Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; University of Colorado School of Medicine, Aurora, Colo.
University of Colorado School of Medicine, Aurora, Colo.
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1361-1368. doi: 10.1016/j.jtcvs.2021.01.033. Epub 2021 Jan 23.
Neonatal orthotopic heart transplantation was introduced in the 1980s as a treatment for complex congenital heart disease. Progress in single-ventricle palliation and biventricular correction has resulted in a decline in neonatal heart transplant volume. However, limited reports on neonatal heart transplants have demonstrated favorable outcomes. We report the long-term outcomes of patients with neonatal heart transplants at our institution spanning nearly 30 years.
A retrospective analysis of neonatal heart transplants and neonates listed for transplant was performed at Children's Hospital Colorado. Primary outcomes were early and late survival. Secondary outcomes were rejection episodes, retransplantation, and development of cardiac allograft vasculopathy or post-transplant lymphoproliferative disease.
A total of 21 neonates underwent orthotopic heart transplantation at our institution. Among these, 10 neonates were transplanted from 1991 to 2000, 8 neonates were transplanted from 2001 to 2010, and 3 neonates were transplanted from 2011 to 2020. The average age of these patients was 17 days, and the average weight was 3.43 kg. Early survival was 95.2%. Survival at 1 and 5 years was 85.7% (confidence interval [CI], 61.9%-95.2%) and 75% (CI, 45.6%-85.5%), respectively. Of eligible patients, the 10-year and 20-year survival was 72.2% (CI, 45.1%-85.3%) and 50% (CI, 25.9%-70.1%), respectively.
Our institution reports favorable outcomes of neonatal heart transplantation. These results should be considered within the context of outcomes for patients awaiting transplant and the limited donor availability. However, the successful nature of these procedures suggest it may be necessary to reevaluate the indications for neonatal heart transplantation, particularly where risk of mortality and morbidity with palliative or corrective surgery is high.
新生儿心脏原位移植术于 20 世纪 80 年代被引入，用于治疗复杂的先天性心脏病。单心室姑息治疗和双心室矫正的进展导致新生儿心脏移植量下降。然而，关于新生儿心脏移植的有限报告表明其结果良好。我们报告了本机构近 30 年来接受新生儿心脏移植的患者的长期结果。
对科罗拉多儿童医院接受心脏移植和移植名单上的新生儿进行了回顾性分析。主要结果是早期和晚期存活率。次要结果是排斥反应发作、再次移植以及心脏同种异体血管病或移植后淋巴增生性疾病的发展。
共有 21 名新生儿在本机构接受了原位心脏移植。其中，10 名新生儿在 1991 年至 2000 年期间接受移植，8 名新生儿在 2001 年至 2010 年期间接受移植，3 名新生儿在 2011 年至 2020 年期间接受移植。这些患者的平均年龄为 17 天，平均体重为 3.43kg。早期存活率为 95.2%。1 年和 5 年存活率分别为 85.7%（置信区间 [CI]，61.9%-95.2%）和 75%（CI，45.6%-85.5%）。在符合条件的患者中，10 年和 20 年存活率分别为 72.2%（CI，45.1%-85.3%）和 50%（CI，25.9%-70.1%）。
本机构报告了新生儿心脏移植的良好结果。这些结果应在等待移植的患者的结果和有限的供体可用性的背景下考虑。然而，这些手术的成功性质表明，可能有必要重新评估新生儿心脏移植的适应证，特别是在姑息性或矫正性手术的死亡率和发病率较高的情况下。
