To summarize key technologies and methods of pediatric heart transplantation and to provide a reference for the development of pediatric heart transplantation in China.

The clinical data of 47 pediatric heart transplantation recipients who got transplantation between January 1, 2008 and December 31, 2018 in the Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. Clinical features, surgical related indicators, postoperative complications and survival rate of recipients were collected.

Twenty-four recipients were male and 23 recipients were female among 47 recipients. The mean age, weight and preoperative pulmonary arterial pressure of 47 recipients was (10.3±4.8) years, (32±15) kg and (33±12) mmHg. The protopathy included 36 cases of cardiomyopathy, 9 cases of congenital heart disease and 2 cases of cardiac tumor. Four recipients had a history of heart surgery. The panel reactive antibody of recipients was less than 10%. The ABO blood type between recipient and donor: 39 cases were same and 8 cases were compatible. The mean donor/recipient body weight ratio was 1.6±0.6. The mean cold ischemic time of donor heart was (330±115) minutes, with 24 cases greater than 6 hours. Thirty-seven recipients received bicaval heart transplantation and 10 recipients received biatrial heart transplantation. The mean duration of intraoperative cardiopulmonary bypass was (119±53) minutes, in which the mean CPB-assist time was (80±48) minutes. The average duration of postoperative mechanical ventilation was 32 h (13-1 250 h), and the average intensive care unit stay was 7 d (5-11 d). Postoperative complications occurred in 20 cases including 7 cases of cardiac insufficiency, 5 cases of arrhythmia, 7 cases of renal insufficiency, 3 cases of rejection and 1 case of hematological disease. The left ventricular ejection fraction of recipients was (67±5)% (57%-79%). Forty-six recipients were safely discharged and 1 recipient died of pneumonia 59 days after transplantation. The mean follow up time were (42±31) months (6-129 months), and the 1-year, 3-year, and 5-year survival rate after transplantation was 95.74%, 93.01% and 93.01% respectively.

Heart transplantation is an effective means for end-stage heart disease in children. The clinical outcome of pediatric heart transplantation in our center is satisfactory with good intermediate and long-term survival rate, and a set of complete heart transplantation technique processes has been established.