A New Operation For Truncus Arteriosus With Unrepairable Truncal Valve: The First Human Partial Heart Transplant
Joseph W. Turek, MD, PhD, MBA, Lillian Kang, MD, Anna Hoover, Neel Prabhu, Michael Mulvihill, MD, Michael P. Carboni, MD, Nicholas D. Andersen, MD, T. Konrad Rajab, MD.
Duke University Medical Center, Durham, NC, USA.
Objectives: Partial heart transplantation is a novel approach for delivering growing pediatric heart valve replacements. This report describes a novel operation for truncal valve replacement using partial heart transplantation.
Methods: The patient was prenatally diagnosed with type A2 truncus arteriosus and truncal valve dysfunction unamenable to repair. IRB exemption was obtained from the transplanting institution. Buy-in from all stakeholders - parents, providers, organ procurement organizations - was achieved.
Results: At 18 days of life, an ABO-matched donor was identified. The donor heart was procured after cardiac death. The aortic root with attached ventricular tissue and the pulmonary root were dissected. The recipient operation involved confirmation of truncal valve dysfunction, transplantation of the aortic root and closure of the VSD with donor ventricular tissue, coronary re-implantation, enlargement of the right ventricular outflow tract, and transplantation of the pulmonary root. Ischemic, bypass, and clamp times were 395, 215, and 145min. The patient was extubated on POD6, weaned off hemodynamic drips on POD17, and discharged on POD30. Serial echocardiograms have shown growth (Figure) and excellent function of the transplanted valves.
Conclusions: Partial heart transplantation is the first clinically successful approach to deliver growing heart valve replacements. It is particularly suitable for truncus arteriosus because the Ross operation is not an option. Further studies are necessary to determine the optimal level of immune suppression for a partial heart transplant.
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