Ya-fei Cheng, Cong-li Meng, Yi-ru Wang, Lin Chen, Ya-qun Ma, Wen-zhi Guo, Hang Guo
Seventh Medical Center to Chinese PLA General Hospital. Southern Medical University.
China
Frontiers in Pediatrics
Front Pediatr 2026; 14:
DOI: 10.3389/fped.2026.1842135
Abstract
Background: Orthotopic heart transplantation is the standard treatment for pediatric end-stage heart disease. Due to the wide age range and high physiological heterogeneity among pediatric recipients, perioperative anesthesia management is particularly complex. Literature describing real-world perioperative practices for high-risk populations remains limited.
Objective: This descriptive study aims to summarize the perioperative anesthesia management strategies and short-term clinical outcomes for pediatric heart transplant recipients at a single center.
Methods: This retrospective descriptive study enrolled 27 pediatric patients who underwent orthotopic heart transplantation at a single center from May 2022 to October 2025. Data on baseline characteristics, intraoperative variables, complications, and outcomes were collected. No control group was established, and no causal inference was performed.
Results: The cohort included 27 patients (13 male, 14 female), aged 6 months to 16 years (weight 7.0-95.0 kg). Dilated cardiomyopathy was the most common diagnosis (20/27, 74.1%). All patients were NYHA class III-IV; median LVEF was 28.5%. Preoperative ECMO support was used in 15 patients (55.6%). No major cardiovascular events occurred during induction or pre-CPB. Mean CPB time was 183.3 ± 55.6 min; mean cold ischemia time was 249.5 ± 101.1 min. Mean postoperative mechanical ventilation was 7.7 ± 9.5 days. Postoperative ECMO was required in 11 patients (40.7%). At follow-up, 23 patients were alive and 4 died (survival 85.2%). Major complications included hypoxic-ischemic encephalopathy (n = 4), AKI requiring CRRT (n = 5), and peripheral nerve injury (n = 2).
Conclusion: Among the pediatric heart transplant recipients with severe conditions in this cohort (including a high proportion of ECMO bridged cases), the perioperative anesthesia management strategy implemented included low-dose staged induction, invasive monitoring, and multidisciplinary collaboration. Pulmonary hypertension, primary graft dysfunction, and multi-organ complications were commonly observed in this cohort. This study is descriptive and observational; causal relationships cannot be inferred, and the findings require further validation in larger sample sizes or multicenter studies.
Category
Class II. Pulmonary Hypertension Associated with Left Ventricular Systolic or Diastolic Dysfunction
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Heart Dysfunction Associated with Pulmonary Vascular Disease (Right)
Procedural Risk and Care for Individuals with Pulmonary Vascular Disease
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes