Partial Heart Transplant for Congenital Heart Disease.
| Title: | Partial Heart Transplant for Congenital Heart Disease. |
|---|---|
| Authors: | Overbey DM; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.; Duke Department of Surgery, Duke University, Durham, North Carolina.; Aykut B; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.; Duke Department of Surgery, Duke University, Durham, North Carolina.; Kucera JA; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.; Medina CK; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.; Sethi NJ; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.; Barker PCA; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.; Shea EV; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.; Turek JW; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.; Duke Department of Surgery, Duke University, Durham, North Carolina. |
| Source: | JAMA [JAMA] 2025 Sep 23; Vol. 334 (12), pp. 1077-1083. |
| Publication Type: | Evaluation Study; Journal Article; Comment |
| Language: | English |
| Journal Info: | Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Chicago : American Medical Association, 1960- |
| MeSH Terms: | Heart Defects, Congenital*/surgery ; Heart Transplantation*/methods ; Heart Transplantation*/adverse effects ; Heart Valve Diseases*/surgery ; Heart Valve Diseases*/congenital; Aortic Valve/growth & development ; Aortic Valve/transplantation ; Immunosuppressive Agents/therapeutic use ; Pulmonary Valve/growth & development ; Pulmonary Valve/transplantation ; Tacrolimus/therapeutic use ; Graft Rejection/prevention & control ; Aftercare/methods ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Feasibility Studies ; Treatment Outcome ; Retrospective Studies ; Adolescent ; Adult |
| Abstract: | Importance: Partial heart transplant, or living valve replacement, has the potential to advance surgical management of irreparable valvular disease by providing a viable option with capacity for growth.; Objectives: To describe the early experience and assess the feasibility, safety, and efficacy of partial heart transplant in patients with congenital heart valve disease.; Design, Setting, and Participants: Case series of the first 19 patients to undergo partial heart transplant at a single high-volume pediatric cardiac surgery and transplant center in the US between April 2022 and December 2024. No patients were excluded or lost to follow-up.; Exposures: Partial heart transplant using semilunar valves from donor hearts. Maintenance immunosuppression consisted of tacrolimus monotherapy with a trough level goal of 4 to 8 ng/mL.; Main Outcomes and Measures: Efficacy was defined as growth of the transplanted valve annulus and leaflets over time. Secondary outcomes included valve dysfunction and complications related to immunosuppression.; Results: Among the 19 participants with irreparable congenital heart valve dysfunction, 53% were male and 47% female. The median age at the time of transplant was 97 days. The median follow-up was 26 weeks. Three patients received partial heart transplant of both semilunar valves, 7 underwent living pulmonary valve replacement in the pulmonary position, 2 had a living aortic valve allograft in the aortic position, and 7 had a living aortic valve allograft in the pulmonary position. Nine patients constituting the initial cohort of partial heart transplant recipients had their annular diameter and valve leaflet length longitudinally analyzed for growth. All valves functioned well and demonstrated growth along appropriate z scores. Annular diameter increased from medians of 7 mm (aortic valve) and 9 mm (pulmonary valve) to 14 mm (aortic valve) and 17 mm (pulmonary valve), respectively. Leaflet length similarly increased from medians of 0.5 mm (aortic valve) and 0.49 mm (pulmonary valve) to 1 mm (aortic valve) and 0.675 mm (pulmonary valve), respectively. One patient required reoperation unrelated to the implanted valve. No significant complications related to immunosuppression were observed.; Conclusions and Relevance: Partial heart transplant appears feasible, safe, and efficacious. All transplanted valves demonstrated growth based on annular and leaflet length measurements. Careful follow-up and monitoring are crucial to support the continued expansion of this novel technique. |
| Comments: | Comment in: JAMA. 2025 Sep 23;334(12):1065-1067. doi: 10.1001/jama.2025.14668.. (PMID: 40864444) |
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| Substance Nomenclature: | 0 (Immunosuppressive Agents); WM0HAQ4WNM (Tacrolimus) |
| Entry Date(s): | Date Created: 20250827 Date Completed: 20250923 Latest Revision: 20260327 |
| Update Code: | 20260327 |
| PubMed Central ID: | PMC12457970 |
| DOI: | 10.1001/jama.2025.13580 |
| PMID: | 40864436 |
| Database: | MEDLINE |
Evaluation Study; Journal Article; Comment