In a significant medical breakthrough, a team at Duke Health has pioneered two world-first heart repair surgeries, living mitral valve replacement, and reanimation innovations in children to save lives and also to improve organ stewardship for the field.
They were able to perform the world’s first living mitral valve replacement after an adolescent girl received a full heart transplant and donated the healthy valves from her original heart.
The valves were then used to save the lives of two other girls, one of whom received the new procedure. All three girls who were part of the case are from different parts of North Carolina.
It is important to note that donation after circulatory death (DCD) requires a heart to be evaluated before donation, but current perfusion technologies cannot be used for donor hearts from children.
To overcome this, a Duke team developed a novel technique that temporarily reanimates the donor heart outside of the body on a surgical table using extracorporeal membrane oxygenation — allowing surgeons to assess the organ’s viability before transplant.
The Duke scientists call the new technique on-table heart reanimation.
The first-of-its-kind case saved the life of a then-3-month-old patient, who received a reanimated donor heart earlier this year.
Partial heart recipients receive immunosuppression at a dosage that is considered non-life-altering, and recipients have continued to grow and thrive since the first partial heart procedure three years ago.
The living mitral valve replacement is another way Duke continues to improve organ stewardship and pediatric heart surgery.
According to reports, Paediatric heart surgeon Douglas Overbey, MD, MPH, who was on the team performing the operations said, “Three people benefited from one organ that was offered. It’s been several months now, and all three are doing well. The adolescent recipient is back to competitive running.
“We offer a lot of innovation. We have access to organ offers that other centres in the nation generally wouldn’t access, resulting in a lower waitlist time at Duke.”
Both techniques have the potential to save as many young lives as there are viable paediatric donor hearts currently going unused.
Overbey confirmed that Duke Health has performed over 25 partial heart transplants to date, including domino and living Ross procedures.
“These novel solutions to paediatric heart problems, whether aiming to increase the donor pool or implant living valves that grow with children, are all born out of necessity and a desire to improve the lives of our most vulnerable patients.
“The current standard of care for paediatric heart valve replacement uses preserved non-living tissue or mechanical valves, which do not grow along with the child. As a result, recipients require multiple future valve replacement surgeries and blood thinners for mechanical valves, which both carry risks.”
