RESUMEN
ABSTRACT Introduction: Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil Methods: This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5. Results: Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients. Conclusion: Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.
RESUMEN
INTRODUCTION: Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil. METHODS: This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5. RESULTS: Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients. CONCLUSION: Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.
Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Brasil , Niño , Estudios de Cohortes , Insuficiencia Cardíaca/cirugía , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Transposición de los Grandes Vasos/cirugía , Preescolar , Cianosis/diagnóstico , Cianosis/etiología , Femenino , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Humanos , Radiografía , Transposición de los Grandes Vasos/diagnóstico por imagen , UltrasonografíaAsunto(s)
Adolescente , Femenino , Humanos , Síndrome de Down/complicaciones , Cardiopatías Congénitas/complicaciones , Defectos del Tabique Interatrial/complicaciones , Hipotiroidismo/complicaciones , Atrios Cardíacos/cirugía , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/cirugía , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Hipotiroidismo/diagnóstico , Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéuticoRESUMEN
Dados Clínicos: Criança negra, sexo feminino e natural de Paulínia, SP. No quarto dia de vida, apresentou cianose de extremidades, recebendo prostaglandina e sendo encaminhada para nosso Serviço após diagnóstico de cardiopatia congênita. Neste momento, a radiografia lembrava área cardíaca com forma ovóide e eletrocardiograma com sobrecarga ventricular...