End-stage paediatric heart failure in low- and middle-income countries: challenges in surgical management.

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-06-01 Epub Date: 2024-11-25 DOI:10.1007/s12055-024-01853-z

Komarakshi Balakrishnan

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引用次数: 0

Abstract

Purpose: To define the challenges faced in the surgical treatment of end-stage heart failure in low- and middle-income countries and offer possible solutions.

Methods: The World Bank definition of low- and middle-income countries (LMIC) is gross national income less than US $1085 and US $4255 respectively. In this list, India is the only country with a significant paediatric heart transplant and mechanical circulatory support programme. Hence, the Indian experience was used as an example in this study. A total of 141 children less than or equal to 18 years underwent a heart transplant over a 10-year period in a single surgical unit. The youngest was 8 months old. Twenty children were younger than 5 years of age and 58 were less than 10 years. The major problems to overcome were shortage of paediatric donors, challenges in organ transport, challenges in keeping sick recipients alive while awaiting a donor heart and dealing with cost implications and long-term care. A third of these patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) I or II. Fourteen percent were on mechanical circulatory support prior to transplant. Hospital mortality was defined as death within 90 days of transplant. The follow-up was up to 10 years.

Results: The 90-day survival was 85.11%. The risk factors for hospital mortality were low INTERMACS (odds ratio - OR 0.3, p ~ 0.004), high creatinine (OR 3.6, p ~ 0.06) and high pretransplant right atrial pressure more than 15 mm Hg (OR 4.7, p ~ 0.03). The Kaplan-Meier survival curve showed a survival of over 70% at 10-year follow-up. The donors were typically older and the donor to recipient weight ratio was also significantly more than in published literature. Donor age more than 25 years had poorer outcomes long term. The economic challenges of running a programme in LMIC economies are enormous and need several innovative solutions including routine use of commercial aircrafts for organ transport.

Conclusions: Despite numerous challenges, a successful paediatric heart transplant programme is possible in LMIC countries with outcomes comparable to published data.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01853-z.

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低收入和中等收入国家的终末期儿科心力衰竭：外科治疗的挑战。

目的：明确中低收入国家终末期心力衰竭手术治疗面临的挑战，并提供可能的解决方案。方法：世界银行对低收入和中等收入国家（LMIC）的定义是国民总收入分别低于1085美元和4255美元。在这份名单中，印度是唯一拥有重要儿科心脏移植和机械循环支持规划的国家。因此，本研究以印度的经验为例。在10年的时间里，共有141名小于或等于18岁的儿童在同一个外科病房接受了心脏移植手术。最小的只有8个月大。20名儿童小于5岁，58名儿童小于10岁。需要克服的主要问题是儿科供体短缺、器官运输方面的挑战、在等待供体心脏的过程中保持病人存活的挑战，以及处理费用问题和长期护理问题。这些患者中有三分之一是机械辅助循环支持（Interagency Registry for mechanical Assisted circulation Support， INTERMACS） I或II。14%的患者在移植前接受了机械循环支持。医院死亡率定义为移植后90天内的死亡。随访时间长达10年。结果：90天生存率为85.11%。医院死亡的危险因素为低INTERMACS（比值比- 0.3,p ~ 0.004）、高肌酐（比值比- 3.6,p ~ 0.06）和移植前右房压高于15 mm Hg（比值比- 4.7,p ~ 0.03）。Kaplan-Meier生存曲线显示10年随访时生存率超过70%。供体通常年龄较大，供体与受体的体重比也明显高于已发表的文献。供体年龄超过25岁的长期预后较差。在低收入和中等收入国家的经济体中开展一个项目的经济挑战是巨大的，需要一些创新的解决方案，包括常规使用商业飞机运输器官。结论：尽管面临诸多挑战，但在低收入和中等收入国家，一个成功的儿科心脏移植项目是可能的，其结果与已发表的数据相当。图片摘要：补充资料：在线版本包含补充资料，网址为10.1007/s12055-024-01853-z。

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来源期刊

Indian Journal of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

1.20

自引率

14.30%

发文量

141

期刊介绍： The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.