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Children’s Health: Outcomes improve in childhood heart transplants

A combination of more effective medications and better followup care leads to longer survival

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A new heart is sometimes the only option for children with serious cardiac defects. Fortunately, a Canadian study has shown that these major operations are becoming more and more successful.

“If you look at our last 10 years, our outcomes are much better than our first 10 years,” says Dr. Bryce Laing, a cardiac surgery resident at the University of Alberta in Edmonton. “It is hard to put your finger on one thing that made a difference. It is a combination of things, such as improved medications, better followup and better management during the yearly postop visits.”

Laing and his colleagues reviewed the outcomes of all of their pediatric heart transplantation cases over the past 18 years. These included 76 heart and one heart-lung transplantation performed in 70 patients under the age of 18 between 1987 and June 2006.

Fifty-two patients (74 per cent) were still alive. Overall survival rates were 84 per cent at one year, 65 per cent at five years and 53 per cent at 10 years. But when the researchers looked only at the 59 children operated on since 1996, the one-year survival rates improved to 88 per cent and five-year survival rates shot up to 85 per cent.

The average age at transplantation was just over six years, and six per cent of children died within a month of the surgery. The longest surviving transplant was 16 years and the longest surviving patient had the operation 19 years ago.

Some heart defects are detected during the second and third trimesters of pregnancy and babies are put on heart transplant waiting lists before they are born. Two such children were successfully transplanted. And five infants received hearts with an incompatible blood type, and all were still alive, including one who had undergone the operation more than two years earlier.