Purpose of review: To review the recent publications on pediatric heart failure and pediatric transplantation.
Recent findings: Little progress has been made in the chronic medical management of pediatric heart failure. Basic science studies demonstrating disparate regulation of β2-adrenergic receptors and microRNA between pediatric and adult heart failure may give clues to the lack of improvement in pediatric outcomes. Pediatric ventricular assist devices have significantly improved survival of bridge-to-transplant, but currently have too many limitations for destination therapy for children. Several areas of pediatric heart transplant have had significant developments over the last few years: the role of antibodies in mediating graft dysfunction after transplantation, ABO-incompatible transplant, extending the pediatric limits on acceptable pulmonary vascular resistance, and risk prediction of pediatric transplant outcomes. Failed single-ventricle palliation is a growing indication for heart transplantation with its own unique challenges.
Summary: Pediatric heart transplantation can have excellent outcomes with survival beyond 20 years after transplant common, especially in the infant. However, the growing population of children and young adults being referred for heart transplantation after failed congenital heart surgery, especially after failed single-ventricle palliation, is presenting new obstacles that may start reducing the survival rates for pediatric heart transplantation. This may in part be ameliorated by earlier referral for transplant evaluation.