Partial Heart Transplantation Delivers Growing Heart Valve Replacements In Piglets
Lillian Kang, MD1, Jennie H. Kwon, MD2, Kristi L. Helke, DVM, PhD2, David C. Fitzgerald, DHA, MPH, CCP2, Carolyn Taylor, MD2, Marc Hassid, MD2, Neel Prabhu1, Anna Hoover1, Stephen G. Miller, MD1, Deani H. McVadon, MD2, Morgan A. Hill2, Nicholas D. Andersen, MD1, Minoo N. Kavarana, MD2, Joseph W. Turek, MD, PhD, MBA1, T. Konrad Rajab, MD2.
1Duke University Medical Center, Durham, NC, USA, 2Medical University South Carolina Center, Charleston, SC, USA.
Objective(s): Partial heart transplantation is a new approach to deliver growing heart valve replacements for neonates and infants. The objective of this study is to provide proof of principle for this new type of transplant in piglets.
Methods: The pulmonary valve was orthotopically transplanted in five pairs of ABO-matched piglets weighing 8-15 kg. The operations were performed on a beating heart using cardiopulmonary bypass. Recipient piglets received the standard immune suppression for pediatric orthotopic heart transplants consisting of induction immunotherapy with tacrolimus 0.05 mg/kg and mycophenolate 20 mg/kg, intraoperative methylprednisolone 10 mg/kg before graft reperfusion, and post-operative tacrolimus titrated to a target trough 10 ng/mL, mycophenolate 20 mg/kg BID and prednisolone tapered to 0.65 mg/kg BID. Growth and function of the transplanted pulmonary valve and the native aortic valve were measured using serial echocardiography by a blinded cardiologist.
Results: The first piglet did not emerge from anesthesia. The second piglet was euthanized on post-operative day 2 due to hypoxia from a respiratory tract infection. The remaining three piglets were long-term survivors. There was statistically significant growth of the transplanted pulmonary valve and native aortic valve, and no valve dysfunction. Additional operations and histological examinations are pending.
Conclusions: Partial heart transplantation delivers growing heart valve replacements in piglets. These findings supported the first clinical partial heart transplant, which is reported in a separate abstract.
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