MEDIUM-TERM RESULTS OF PEDIATRIC-PATIENTS UNDERGOING ORTHOTOPIC HEART-TRANSPLANTATION

To establish the medium-term results of our transplant population, we retrospectively reviewed the charts of 51 consecutive patients who und erwent orthotopic heart transplantation between July 1988 and April 19 95. These patents comprised two groups: group A consists of 26 patient s (age 6 days to 16.4 years, median 1.4 years) with no previous heart surgery, and group B consists of 25 patients (ages 0.1 to 14.3 years, median 8.3 years), all of whom had heart surgery before undergoing tra nsplantation. There was no difference between these groups in early or late survival rates, and neither age at transplantation nor sex was a n indicator of survival. There have been 14 deaths, six early (before hospital discharge) and eight late. Early deaths have predominantly be en attributed to long-term ventilation and hemodynamic instability bef ore transplantation, and late deaths to graft coronary artery disease (n = 4), acute coronary vasculitis (n = 3), and acute cellular rejecti on (n = 1). Although infection has resulted in significant morbidity ( 57 hospital admissions), there have been no late deaths resulting from infection. Sepsis accounts for four early deaths in chronically ill p atients. Orthotopic heart transplantation in the pediatric patient wit h and without previous heart surgery is a viable option for those with end-stage heart disease and those in whom other surgical options carr y a prohibitively high mortality rate.