Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre

Salem, Mohamed; Leroy, Martin; Zajons, Thomas; Al-Tawil, Mohammed; Haneya, Assad; Skrzypek, Susanne; Thul, Joseph; Müller, Matthias; Jux, Christian; Akintürk, Hakan

doi:10.3390/jcdd13060267

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Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre

by

Mohamed Salem

^1,*,†

,

Martin Leroy

^2,†,

Thomas Zajons

³,

Mohammed Al-Tawil

⁴

,

Assad Haneya

⁴,

Susanne Skrzypek

⁵

,

Joseph Thul

⁵,

Matthias Müller

³

,

Christian Jux

⁵

and

Hakan Akintürk

¹

Pediatric Heart Centre, Department of Congenital Heart Surgery, University Hospital of Giessen and Marburg, Justus Liebig University, 35390 Gießen, Germany

²

Centre for Congenital Heart Disease/Pediatric Cardiology Heart- and Diabetescentre NRW, University Clinic of Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany

³

Pediatric Heart Centre, Department Pediatric Cardiac Anesthesia, University Hospital of Giessen and Marburg, Justus Liebig University, 35390 Gießen, Germany

⁴

Department of Cardiovascular Surgery, Krankenhaus der Barmherzigen Brüder Trier, 54942 Trier, Germany

⁵

Pediatric Heart Centre, Department of Pediatric Cardiology, University Hospital of Giessen and Marburg, Justus Liebig University, 35390 Gießen, Germany

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Cardiovasc. Dev. Dis. 2026, 13(6), 267; https://doi.org/10.3390/jcdd13060267 (registering DOI)

Submission received: 23 March 2026 / Revised: 27 May 2026 / Accepted: 1 June 2026 / Published: 12 June 2026

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Abstract

Background: Heart transplantation (HTx) is a well-established therapy for pediatric patients with end-stage heart failure. Over the past decades, the field has considerably evolved, with noticeable changes in surgical techniques and post-transplant outcomes. This study presents our center’s experience over the past three decades. Methods: Between 1988 and 2024, we performed 256 heart transplants in pediatric patients (<18 years) with congenital heart defects (CHD) or myopathy. We divided our cohort into three periode, eras: Era1 (1988–1999), Era2 (2000–2011), and Era3 (2012–2024). We analyzed and reported baseline patient data, postoperative outcomes, and survival analysis. Results: In the first era, most HTx recipients were infants (75%), with CHD accounting for 75% of cases. In the latest era, older children and adolescents were transplanted more frequently with infants representing only 22%, and myopathies became a more predominant indication, representing 57% of patients. The use of mechanical circulatory support increased significantly (<0.001), and a complete shift towards the bi-caval surgical technique was achieved in the recent era. In terms of post-HTx outcomes, 30-day mortality and allograft vasculopathy significantly decreased in the recent era compared with previous periods (<0.001). Conversely, operative time and post-HTx hemodialysis were more frequently observed in the recent era (<0.001). Long-term survival numerically improved in the middle and recent eras compared with the early era; however, no statistically significant difference in Kaplan–Meier survival across eras was observed (log-rank p = 0.19). Conclusions: Over the past three decades, HTx in pediatric patients has evolved, with improvements in early survival and reduced allograft vasculopathy. Changes in patient demographics, surgical technique, and use of MCS in the recent era highlight the ongoing progress as well as the remaining challenges in this complex population.

Keywords: pediatric heart transplantation; evolution of pediatric heart transplantaion; congenital heart defects

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MDPI and ACS Style

Salem, M.; Leroy, M.; Zajons, T.; Al-Tawil, M.; Haneya, A.; Skrzypek, S.; Thul, J.; Müller, M.; Jux, C.; Akintürk, H. Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre. J. Cardiovasc. Dev. Dis. 2026, 13, 267. https://doi.org/10.3390/jcdd13060267

AMA Style

Salem M, Leroy M, Zajons T, Al-Tawil M, Haneya A, Skrzypek S, Thul J, Müller M, Jux C, Akintürk H. Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre. Journal of Cardiovascular Development and Disease. 2026; 13(6):267. https://doi.org/10.3390/jcdd13060267

Chicago/Turabian Style

Salem, Mohamed, Martin Leroy, Thomas Zajons, Mohammed Al-Tawil, Assad Haneya, Susanne Skrzypek, Joseph Thul, Matthias Müller, Christian Jux, and Hakan Akintürk. 2026. "Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre" Journal of Cardiovascular Development and Disease 13, no. 6: 267. https://doi.org/10.3390/jcdd13060267

APA Style

Salem, M., Leroy, M., Zajons, T., Al-Tawil, M., Haneya, A., Skrzypek, S., Thul, J., Müller, M., Jux, C., & Akintürk, H. (2026). Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre. Journal of Cardiovascular Development and Disease, 13(6), 267. https://doi.org/10.3390/jcdd13060267

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Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre

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