Replacing the defective or malfunctioning heart with a fresh, and completely functional healthy heart from a separate donor, is known as heart transplantation. The necessity of transplanting the heart in infants, children, and adults are alike:, i.e., terminal failure. Pediatric heart transplantation is preferred only when the candidate fails to respond to other conservative treatments and is left with the only choice. Deciding when the child requires a heart transplant is mostly dependent on the doctor, who after detailed analysis and thorough understanding of the condition may approve for the procedure.
More than 3500 heart transplants are performed every year across the world, among which around 20% of the transplants are performed on infants and children with congenital heart diseases. Owing to the advancements in the medical field, the success rates of heart transplantation in children has increased manifolds with approximately 93-98% short-term and 83-85% long-term survival rates being recorded over the last decade.
a. When does my child require a heart transplant?
Heart transplantation in children is performed in order to extend the longevity of lifespan of the candidate. However, the requirement of transplant depends on the type and aggressiveness of defect or disease acquired. Contrary to ischemic heart disease, which happens to be the most common reason for transplantation procedure in adults, in children, it may be required in the following cases:
• Cardiomyopathy or the degeneration of the cardiac muscles leading to failure of disciplined functioning
• Congenital defects in the heart which may involve holes or defects in the septum, cardiac linking or blood vessels
• Acquired terminal heart diseases
b. What happens during heart transplant for a child?
Transplantation of faulty heart with a healthy heart is the standard procedure of heart transplant in children and adult alike. Heart transplant involves two standard procedures and depends on the aggressiveness of the child’s health condition. The two types are:
• Orthotopic heart transplant
In this procedure, the defective heart is replaced by the healthy donor heart on the exact position. The healthy heart then functions like the recipient’s own.
• Heterotopic heart transplant
In this procedure, the heart from the donor is placed along with the existing heart and is usually affixed in the tighter chest. The two hearts are made to perform in a coordinated manner.
Irrespective of the type of transplant, the general procedure is mostly same.
• Once a suitable heart is available, the listed candidate is summoned to the hospital and prepared for the surgery within 2-3 hours
• Several confirmatory tests are performed to ensure that the available heart is a perfect match for the candidate
• After being prepared for the surgical procedure, the candidate is provided with anesthetic drugs
• Heart transplantation involves open surgery and thus, the chest is slit open
• The defective heart is then taken out and replaced with the healthy heart
• The blood vessels are sutured in exact positions like the one existing previously
• The chest is stitched back, bandaged and allowed to heal.
c. What are the steps to recovery post heart transplant surgery?
Implementing post-surgical measures is imperative and should not be neglected under any circumstances. Right after the surgical procedure, the child is admitted in the Cardiac Intensive Care Unit, abbreviated as the CICU, where umpteenth protective care is provided to the candidate. For a period of 8-10 days, the candidate is subjected to life-support or ventilators to ensure adjustability and complete functioning of the heart. The stay in CICU may either be shorter or longer depending on the complexity of the child’s condition.
• After the heart begins to function properly, the child is shifted too pediatric cardiac ward where close monitoring is performed for approximately one month. Throughout the tenure, the family and the candidate is taught to get accustomed to the new heart and made to learn the dos and don’ts.
• Repeated follow-up appointments are scheduled after heart transplant in children. This is to ensure safety as well as observe the functioning of the heart. Any kind of anomaly, if noticeable, should be reported immediately to the surgeon.
• Medications consisting of immunosuppressants and pain killers should be given as directed and not overdone unless approved or advised by the surgeon.
• The child needs to be strictly under bed rest for a given period of time, and should avoid heavy physical activities at all cost.
• Resuming daily activities, like going to school, exercising, etc., should only be done after thorough consultation with the surgeon.
• Parents should strictly monitor their eating habits and obey the instructions from the healthcare provider thoroughly.
• Owing to the doses of immunosuppressive medicines, the candidate shall have low body immunity and thus, extra care should be taken to avoid cough and cold, infections, or other diseases.
• Special care should be given to the hygiene of the candidates and any kind of health change should not be taken lightly.