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Surgery Updates of Heart Transplantation in Children and Adults
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Surgery Updates of Heart Transplantation in Children and Adults

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 2312

Special Issue Editor

Dr. Elizabeth J. Maynes

E-Mail Website
Guest Editor
Department of Surgery, Division of Anatomy, USUHS, Bethesda, MD 20814, USA
Interests: general surgery; cardiac surgery; reconstructive surgery; anatomical variations in surgery; heart transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgery updates in heart transplantation for both children and adults have significantly advanced the field of cardiac transplantation. Heart transplantation remains the gold standard treatment for end-stage heart failure when medical management is no longer effective. Recent developments in surgical techniques, immunosuppressive therapies and organ preservation have improved outcomes and expanded the eligibility criteria for transplantation in both pediatric and adult populations.

In children, advancements in donor–recipient size matching, innovative surgical approaches and improved post-transplant care have increased survival rates and enhanced the long-term quality of life. Additionally, the use of ventricular assist devices as a bridge to transplantation has become more common in pediatric patients with severe heart failure.

For adults, advancements include extended donor criteria, such as the use of marginal donors and the development of minimally invasive techniques, reducing surgical trauma and improving recovery times. Furthermore, personalized immunosuppressive regimens and improved management of complications have contributed to better graft survival and overall patient outcomes.

These surgery updates in heart transplantation for both children and adults have revolutionized the field, offering new hope and improved outcomes for patients with end-stage heart failure. Ongoing research and technological advancements continue to drive progress in this vital area of cardiac surgery.

Dr. Elizabeth J. Maynes
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac surgery
  • heart transplantation
  • heart failure
  • surgical techniques
  • heart diseases
  • heart injuries
  • solid organ transplantation
  • donor–recipient size matching
  • minimally invasive techniques
  • general surgery

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Published Papers (2 papers)

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14 pages, 1344 KiB  
Article
Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review
by Maria del Val Groba Marco, Miriam Cabrera Santana, Mario Galvan Ruiz, Miguel Fernandez de Sanmamed, Jose Luis Romero Lujan, Jesus Maria Gonzalez Martin, Luis Santana Ortega, María Vazquez Espinar, Francisco Portela Torron, Vicente Peña Morant, Eduardo Jose Caballero Dorta and Antonio Garcia Quintana
J. Clin. Med. 2024, 13(17), 4972; https://doi.org/10.3390/jcm13174972 - 23 Aug 2024
Viewed by 1290
Abstract
(1) Background: Cardiac donation after circulatory death (DCD) is an emerging paradigm in organ transplantation. However, this technique is recent and has only been implemented by highly experienced centers. This study compares the characteristics and outcomes of thoraco-abdominal normothermic regional perfusion (TANRP) and [...] Read more.
(1) Background: Cardiac donation after circulatory death (DCD) is an emerging paradigm in organ transplantation. However, this technique is recent and has only been implemented by highly experienced centers. This study compares the characteristics and outcomes of thoraco-abdominal normothermic regional perfusion (TANRP) and static cold-storage DCD and traditional donation after brain death (DBD) cardiac transplants (CT) in a newly stablished transplant program with restricted donor availability. (2) Method: We performed a retrospective, single-center study of all adult patients who underwent a CT between November 2019 and December 2023, with a follow-up conducted until August 2024. Data were retrieved from medical records. A review of the current literature on DCD CT was conducted to provide a broader context for our findings. The primary outcome was survival at 6 months after transplantation. (3) Results: During the study period, 76 adults (median age 56 years [IQR: 50–63 years]) underwent CT, and 12 (16%) were DCD donors. DCD donors had a similar age (46 vs. 47 years, p = 0.727), were mostly male (92%), and one patient had left ventricular dysfunction during the intraoperative DCD process. There were no significant differences in recipients’ characteristics. Survival was similar in the DCD group compared to DBD at 6 months (100 vs. 94%) and 12 months post-CT survival (92% vs. 94%), p = 0.82. There was no primary graft dysfunction in the DCD group (9% in DBD, p = 0.581). The median total hospital stay was longer in the DCD group (46 vs. 21 days, p = 0.021). An increase of 150% in transplantation activity due to DCD was estimated. (4) Conclusions: In a new CT program that utilized older donors and included recipients with similar illnesses and comorbidities, comparable outcomes between DCD and DBD hearts were observed. DCD was rapidly incorporated into the transplant activity, demonstrating an expedited learning curve and significantly increasing the availability of donor hearts. Full article
(This article belongs to the Special Issue Surgery Updates of Heart Transplantation in Children and Adults)
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6 pages, 200 KiB  
Opinion
In the Twilight of Evidence: Is Bypass Surgery Still on the Table for Cardiac Allograft Vasculopathy?
by Emyal Alyaydin and Andreas J. Flammer
J. Clin. Med. 2025, 14(1), 132; https://doi.org/10.3390/jcm14010132 - 29 Dec 2024
Viewed by 657
Abstract
Background: Cardiac allograft vasculopathy (CAV) is a major prognosis-limiting factor in patients undergoing orthotopic heart transplantation (HT). Due to the diffuse involvement of the coronary tree, CAV lesions are often not amenable to percutaneous coronary intervention (PCI), leaving coronary artery bypass grafting (CABG) [...] Read more.
Background: Cardiac allograft vasculopathy (CAV) is a major prognosis-limiting factor in patients undergoing orthotopic heart transplantation (HT). Due to the diffuse involvement of the coronary tree, CAV lesions are often not amenable to percutaneous coronary intervention (PCI), leaving coronary artery bypass grafting (CABG) and retransplantation as primary revascularization options. Aim and Results: The latest guidelines from the International Society for Heart and Lung Transplantation (ISHLT) recognize CABG as a viable option but with a downgraded strength of recommendation. The 2023 ISHLT guidelines now categorize CABG as a Class IIb recommendation (Level of Evidence: C) for highly selected CAV patients with anatomically suitable lesions, a downgrade from the Class IIa recommendation in the 2010 guidelines. This adjustment underscores the persisting reliance on limited, retrospective studies and the lack of substantial new data supporting CABG in CAV management. Our article examines the evidence collected since 2010 on this topic, highlighting key findings and assessing the role of CABG in contemporary transplant practice. This article calls for targeted investigations to better define the role of CABG as a therapeutic option, addressing the gaps in evidence for surgical revascularization in HT patients. Full article
(This article belongs to the Special Issue Surgery Updates of Heart Transplantation in Children and Adults)
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