one had extracorporeal membrane oxygenation as a bridge to transplantation. Immunosuppression included cyclosporine, azathioprine (Imuran), and corticosteroids with an effort to wean the patients from steroids by 6 months to 2 years. Three early deaths resulted - from technical errors in two patients and from hyperacute rejection in one patient at 3 days. Four late deaths have occurred. Two patients died at 2 and 13 months of acute rejection. One patient died at 15 months of acute rejection after retransplantation. One patient died at 7 months of respiratory syncytial viral pneumonia. The remaining 12 patients are surviving 5 to 47 months (mean 20 months) after orthotopic cardiac transplantation. Rejection surveillance in the first 6 months is by clinical signs supplemented by echocardiography, electrocardiography, and cell cycle analysis; endomyocardial biopsy is used after 6 months of age. For the cumulative series, 24 episodes of suspected rejection have been treated during 277 at-risk patient months with intravenous methylprednisolone (Solu-Medrol) (n = 18) and monoclonal antibody (OKT3) (n = 6), for an incidence of 1.04 episodes of rejection per patient per year. Serious posttransplantation infections including endocarditis, catheter sepsis, meningitis, and colonic perforation were successfully treated in four patients. Subjectively, their quality of life is excellent as shown by normal growth and development milestones and a low hospital readmission rate (1.4 episodes per patient per year). These encouraging intermediate term results warrant continued application of infant orthotopic cardiac transplantation for severe forms of congenital heart disease.

Original languageEnglish (US)
Pages (from-to)826-832
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume101
Issue number5
StatePublished - Jan 1 1991
Externally publishedYes

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Heart Transplantation
Azathioprine
Heart Diseases
Endocardial Fibroelastosis
Methylprednisolone Hemisuccinate
Viral Pneumonia
Hypoplastic Left Heart Syndrome
Muromonab-CD3
Patient Readmission
Extracorporeal Membrane Oxygenation
Aortic Valve Stenosis
Methylprednisolone
Endocarditis
Cardiomyopathies
Growth and Development
Meningitis
Immunosuppression
Cyclosporine
Echocardiography
Sepsis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Backer, C. L., Zales, V. R., Harrison, H. L., Idriss, F. S., Benson, D. W., & Mavroudis, C. (1991). Intermediate term results of infant orthotopic cardiac transplantation from two centers. Journal of Thoracic and Cardiovascular Surgery, 101(5), 826-832.

Intermediate term results of infant orthotopic cardiac transplantation from two centers. / Backer, C. L.; Zales, V. R.; Harrison, H. L.; Idriss, F. S.; Benson, D. W.; Mavroudis, Constantine.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 101, No. 5, 01.01.1991, p. 826-832.

Research output: Contribution to journalArticle

Backer, CL, Zales, VR, Harrison, HL, Idriss, FS, Benson, DW & Mavroudis, C 1991, 'Intermediate term results of infant orthotopic cardiac transplantation from two centers', Journal of Thoracic and Cardiovascular Surgery, vol. 101, no. 5, pp. 826-832.
Backer, C. L. ; Zales, V. R. ; Harrison, H. L. ; Idriss, F. S. ; Benson, D. W. ; Mavroudis, Constantine. / Intermediate term results of infant orthotopic cardiac transplantation from two centers. In: Journal of Thoracic and Cardiovascular Surgery. 1991 ; Vol. 101, No. 5. pp. 826-832.
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