Initial Clinical Experience With Partial Heart Transplantation for Mitral Valve Replacement: An Experimental Approach

Douglas M Overbey; Joseph W Turek; Seth E M Wolf; John A Kucera; Erin V Shea; Jeffrey G Gaca; Muhammed I Aydin; Yue-Hin Loke; Yves d'Udekem

doi:10.1016/j.athoracsur.2026.06.018

Initial Clinical Experience With Partial Heart Transplantation for Mitral Valve Replacement: An Experimental Approach

Ann Thorac Surg. 2026 Jun 23:S0003-4975(26)00582-5. doi: 10.1016/j.athoracsur.2026.06.018. Online ahead of print.

Authors

Douglas M Overbey¹, Joseph W Turek², Seth E M Wolf³, John A Kucera⁴, Erin V Shea⁵, Jeffrey G Gaca⁶, Muhammed I Aydin⁷, Yue-Hin Loke⁸, Yves d'Udekem⁷

Affiliations

¹ Duke Congenital Heart Surgery Research and Training Lab, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina. Electronic address: douglas.overbey@duke.edu.
² Duke Congenital Heart Surgery Research and Training Lab, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.
³ Duke Congenital Heart Surgery Research and Training Lab, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
⁴ Duke Congenital Heart Surgery Research and Training Lab, Durham, NC, USA.
⁵ Duke University School of Medicine, Durham, NC, USA; Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, North Carolina.
⁶ Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
⁷ Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁸ Division of Cardiology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

PMID: 42336079
DOI: 10.1016/j.athoracsur.2026.06.018

Abstract

Background: Mitral valve replacement in children is limited by the need for anticoagulation, lack of growth potential, and high reoperation rates. Partial heart transplantation (PHT) offers a living, growth-capable alternative. While successfully applied to semilunar valves, its use in the atrioventricular position has not been described. This study reports the initial two cases of mitral PHT and evaluates early technical and physiologic outcomes.

Methods: Two pediatric patients underwent mitral PHT at separate institutions under IRB approval. In both cases, donor mitral valves with preserved subvalvular apparatus were implanted orthotopically. Procedural details, postoperative echocardiographic findings, and histopathologic analyses were reviewed to assess function, graft integrity, and mechanisms of failure.

Results: Both cases demonstrated technical feasibility, immediate valve competence, and early postoperative recovery. One patient maintained mild-to-moderate regurgitation at 8 months, while the second developed progressive regurgitation within two months, necessitating re-replacement. Histopathologic analysis revealed excellent graft integration and preserved leaflet and annular architecture but evidence of papillary muscle necrosis, consistent with ischemic injury and subsequent change in chordal length as the likely mechanism of regurgitation.

Conclusions: Mitral partial heart transplantation is technically feasible but remains an experimental approach. Early experience demonstrates successful implantation and biologic integration while identifying papillary muscle ischemia as a key limitation. Future refinements including the use of artificial chordae and careful patient selection.