In early 2022, a team of physicians accomplished a groundbreaking feat: the world's first partial heart transplant in an infant requiring heart valve replacement. This innovative approach deviated from the traditional use of non-living valves, which don't grow with the child and necessitate multiple replacements, each carrying a substantial 50% mortality risk. Now, a new study has brought encouraging news, revealing that the procedure has achieved a significant milestone - the successful integration of functioning valves and arteries that grow alongside the young patient.

Conducted by a team at Duke Health (Durham, NC, USA), the study discovered that the novel method of valve procurement employed during this partial heart transplant resulted in two effectively functioning valves and arteries. Remarkably, these are growing in concert with the child as if they were native vessels. Additionally, the procedure was found to require significantly less immunosuppressant medication – about one-fourth of the amount needed for a full heart transplant. This could potentially spare patients from the severe side effects associated with long-term use of these drugs.

This breakthrough has laid the groundwork for what is known as a domino heart transplant, wherein a single heart can save two lives. In such transplants, a patient with healthy valves but a failing heart muscle receives a full heart transplant. Their healthy valves are then used for another patient, creating a domino effect of life-saving procedures. To date, the partial heart transplant has been successfully performed 13 times across four global centers, including nine at Duke. Several of these have been domino transplants. The next critical step is to initiate a clinical trial, which could significantly increase the number of these procedures, thereby greatly expanding the availability of hearts for those in need.

“You could potentially double the number of hearts that are used for the benefit of children with heart disease,” said Joseph W. Turek, M.D., Ph.D., first author of the study and Duke’s chief of pediatric cardiac surgery, who led the landmark procedure. “Of all the hearts that are donated, roughly half meet the criteria to go on to be used for full transplant, but we believe there’s an equal number of hearts that could be used for valves. If you introduce the donated hearts that weren’t being put to use into the supply chain and add the valves from domino heart transplants, that can create a substantial change.” 

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