Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results.
BACKGROUND
In children with dilated cardiomyopathy who are on the waiting list for heart transplantation, we evaluate the seriousness of their hemodynamic conditions. Some develop cardiogenic shock, and the mortality rate is high. Even with inotropic and respiratory support, heart transplantation is considered an extremely grave circumstance.


OBJECTIVE
The objective of this study is to report on our experience with children in this condition, in an attempt to analyze the viability, applicability and results of heart transplantation in these children.


METHODS
From March 2001 to February 2004, 22 children with dilated cardiomyopathy who were on the waiting list for heart transplantation developed cardiogenic shock, requiring transfer to pediatric intensive care unit (ICU), intubation and inotropic support. Their ages ranged from 11 months to 11 years (mean age: 4.3 years), 55% were males, 14 could be listed as clinical priority, and the remaining 8 were removed from the waiting list due to their unfavorable clinical conditions.


RESULTS
Eight heart transplantations were performed, and 6 children died while on the waiting list (42.9%). Two children died (25%) after transplantation and the remaining 6 were discharged from hospital in good clinical condition. The two main complications were organ rejection in 4 cases and infection in 5 cases. Two patients developed neurological complications, and one of them fully recovered.


CONCLUSIONS
Children with cardiomyopathy and cardiogenic shock require immediate heart transplantation; only 57.1% could be transplanted, with an early 25% mortality rate. Those who survived transplantation showed good clinical progress, similar to that of children transplanted on an elective basis.
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil. mbjatene@cardiol.br
Marcelo Biscegli
MB
Jatene
Leonardo Augusto
LA
Miana
Alexander John
AJ
Pessoa
Arlindo
A
Riso
Estela
E
Azeka
Carla
C
Tanamati
Solange
S
Gimenez
Antonio Augusto
AA
Lopes
Miguel Barbero
MB
Marcial
Noedir Antonio Groppo
NA
Stolf
D001938:Brazil / Q000453:epidemiology; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014850:Waiting Lists