Heterotopic heart transplantation for elevated pulmonary vascular resistance in pediatric patients.

BACKGROUND

The presence of significant elevation of pulmonary vascular resistance is a major risk factor for death after orthotopic heart transplantation. The choice of procedure for the pediatric patient remains contentious.

METHODS

We report three pediatric patients with pulmonary hypertension and raised pulmonary resistance, including two infants, in whom heterotopic transplantation was performed with smaller donor hearts. The hearts were anastomosed to provide left ventricular support alone because predominant left ventricular failure was present, the pulmonary resistance was expected to fall gradually after surgery, and we wished to avoid the potential problems of a pulmonary conduit associated with growth and possible reoperation.

RESULTS

The clinical results have been satisfactory in all three patients, who were well and without symptoms. No pulmonary compromise was observed in the smaller thoracic cavity of the two infants. The transpulmonary gradient fell in all three patients, although this reduction was not immediate.

CONCLUSIONS

This technique in carefully selected recipients can allow safer transplantation in pediatric patients with elevated pulmonary resistance, can increase the donor pool by allowing use of smaller hearts and nonideal donors, and may reduce the mortality on the transplant waiting list by providing earlier transplantation.