PREDICTORS OF OPERATIVE MORTALITY AND MORBIDITY AFTER INFANT HEART-TRANSPLANTATION

We retrospectively analyzed the impact of recipient, donor, and operat ive factors on the operative mortality and morbidity of 36 consecutive infant heart transplantations. Operative survival was excellent at 94 %. Among 34 survivors, operative morbidity in 12 patients included acu te severe allograft failure with or without prolonged ventilatory supp ort. The cohort was characterized by age less than 4 months (32 of 36) , a diagnosis of hypoplastic left heart syndrome (29 of 36), and the u se of circulatory arrest (27 of 36); these variables were colinear and could not be used to predict operative mortality or morbidity. None o f the remaining recipient, donor, or operative characteristics predict ed survival or acute severe allograft failure. A donor-to-recipient we ight ratio greater than 2 and a circulatory arrest time greater than 3 9 minutes predicted the need for prolonged ventilatory support. Despit e the need for aggressive or prolonged support after 12 of 36 transpla ntations, operative survival was high at 94% (34 of 36 procedures, 32 of 34 patients). The use of less restrictive donor criteria combined w ith aggressive management of acute allograft failure can result in exc ellent operative survival after infant heart transplantation.