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J Thorac Cardiovasc Surg 2008;135:154-155
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Discussion

David N. Campbell (Denver, Colo). Obviously you and your coauthors have put a lot of work and effort into this very impressive study, which does cover a large number of pediatric and young adults. We actually use 18 and under for pediatric age, so there are some young adults in this "pediatric" group, but 3500 patients is an impressive number of patients over a decade between 1995 and 2005. These were all transplanted and then entered into the UNOS database. Again, this consists of a great deal of time and effort to get this information. I have two comments and then two questions.

As you pointed out well in the manuscript, in pediatric heart transplant recipients, PVR is not an identifier for poor outcome and poor survival as it is in adults. This is something that gets lost sometimes in the pediatric patient group.

You have re-emphasized that the predictors of pretransplant clinical status remain a significant predictor of poor outcomes and, as you have pointed out, these are hospitalization, intensive care unit care, mechanical ventilation, and particularly ECMO support. All of these portend a very poor outcome.

I think the message to be taken from this is that earlier intervention in the pediatric group is warranted, and we are far behind the adults in terms of using ventricular assist devices. I know Columbia, particularly, is a large user of those, and I know that you have already set out a scale very much like you have used for this pediatric group. I think it is very important that the pediatric heart transplant surgeons begin to use mechanical assist devices much earlier. We are obviously coming onto that scene later . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2008 135: 147-155. [Abstract] [Full Text] [PDF]