Semilunar valve growth and function 10 years after infant heart transplantation: Predicting long‐term outcomes of partial heart transplants

IF 1.2 4区医学 Q3 PEDIATRICS

Pediatric Transplantation Pub Date : 2024-04-03 DOI:10.1111/petr.14746

Taufiek K. Rajab, Mohamed Abdelrahman, Elridge J. Schwartzenburg, Berk Aykut, Joseph W. Turek, Deani H. McVadon

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Abstract

IntroductionPartial heart transplants are a new type of pediatric transplant that replace defective heart valves with the parts of matched donor hearts containing the necessary valves. Short‐term outcomes of partial heart transplants are excellent, but long‐term outcomes are unknown. In order to predict the long‐term outcomes of partial heart transplants, we evaluated long‐term growth and function of semilunar heart valves transplanted in infancy as part of a heart transplant.MethodsAll children who underwent infant heart transplantation at a single center from 1997 to 2014 were included in this study. Children in whom echocardiograms after heart transplantation and after 10 years were not available for review were excluded. The echocardiograms were reviewed by two authors to analyze semilunar valve annulus diameters, Z‐scores, peak valve gradients, and valve regurgitation. Statistical difference was determined using two‐tailed, paired sample t‐tests with Bonferroni correction for multiple comparisons.ResultsData from 15 patients were analyzed. The aortic valve annulus averaged 1.3 cm (range 0.7–1.8 cm) immediately after transplantation and grew to an average of 1.7 cm (range 1.4–2.3 cm) after 10 years (p < .001). After 10 years, the aortic valve peak gradient avereraged 5.1 mmHg (range 2.1–15.5 mmHg) and none of the valves had more than trivial regurgitation. The pulmonary valve annulus averaged 1.5 cm (range 1.1–2.5 cm) immediately after transplantation and grew to an average of 2.1 cm (range 1.0–2.9 cm) after 10 years (p < .001). After 10 years, the pulmonary valve peak gradient averaged 4.3 mmHg (range 1.1–13.8 mmHg), and 7% of valves had moderate regurgitation.DiscussionSemilunar heart valves transplanted in infancy as part of a heart transplant demonstrate statistically significant growth and excellent function after 10 years. This predicts excellent long‐term outcomes of partial heart transplants.

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婴儿心脏移植10年后半月瓣的生长和功能：预测部分心脏移植的长期结果

导言部分心脏移植是一种新型的儿科移植手术，用匹配的捐赠者心脏中含有必要瓣膜的部分替代有缺陷的心脏瓣膜。部分心脏移植的短期疗效非常好，但长期疗效尚不清楚。为了预测部分心脏移植的长期预后，我们对婴儿期作为心脏移植一部分移植的半月形心脏瓣膜的长期生长和功能进行了评估。排除了心脏移植后和 10 年后超声心动图无法进行复查的患儿。由两位作者对超声心动图进行复查，分析半月瓣瓣环直径、Z-评分、瓣膜峰值梯度和瓣膜反流。统计差异采用双尾配对样本 t 检验，多重比较采用 Bonferroni 校正。移植后，主动脉瓣环平均为 1.3 厘米（0.7-1.8 厘米不等），10 年后平均增至 1.7 厘米（1.4-2.3 厘米不等）（p < .001）。10 年后，主动脉瓣峰值梯度增加了 5.1 mmHg（范围为 2.1-15.5 mmHg），没有一个瓣膜出现轻微的反流。移植后肺动脉瓣环平均为 1.5 厘米（范围为 1.1-2.5 厘米），10 年后增长到平均 2.1 厘米（范围为 1.0-2.9 厘米）（p < .001）。10年后，肺动脉瓣峰值梯度平均为4.3 mmHg（范围为1.1-13.8 mmHg），7%的瓣膜有中度反流。讨论在婴儿期作为心脏移植手术一部分移植的半月形心脏瓣膜在10年后显示出显著的统计学增长和良好的功能。这预示着部分心脏移植的长期疗效极佳。

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来源期刊

Pediatric Transplantation 医学-小儿科

CiteScore

2.90

自引率

15.40%

发文量

216

审稿时长

3-8 weeks

期刊介绍： The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.