Robert Jaquiss, M.D. Answers Questions On: Heart Transplant

There are two broad condition groups that lead to a child needing a heart transplant. One is cardiomyopathy, which is when the muscle of the heart, the energy source for pumping, becomes weakened. This can happen because of an infection in the heart muscle or as a result of an intrinsic genetic abnormality in the muscle itself. The heart has all the appropriate parts and connections, but its muscle is simply too weak to beat and propel blood with force in the amount that is necessary. This condition is responsible for a significant portion of our heart transplant candidates and recipients.

The other group includes a number of congenital heart malformations that are so profoundly abnormal that the children’s cardiovascular systems can’t pump efficiently. The most common of these is a single ventricle heart in which there is only one functional pump chamber as opposed to the normal heart which has two pumping chambers. We do everything we can to make such hearts more efficient, but ultimately for some children, transplant is the only option.

With a person of any age who has heart failure, the first line of therapy is always medication. But for patients whose heart failure is more severe and isn’t completely treatable with medications, we can use mechanical circulatory support, where we insert a pump to replace the function of one or both chambers of the heart, until a transplant becomes necessary or available. There is only one type of pump designed specifically for children, whereas for adults there are several options, so this is a particular research interest for me.

For most patients who receive a heart transplant, their quality of life will be excellent. They’re able to attend school, participate in athletic activities, become employed, get married, and have children. However, they have to keep a very tight adherence to a complicated regimen of medications and doctor visits, and there is a risk of side effects related to the medications.

In the early part of my career, I was involved in a transplant on a baby who was a few hours old, but that’s extraordinarily unusual. We are able to perform transplants on babies as young as a few days or a few weeks old.