Pediatric Heart Transplant

Heart transplant is a life-saving treatment for children with end-stage heart failure or severe heart defects.

A pediatric heart transplant is a critical procedure performed to replace a child’s diseased or failing heart with a healthy donor heart.

Understanding the heart transplant process can help ease concerns and prepare you and your family for the journey ahead.

The pediatric heart transplant program at WashU Medicine and St. Louis Children’s Hospital began in 1986. Over the decades, our team has helped hundreds of families, with patients ranging from young children to people in their 20’s needing a lifesaving heart transplant. People come to our center from across the country, and we are honored to care for each of our patients and their families.

What is a heart transplant?

A heart transplant is a surgery that replaces a failing or defective heart with a heart donated from someone else.

Heart transplant is a last-resort procedure for people who do not respond to medical treatment and need a new heart.

Screening and diagnosis

Before considering a heart transplant, thorough screenings and diagnostic tests are essential. These may include:

• Blood tests: To check for underlying conditions and compatibility factors.
• Electrocardiograms (ECGs): To measure the heart’s electrical activity.
• Echocardiograms: To visualize the heart’s structure and function.
• Cardiac catheterizations: To measure heart function and pressure.
• Imaging studies: Such as MRIs or CT scans to get detailed pictures of the heart.

These tests provide a comprehensive understanding of the child’s heart condition and determine the need for a transplant.

Who needs a heart transplant?

Several conditions might lead to a newborn or child needing a heart transplant, including:

• Congenital heart defects: Structural problems present at birth.
• Cardiomyopathy: Diseases of the heart muscle.
• Heart failure: Often caused by heart muscle damage from infection or other medical conditions.
• Previous heart surgeries: That have not yielded the desired outcomes.

Assessing these risk factors helps medical professionals identify the most appropriate treatment plan.

Assist devices

In some cases, mechanical assist devices may be necessary either as a bridge to transplant or longer-term support:

• Ventricular assist devices (VADs): Help the heart pump blood throughout the body.
• Extracorporeal membrane oxygenation (ECMO): A temporary solution providing heart and lung support.

These devices can be lifesaving while awaiting a transplant.

Multidisciplinary team approach

WashU Medicine employs a multidisciplinary team approach to pediatric heart transplants, ensuring comprehensive care.

The team typically includes:

• Cardiologists: Experts specializing in pediatric heart conditions.
• Congenital heart surgeons: Highly skilled surgeons who perform transplants.
• Anesthesiologists: Specialists who manage anesthesia during surgery.
• Intensive care physicians and nurses: Professionals who provide care in the ICU after surgery.
• Pharmacists: Experts in managing the complex medication regimens required after transplant.
• Social workers and psychologists: Providing emotional and logistical support to the family.

The transplant procedure

At WashU Medicine and St. Louis Children’s Hospital, our pediatric heart transplant program offers a comprehensive and compassionate approach to treating children in need of a heart transplant.

Currently, the standard procedure for pediatric heart transplants at WashU Medicine and most major medical centers involves an open-heart surgery approach. This is because the complexities of heart transplantation require direct and comprehensive access to the heart and major blood vessels to ensure precise and successful transplantation of the donor heart.

What to expect

• Preparation: The child will be evaluated and prepared for surgery under general anesthesia.
• Removal: The diseased heart is carefully removed through an incision in the chest.
• Implantation: The donor heart is sewn into place, connecting major blood vessels.
• Function check: Once the new heart begins to function properly, the chest is closed.

This procedure can take several hours and requires a highly specialized surgical team.

Pediatric heart donors

Pediatric heart donors are typically children or young adults who have experienced irreversible brain injuries. Critical points include:

• Consent: Obtained from the donor’s family.
• Compatibility: Ensured through blood type, size, and other medical factors.
• Ethical practices: Ensuring donor families are treated with respect and transparency.

The decision to donate an organ is a difficult one. Donor organs make it possible to provide lifesaving transplants for people in need.

Understanding donor information helps families appreciate the importance and impact of organ donation.

Potential complications

As with any major surgery, heart transplants come with potential complications:

• Rejection: The immune system may attack the new heart. This is managed with immunosuppressive medications.
• Infections: Immunosuppressive medications can increase the risk of infections.
• Cardiac allograft vasculopathy: A condition where the coronary arteries in the new heart become narrowed.

Regular monitoring and follow-up care are crucial to detect and address any complications promptly.

Recovery and long-term management

Recovery and follow-up are important to the transplant process.

This includes:

• Intensive monitoring: Initially in the ICU, followed by regular outpatient check-ups.
• Medications: Immunosuppressant drugs to prevent rejection, and other medications to support overall health.
• Lifestyle adjustments: Including a balanced diet, regular exercise, and avoiding infections. Members of your care team will provide information to help.
• Emotional support: For both the patient and their family through counseling and support groups.

Long-term management is essential for ensuring the success and longevity of the transplanted heart.