ArticleJournal of cardiovascular development and disease2026
Three and a Half Decades of Pediatric Heart Transplantation: Evolution of Surgical Practice and Outcomes at a High-Volume Centre.
Article in Journal of cardiovascular development and disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHeart 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.
methodsBetween 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.
resultsIn 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
conclusionsOver 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.
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