Thoracic and Cardiovascular Surgeon, Supplement

The use of mechanical circulatory support for the treatment of heart failure in the pediatric population has become increasingly important in pediatric heart surgery units; however, the treatment options for the pediatric population have not attained the same level of technological development as we have seen for the adult population. The use of mechanical assistance as a bridge to transplantation or a bridge to recovery are the main indications for mechanical circulatory support in infants and children. The problem of organ donor shortage is even worse compared to the situation in the field of adult heart transplantations. Especially in Europe however, newly developed pulsatile, paracorporeal ventricular assist devices designed for long-term assist in children have demonstrated their ability to provide excellent results beyond the abilities of extracorporeal membrane oxygenation and centrifugal pumps, which are still the mainstay of mechanical support in children worldwide. Especially in the group of the smallest patients, the use of the most appropriate form of circulatory assistance has to be carefully considered as the co-incidence of respiratory failure as well as other complex physiological situations will severely influence the outcome.

M. Deiwick

A. Hoffmeier

T. D. T. Tjan

T. Krasemann

C. Schmid

H. H. Scheld

The thoracic and cardiovascular surgeon. Supplement

Heart Failure in Children - Mechanical Assistance

儿童心力衰竭 - 机械辅助

Marfan syndrome is a connective tissue disease with typical clinical signs and cardiac involvement. Its appearance in the neonatal period has a bad prognosis due to incompetence of all cardiac valves with subsequent congestive heart failure. Conservative management usually fails, the children die during their first year of life. We report on a girl with neonatal Marfan syndrome who suffered from regurgitance of all cardiac valves, enlarged ventricles, and dilated great arteries. She was NYHA class IV. At the age of six months she underwent heart transplantation. To prevent aneurysm formation and dissection of the great vessels, the whole aortic arch and pulmonary trunk were replaced as well.

S. Kotthoff

H.-G. Kehl

V. Debus

J. Vogt

Cardiac Transplantation in Neonatal Marfan Syndrome - A Life-Saving Approach

新生儿马凡综合征的心脏移植 - 一种救命的方法

Peri- and early postoperative mortality significantly influences the probability of survival following heart transplantation in children. Main causes of death early after transplantation are rejection, non specific graft failure and RV failure due to pulmonary hypertension. Optimal therapy of pulmonary hypertension and aggressive use of assist devices as a bridge to recovery will substantially improve survival in the early period after transplantation. Furthermore, the use of marginal donor organs will be more acceptable because transient myocardial insufficiency may recover during extracorporeal life support.

J. Bauer

J. Thul

K. Valeske

M. Müller

I. Michel-Behnke

J. Gehron

D. Schranz

H. Akintürk

Perioperative Management in Pediatric Heart Transplantation

小儿心脏移植围手术期管理

Introduction: Heart transplantation (HTx) has increasingly become a therapeutic option for end-stage heart failure of any origin in children. Short- and mid-term results are promising. However, long-term outcome has been a matter of concern because of acute or chronic rejection and side effects of immunosuppression. We performed a retrospective study of up to 15-years of follow-up on this patient entity. Methods: Between 1988 and 2004, 58 HTx were performed in 55 children (cardiomyopathy (DCM) 32, congenital heart disease (CHD) 23, Re-HTx 3). Mean age was 9.1 ± 7.2 years (4 days - 17.9 years). Twenty-nine patients had a total of 51 previous operations. Results: Operative mortality was 4/58 (6.8 %) due to primary graft failure. Late mortality was 7/54 (12.1 %) due to acute rejection (2), pneumonia (2), intracranial hemorrhage (1), suicide (1) and lymphoma (1). Mean follow-up was 5.2 ± 4.2 years. One-, 5-, and 10-year survival was 86 %, 80 % and 80 %, respectively, and improved significantly after 1995 (92 % and 92 %; p = 0.04). Survival was comparable for DCM and CHD patients (1-year: 88 % vs. 82 %; p = 0.19; 5-years: 84 % vs. 77 %; p = 0.12). Three patients with therapy resistant rejection and assisted circulation required retransplantation and are alive. Freedom from acute rejection was 46 % with primary cyclosporine immunosuppression and 63 % with tacrolimus. Ninety-eight percent of the survivors are at home and in excellent cardiac condition. Conclusion: Pediatric heart transplantation is a curative treatment for DCM and CHD with excellent clinical mid-term results. However, further follow-up is necessary to evaluate long-term side effects of immunosuppressants. Donor shortage remains a problem.

J. Groetzner

B. Reichart

U. Roemer

A. Tiete

J. Sachweh

R. Kozlik-Feldmann

H. Netz

S. Daebritz

Results of Pediatric Cardiac Transplantation - Long-Term Results of a 15-Year Experience

小儿心脏移植结果 - 15年经验的长期结果

Heart transplantation is not a unique event, neither from the medical point of view nor from the standpoint of psychosocial care. It is a process which begins during the evaluation for transplantation and continues up to re-integration of the patient into everyday life. It is obvious that during the entire time both the child suffering from heart disease and the family of the affected child have to deal with heavy emotional stresses and adjustments. For this reason transplantation centers are obliged by law to provide psychological care.

ISSN	0946-4778
h-index	11

Publication Information	Publisher: Georg Thieme Verlag，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2019，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Thoracic and Cardiovascular Surgeon, Supplement

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Heart Failure in Children - Mechanical Assistance

Cardiac Transplantation in Neonatal Marfan Syndrome - A Life-Saving Approach

Perioperative Management in Pediatric Heart Transplantation

Results of Pediatric Cardiac Transplantation - Long-Term Results of a 15-Year Experience

Psychological Care of Heart-Transplanted Children and their Families

Heart Failure in Children - Mechanical Assistance

Cardiac Transplantation in Neonatal Marfan Syndrome - A Life-Saving Approach

Perioperative Management in Pediatric Heart Transplantation

Results of Pediatric Cardiac Transplantation - Long-Term Results of a 15-Year Experience

Psychological Care of Heart-Transplanted Children and their Families