Partial Heart Transplantation Enables Growing Valve Replacement for Children

Mechanical or bioprosthetic valves do not grow with pediatric patients, driving multiple reoperations and cumulative risk. Shortages of size-appropriate donor valves further limit durable solutions. To help address this challenge, surgeons have developed a partial heart transplantation approach that places living pediatric valve tissue capable of growth.

Partial heart transplantation was highlighted at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), held April 22–25 in Toronto, Canada. The approach was presented by Joseph Turek, MD, Ph.D, Pediatric Heart Transplant Surgeon from Duke University, which has led related immunologic innovations. The session described how this surgical strategy could expand access to durable pediatric valve replacements. 

The technique replaces only diseased valves and associated structures rather than the entire heart. Donor valves are sourced from hearts explanted during standard heart transplantation when myocardial or coronary pathology necessitates replacement but valves remain structurally normal. Living pediatric valve tissue can grow with the recipient, reducing the need for serial high-risk reoperations. 

More than 330,000 children worldwide require valve interventions each year due to congenital defects, underscoring the scale of unmet need. Expanded use of donor valves from explanted hearts could enable thousands of additional valve transplants annually. Dr. Turek describes the procedure as a “domino effect” of traditional heart transplantation. Hearts removed due to disease of the muscle, coronary arteries, or congenital defects may still contain structurally normal valves, which can then be transplanted into another patient.

Additional advances highlighted in the session aim to expand the donor pool and reduce rejection. Heart–thymus co-transplantation, based on a Duke-developed technique using cultured thymus tissue, is designed to reshape recipient immunity. In children with T-cell deficiency who require heart transplantation, the combined approach has enabled the use of very low immunosuppressive doses and is being explored as a way to further reduce or potentially eliminate chronic immunosuppression while extending graft survival.

Efforts to increase donor availability include pediatric donation after circulatory death with on-table reanimation, which allows functional assessment of the donor heart prior to implantation. In parallel, preclinical xenotransplantation studies using genetically modified pigs outline a longer-term strategy to address organ scarcity.

"Some of these technologies are still emerging. But partial heart transplantation is already here—and it's poised to benefit far more patients who need valves than those who need entire hearts," said Dr. Turek.

“We perform about 5,000 heart transplants each year in the United States. From those hearts alone, you could theoretically obtain two ‘domino’ valves per patient. Even after accounting for valves that can't be used, this could translate into thousands of valve transplants annually in the United States,” he added. 

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Duke Department of Surgery