Vanderbilt Surgeons Perform Innovative Partial Heart Transplant

“This has been a monumental struggle in our field for a very long time,” said Ziv Beckerman, MD, who serves as the Surgical Director of Pediatric Heart Transplantation and Associate Chief of Pediatric Cardiac Surgery within the Golisano Pediatric Heart Institute at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Surgeons at Vanderbilt have performed a partial heart transplant, a first for both the hospital and the state of Tennessee, Vanderbilt Health News reported.

The procedure allows doctors to transplant only the specific portion of the heart containing a necessary valve, rather than the entire organ. This technique offers a way to provide living tissue that can grow alongside a developing child, addressing a long-standing limitation in pediatric cardiac care.

For decades, families dealing with infant or young child heart valve issues faced a difficult reality. Conventional replacement valves are fixed-sized and do not expand as a child grows. As a result, a child reaching their late teens might require three to four separate open-heart surgeries to replace failing, undersized prostheses.

Growing tissue replaces repeated surgeries

The new approach aims to break a continuous cycle of surgical intervention. By using living donor tissue, the repair has the potential to be more durable and sustain the patient through their developmental years.

“Our only option has been to replace the failing valve with one that did not grow with the patient,” Beckerman told Vanderbilt Health News.

“All of the options available to us were fixed-sized valves, so when we replace a valve in a baby, by the time that child reaches 18-20 years of age, there is a real potential that they would have had three to four open-heart surgeries or more. And every time we go in, it’s a risk.”

While traditional methods like mechanical or bioprosthetic prostheses and homografts play important roles in congenital heart surgery, none provide the reliably growing living tissue offered by this partial transplant technique.

The medical team’s primary objective is to improve the long-term trajectory for these patients. Beyond the technical achievement, the procedure is viewed as a way to provide a better quality of life by minimizing the physical and emotional toll of repeated operations.

“Our focus is keeping our patients alive and well while at the same time giving them a good quality of life,” Beckerman said.

Managing the risks of living tissue

The transition to partial heart transplantation is not without new complexities. Because the procedure involves living donor tissue, patients must use immunosuppressive medications to prevent the body from rejecting the transplant.

Medical teams are currently working to determine the specific requirements for immunosuppression dosing as this therapy becomes a viable option for valve repair. Because the procedure is still considered a new therapy, close monitoring is required to understand how the tissue grows and how patients respond over the long term.

“We want to present the best solution for each child,” explained David Bearl, MD, MA, the Medical Director of the Pediatric Advanced Cardiac Therapies team and an Associate Professor of Pediatrics at Monroe Carell. “Our biggest goal is to reduce the number of procedures this population of patients must undergo.”

“Our hope is that this will be more durable and sustaining. Early experience is encouraging, but partial heart transplantation is still a new therapy,” Bearl told Vanderbilt Health News.

“We need to closely monitor these patients and learn more about immunosuppression, valve growth and long-term outcomes. Those are critically important questions.”

Currently, Monroe Carell has a waiting list of congenital heart disease patients who are undergoing evaluation to see if they are candidates for this alternative living donor tissue valve.

“For a child with valvular issues, they have to get accustomed to these repeated surgeries throughout their life. It’s a continuous cycle,” Beckerman said.

“We have often wondered if we could give them a solution that would reduce the need for multiple reoperations. Partial heart transplantation gives us that possibility.”