Orthotopic heart transplantation in children.

Heart transplantation is a relatively infrequent but technically demanding procedure in pediatric cardiac surgery. Orthotopic heart transplantation is often offered to older children or adolescents following multiple previous operations, but with advances in intensive care, diagnostics, and management, more infants with complex congenital heart diseases are being listed for transplantation. Primary cardiomyopathies remain the most common indication. Outcomes following cardiothoracic transplantation have improved steadily in recent times. Donor availability has been helped by increasing public awareness and donation after cardiac death, especially of lungs, increasing the number of patients benefiting from heart and/or lung transplantation. While there are still insufficient donors to meet the current needs, effective devices to bridge patients to transplantation are now widely used. Although the many advances have improved the outlook of transplantation, there are still difficulties that have not changed over time. Nevertheless, heart transplantation in children carries a reasonably good survival rate over the entire spectrum of recipient heart conditions. We discuss the salient features of acceptance of an organ and the technical aspects of both simple and complex heart transplantation in children.