Infant Heart Transplantation

Abstract

The surgical management of hypoplastic left heart syndrome (HLHS), a congenital heart disease that is seen in nearly 2,000 neonates in North America each year, remains controversial. The initial report of palliative surgery for HLHS by Norwood, et al. in 1983 heralded modifications, advancements, and the development of a staged reconstructive surgery for this disease [1]. Leonard Bayley at Loma Linda University in 1986 described the use of neonatal cardiac transplantation for infants with hypoplastic left heart [2]. In the early 1980’s the results with staged reconstruction were poor and infant cardiac transplantation seemed a very desirable option. Transplantation would reestablish a normal physiology rapidly and potentially result in improved outcome over the staged operations that ultimately culminate in the Fontan operation (see chapters 6,8,9). The successes with neonatal and infant heart transplantation pioneered by Bayley resulted in early survival rates that were clearly superior to the staged reconstruction operations. Therefore, neonatal cardiac transplantation has been suggested by several institutions to be the surgical intervention of choice for hypo-plastic left heart syndrome, although donor shortage remains a problem for neonates awaiting transplantation. Although initially, the survival of neonates undergoing cardiac transplantation was clearly superior to those undergoing staged reconstruction, recent reports have shown that the progressive improvement in outcome for staged reconstruction has provided early outcomes that may be comparable for both surgical approaches.