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We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7–19.5), 0.9 (0.2–2.0), 6.8 (4.3–10.0) and 14.2 (12.3–15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years – in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival. • First because, patients with congenital heart disease in end-stage heart failure have already undergone one or more previous heart operations. • Second, because of shortage suitable donors many patients need mechanically assist device support as bridge to transplantation. • Heart transplantation in infants and young children remains one of the majority challenges in pediatric cardiac surgery. • Our goal was to identify serious adverse events associated with mortality and graft failure after pediatric heart transplantation. [ABSTRACT FROM AUTHOR]

Intracoronary imaging enables an early detection of intimal changes. To what extend the development of absolute and relative intimal hyperplasia in intracoronary imaging differs depending on age and post-transplant time is not known. Aim of our retrospective study was to compare findings between 24 pediatric (cohort P) and 21 adult HTx patients (cohort A) using optical coherence tomography (OCT) at corresponding post-transplant intervals (≤5 years: P1 (n = 11) and A1 (n = 10); >5 and ≤ 10 years: P2 (n = 13) and A2 (n = 11),. Coronary intima thickness (IT), media thickness (MT) and intima to media ratio (I/M) were assessed per quadrant. Maximal IT >0.3 mm was considered absolute, I/M > 1 relative intimal hyperplasia. Compared to A1, I/M was significantly higher in P1 (maximal I/M: P1: 5.41 [2.81–13.39] vs. A1: 2.30 [1.55–3.62], p = 0.005), whereas absolute IT values were comparable. In contrast, I/M was comparable between P2 and A2, but absolute IT were significantly higher in A2 (maximal IT: P2: 0.16 mm [0.11–0.25] vs. A2: 0.40 mm [0.30–0.71], p < 0.001). A2 presented with higher absolute IT (maximal: A1: 0.16 mm [0.12–0.44] vs. A2: 0.40 mm [0.30–0.71], p = 0.02) and I/M (maximal I/M A1: 2.30 [1.55–3.62] vs. A2: 3.79 [3.01–5.62], p = 0.04). Our results suggest an age- and time-dependent difference in the prevalence of absolute and relative intimal hyperplasia in OCT, with an early peak in children and a progressive increase in adults. • Relative intimal hyperplasia (IH) peaks early in children. • Early relative IH was significantly higher in children than in adults. • Early and mid-term findings were comparable between pediatric cohorts. [ABSTRACT FROM AUTHOR]

Background Cardiac allograft vasculopathy (CAV) is a crucial problem after heart transplantation, in adults as well as in children. CAV is the main risk factor for a reduced long-term graft survival. The early diagnosis and treatment of CAV is essential for a successful long-term preservation of the donor heart. However, asymptomatic progression of CAV and concentric hyperplasia of the coronary arteries may complicate the early diagnosis by conventional measures. Intravascular imaging, such as intravascular ultrasound and optical coherence tomography (OCT), enables the diagnosis of early stage CAV. To date, there is little known about OCT in children. We present our single center experience with OCT after pediatric heart transplantation. Methods Retrospective analysis of OCT (n = 50) after pediatric heart transplantation between June 2013 and March 2016 and comparison between angiographic appearance and OCT. Results 37 patients underwent optical coherence tomography, nine patients were examined twice and two patients tree times. The youngest patient at time of examination was 4 years with a weight of 15 kg (mean 50.86 kg, range 15 to 88 kg). There were no complications, especially no bleeding, no arrhythmias or myocardial ischemic events. Early CAV (Stanford I or II) was detected by OCT in 26 cases. Only in four of these cases, also the coronary angiography showed mild changes. Conclusion OCT is a safe intravascular imaging method that can also be used in children after pediatric heart transplantation up to a minimum weight of 15 kg without an increasing risk of a catheterization procedure. [ABSTRACT FROM AUTHOR]