Aim: This study aimed to summarise our recent clinical experience with children and adolescents selected for heart transplantation with a focus on morbidity and mortality during the waiting time.
Methods: This was a single centre, retrospective study of all consecutive patients
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Aim: This study aimed to summarise our recent clinical experience with children and adolescents selected for heart transplantation with a focus on morbidity and mortality during the waiting time.
Methods: This was a single centre, retrospective study of all consecutive patients listed for heart transplantation between 1994 and 2008 who were less than 20 years old. Clinical parameters, ECG, echocardiography and catheter data as well as duration and complications of mechanical circulatory support, were reviewed from the date of listing to the date of transplantation or death.
Results: The study population consisted of 20 patients with a median age at the time of listing of 13.8 years (range 1–19.6 years). Cardiomyopathy was present in 17 patients (dilated 11, restrictive 3, hypertrophic 1 and unclassified 2) and a congenital heart defect was present in 3. In 13/20 patients, a significant arrhythmia was noted: ventricular fibrillation 2, non sustained ventricular tachycardia 6, supraventricular tachycardia 8 and complete atrioventricular block 4 events. A total of five patients died whilst on the waiting list. The median time to transplantation or death was 61 days (range 1–318 days). The estimated survival rate (Kaplan Meier) was 88, 71 and 47% at 1, 3 and 5 months respectively. There was no difference between the patients who died on the waiting list and the patients who survived to transplantation regarding age, sex, heart failure, arrhythmia and echocardiographic findings. Patients with dilated cardiomyopathy were overrepresented in the group who survived to transplantation (13/15 versus 1/5, p 0.014). Mechanical circulatory support was used in 13/20 patients for a median duration of 59 days (range 1–361 days) resulting in 18 events of complications: thrombosis or embolia 6, bleeding 9, and significant infection or sepsis 3 events. In one patient, a clinically relevant hemisydrome persisted.
Conclusion: The survival to transplantation rate was acceptable in our cohort and is similar to other studies. There were relatively few deaths in patients with dilated cardiomyopathy. Otherwise, an adverse outcome cannot be predicted from clinical or haemodynamic data at the time of listing for transplantation. Thrombo-embolic events continue to be a major issue in patients with mechanical circulatory support.
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