Domino partial heart transplantation.

Heart valve replacement in pediatric cardiothoracic surgery poses problems because conventional heart valve implants do not have the ability to grow. This mandates serial reoperations for implant exchanges until an adult-size implant can fit. Partial heart transplantation eliminates these reoperations because the transplanted valves grow. However, partial heart transplantation competes with heart transplantation for a limited supply of donor hearts. This is a critical barrier to the progress of the field. Domino partial heart transplantation is a new surgical technique that overcomes this barrier by capitalizing cardiectomy hearts from heart transplant recipients for partial heart transplantation. This surgical technique has the potential to transform pediatric heart valve replacement by greatly expanding the cardiac donor pool, increasing the time available for matching donors with recipients and simplifying the logistics of donation. As a result, the number of domino partial heart transplants is expected to exceed the number of partial heart transplants from deceased donors.