World’s first partial heart transplant completed in newborn with truncus arteriosus
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Duke Health announced successful completion of the world’s first partial heart transplant, using living arteries and valves from a donor heart that were fused onto the existing heart of a newborn.
The patient, Owen Monroe from Leland, North Carolina, was born with truncus arteriosus — a condition in which the left and right main coronary arteries fused together — as well as atrial regurgitation in one valve. The combination made it unlikely the patient would survive until full heart transplant; therefore, living tissue from the donor heart of another infant, not suitable for full transplant but with strong valves, was used for the novel procedure.
According to a Duke Health press release, pediatric patients born with truncus arteriosus would typically receive two preserved cadaver arteries with valves; however, the donor tissue would not grow with the patients’ heart and would require multiple follow-up open heart surgeries to replace the cadaver valves, which can limit life expectancy.
The novel use of living valves and arteries allows the valves to grow with the patient over time, increasing life expectancy and potentially eliminating the need for multiple open-heart surgeries, according to the release.
Partial transplant ‘solves a big problem’
“The partial heart transplant is an interesting approach. It solves a big problem that we have in congenital heart surgery, which is that babies and children grow,” Joseph W. Turek, MD, PhD, chief of pediatric cardiac surgery at Duke, associate professor in the department of surgery and the department of pediatrics at Duke University School of Medicine and leader of the Duke Health team during the partial heart transplant surgery, said during a press conference. “When their valves need to be replaced or their arteries need to be replaced, we need those arteries and valves to grow along with them such that we don't have to have repeated operations where, where we have to replace these valves and arteries during the course of their lifetime.”
Procedural methodology of partial transplant
Turek stated that completion of this procedure creates a new field in the area of pediatric heart transplantation.
For the procedure, surgeons dissected the patient’s existing trunk and created a new ascending aorta and valve using the living donor tissue, leaving the branches that go to the lungs attached. Next, the donor arteries and valve were attached to the patient’s existing heart and right ventricle.
“In this particular case, the idea of using partial parts of tissue, this would be a heart that wouldn't otherwise be used or available for donation to another infant," Michael Carboni, MD, associate professor in the department of pediatrics at Duke University School of Medicine and the patient’s pediatric transplant cardiologist, said during the press conference. “It removes the possible need for doing a traditional heart transplant, which we had listed Owen for, if needed, and it uses a resource in an organ that otherwise would go unused. We're not taking that organ away from another infant who would've been able to use the whole heart, but we are able to use the parts of the heart that were functioning well for what we needed it for. That potentially opens up a resource of using organs that go unused, for somebody who doesn't need an entire whole heart transplant.”
At the press conference, Owen’s parents and physicians said he has shown growth and improvements since undergoing the surgery on April 22, 2022.
The Duke team believes a similar approach may be viable for other pediatric patients with congenital heart defects, according to the release.
“Going back to our 16-week anatomy scan, we already knew something was wrong. He had a medical issue, and so going into his delivery, we were already prepared mentally for having to go through traditional surgery,” Nick Monroe, Owen’s father, said during the press conference. “We already had weeks and months prepare mentally, to have him go through this procedure. But then we get the news that the traditional procedure is not viable, but that this is the only alternative for him in his particular case. Also the possibility of letting him lead a normal life and possibly ... without having to have any other further surgeries the rest of his life, which is what we are expecting ... this was the best option for him.”
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