Heart transplantation and the Batista operation for children with refractory heart failure

Medically refractory heart Failure may he present in children with cardiomy opathy (CMP) or complex congenital heart disease (CHD). In adults, the surg ical management of this condition is either heart transplantation or the Ba tista operation. From March 1995 to January 2000, a total of 6 children, ag ed From 1 to 16 years, with medically refractory heart failure associated w ith CMP or complex CHD underwent cardiac transplantation and one of them al so had the Batista operation as a bridge to transplantation. One of the 6 p atients died of intractable sepsis 17 days after the operation, but the oth er 5 were discharged with satisfactory hemodynamics. Immunosuppressive agen ts, including azathioprine, cyclosporin ol FK-506, were given. One patient experienced moderate acute rejection, but it was controlled by FK-506, OKT- 3 and solumedrol. However, another suffered From lymphproliferative disease 8 months after transplant, but it was controlled by intravenous immunoglob ulin, alpha -interferon and acyclovir. Cardiac function during serial follo w-up (range, I month to 5 years) revealed normal systolic and diastolic Fun ction and none received any anticongestive medications. Almost all patients received an oversized donor heart. The left ventricle (LV) mass was remode led, initially as an decrease and later as an increase. The patient who und erwent the Batista operation was discharged 1 month after the operation wit h an increased LV ejection fraction (from 10% to 22%). She was successfully bridged to heart transplantation 7 month?; after the Batista operation. Th e results of cardiac transplantation in growing children are satisfactory a nd remain the mainstay of surgical treatment for medically refractory heart failure in these patients. However, with a shortage of donor hearts, the B atista operation may be adopted as a bridge to heart transplant with a fair response.