Outcomes And Late Complications

Results

Surgical techniques of cardiac transplantation in children have been refined to a point now where, in most series, operative survival is at least 90%.20 At Children's Memorial Hospital, we have had one operative mortality in the past 50 transplants (2% mortality). ISHLT Pediatric Registry data shows a current 5 year survival of 65% and a 10 year survival of 55%.5 In the neonatal age group, the largest series (n=84) has been reported by Chiavarelli and colleagues with an operative mortality of 13% and a 5 year actuarial survival of 81%.21 We have serially evaluated the cardiac index, left ventricular volume, and ejection fraction following heart transplants in both infants and children.22 Cardiac output remains normal as indexed to the patient's body surface area and there is a steady appropriate rise in left ventricular end diastolic volume. The donor heart grows appropriately with the child!

Growth and Development

Longitudinal studies of linear growth of pediatric heart transplant recipients would indicate that growth is not normal. However, there are many variables such as preoperative growth failure caused by chronic disease, prolonged hospitaliza-tion, and other factors that make such studies difficult. Most pediatric heart transplant recipients are somewhat short for their age. Chronic prednisone may play a role. Developmental delay measured by the Denver Developmental Screening has not been documented. Most importantly, ISHLT Pediatric Registry data indicates that at 3 years postop over 95% of recipients have no activity limitations.5

0 0

Post a comment