INFANT HEART-TRANSPLANTATION - IMPROVED INTERMEDIATE RESULTS

Objectives: Our objectives were to (1) review our experience with hear t transplants in infants (age < 6 months), (2) delineate risk factors for 30-day mortality, and (3) compare outcomes between our early and r ecent experience, Methods: Records of all infants listed for transplan tation in our center before September 1996 were analyzed, Early and re cent comparisons were made between chronologic halves of the accrual p eriod, Univariate analysis was used to analyze potential risk factors for 30-day mortality (categorical variables, Fisher's exact test) cont inuous variables, nonparametric Wilcoxon rank-sum test, Multivariable analysis included univariate variables with p values less than or equa l to 0.10, Actuarial survivals were estimated (Kaplan-Meier) and compa red by the log-rank test, Results: Fifty-one of the 60 infants listed for transplantation were operated on (waiting list mortality; 15%), Th irty-day mortality was 18% overall, 30% in the first 3 years and 10% i n the last 3 years (p = 0.07), Sepsis was the commonest cause of early death (4/9), Univariate analysis suggested four potential risk factor s for early death: preoperative mechanical ventilation (p = 0.01), pri or sternotomy (p = 0.002), preoperative inotropic drugs (p = 0.08), an d warm ischemia time (p = 0.08). Multivariable analysis indicated that prior sternotomy (p = 0.01) was an independent risk factor for 30-day mortality, Actuarial survivals were 80%, 78%, and 70% at 1, 2, and 3 years, and these figures improved between early and recent groups (p = 0.05). Late deaths were most commonly due to acute rejection (3/5), C onclusions: Results of heart transplantation in infancy improve with e xperience, Prior sternotomy increases initial risk. Intermediate-term survival for infants with end-stage heart disease is excellent.