HEART-TRANSPLANTATION IN CHILDREN WHO HAVE UNDERGONE PREVIOUS HEART-SURGERY - IS IT SAFE

As heart transplantation becomes more commonly applied to the pediatri c population, it is important to determine if previous palliative or r eparative operations increase the risk of transplantation. Since 1988, 13 children aged 23 months to 14 years (mean 9.5 years) who had under gone previous heart operations underwent orthotopic heart transplantat ion. These children had undergone an average of 3.2 previous operation s (range 1 to 7): 1.9 sternotomies (range 0 to 5) and 1.2 thoracotomie s (range 0 to 3). Three children had undergone only palliative operati ons (Norwood procedure, Waterston shunt, and transthoracic pacemaker); the remaining 10 had undergone at least one ''corrective'' operation: four valve replacements or repairs (three mitral and one aortic), thr ee Fontan procedures, one Rastelli procedure, one double-outlet right ventricle repair, and one ventricular septal defect repair. At the tim e of transplantation, seven patients (54%) were on inotropic support, two with mechanical ventilation. Three patients (23%) had significant levels of preformed antibodies necessitating a prospective cross-match , which significantly delayed transplantation. The transplant procedur e was complicated by the need for pulmonary arterial reconstruction in six patients (46%), transposition of the great arteries in three pati ents (23%), and atrial baffling to redirect anomalous venous drainage in one patient (8%). There was one death 4 days after surgery from sep sis in a patient who had undergone a previous Konno procedure who requ ired 24 hours of mechanical right ventricular assistance after transpl antation. Two children (15%) required mediastinal exploration for blee ding. There has been one late death at 14 months of graft atherosclero sis on follow-up from 7 to 56 months (mean 30 months). All survivors h ave New York Heart Association functional class I disease, with all sc hool-age children attending school. This series suggests that even chi ldren who have undergone multiple previous palliative or reparative ca rdiac procedures can undergo successful orthotopic heart transplantati on with excellent early and intermediate results.