Rare Infant-to-Infant Heart Transplant Done

A rare infant-to-infant heart transplant has been performed by the surgeon who last year transplanted a baboon heart into the infant known as Baby Fae, officials at Loma Linda University Medical Center announced Thursday.

But citing the parents’ request for confidentiality, the hospital said it was “unable to provide condition reports or any additional information specific to the case,” except to say that the operation was performed Wednesday by Dr. Leonard Bailey.

On Thursday evening, hospital spokeswoman Jayne McGill declined to say whether the baby was alive or dead.

The information withheld also included the age, sex and condition of the heart recipient; the age, sex and cause of death of the heart donor; details of the operation, and the procurement process.

Bailey, who performed Baby Fae’s operation last October, had been criticized for not seeking a human heart for the child. Baby Fae died 20 days later because of what Bailey has termed a “catastrophic” decision not to match her blood type and that of the donor baboon.

The hospital said the infant operated on Wednesday was born with hypoplastic left heart syndrome, the same problem that afflicted Baby Fae. This congenital malformation prevents the side of the heart that pumps blood to the body from fully developing. It is almost invariably fatal.

Dr. Hillel Laks, chief of cardiac surgery and director of the heart transplant program at UCLA Medical Center, said transplants in babies are riskier than in adults but can be “safely” performed by a “well-trained, skillful pediatric cardiac surgeon.”

“The risks of everything are increased in the post-operative period,” he said, including complications related to blood loss, overload of the circulation with excess fluid, and mechanical ventilation.

Laks said the greatest unknowns involved the prevention of rejection. Adult heart transplant patients have an average of 20 to 30 biopsies of the heart tissue in the first year after surgery to monitor for microscopic signs of rejection. An infant, however, has much smaller blood vessels and a much thinner heart.

“We have almost no experience in biopsying the hearts of infants and none in biopsying the hearts of neonates (newborns),” he said, “(and) we don’t know if it can be done safely on a repetitive basis.”

Laks said surgeons and society in general will have to decide whether heart transplants in babies will offer a significant prospect of long-term survival.

“Heart transplantation in well-selected adults is now therapeutic and not experimental,” he said. “Heart transplants in infants, particularly neonates, is still highly experimental. The question is whether the longevity and the quality of life is worth the enormous resources that will have to be applied to get any degree of success.”

Previous baby-to-baby heart transplants were performed by Dr. Magdi Yacoub of Harefield Hospital in England in July, 1984, and by Dr. Adrian Kantrowitz, now chief heart surgeon at Sinai Hospital of Detroit, in 1967. The British patient died 26 days after the operation, and the American patient fewer than 7 hours after surgery.

At a scientific meeting in Coronado last month, Yacoub and Bailey disagreed on the availability of infant hearts for transplant. Yacoub said they could be found if surgeons “tried harder.” Bailey said he had not found “suitable” human donors in the past.

Dr. William Norwood of Children’s Hospital of Philadelphia has pioneered surgery for the treatment of hypoplastic left heart syndrome, but Bailey has maintained that the operation is inadequate for most patients.