A surgical innovation called partial heart transplantation could transform care for children with severe heart valve disease, allowing for thousands of additional valve transplants each year, according to a presentation delivered today by Joseph Turek, MD, PhD, at the International Society for Heart and Lung Transplantation (ISHLT) 46th Annual Meeting and Scientific Sessions.
"Partial hearts have arrived," said Dr. Turek, a Pediatric Heart Transplant Surgeon at Duke University. "This is real, reproducible, and changing what we can offer patients."
Diseased Hearts Offer Hope to Other Patients
Unlike a heart transplant, a partial heart transplant involves replacing only defective valves and related structures. Every year, more than 330,000 children worldwide require interventions for poorly functioning heart valves due to congenital defects. Because artificial valves do not grow with the child, these patients often undergo multiple high-risk valve replacements before reaching adulthood.
Dr. Turek calls the procedure a 'domino effect' of traditional heart transplantation. Diseased hearts removed and replaced due to issues with the muscle, coronary arteries, or congenital defects often have valves that are structurally normal and can be transplanted into another patient.
"We perform about 5,000 heart transplants each year in the United States," Dr. Turek said. "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."
Partial Heart Transplantation Benefits the Youngest Patients
He noted that demand for valves far exceeds demand for full hearts, making this expanded availability particularly significant. For patients, transplanted pediatric valve tissue grows with the child, eliminating the need for repeat replacements.
Dr. Turek also described additional advances that are expanding the donor pool and reducing rejection among transplant recipients:
- heart–thymus co‑transplantation to induce immune tolerance
- donation after circulatory death (DCD) and 'on‑table reanimation'
- preclinical xenotransplantation using genetically modified pigs.
The heart–thymus co‑transplantation is based on a Duke‑developed technique that uses cultured thymus tissue to reshape a patient's immune system. For a child with a T‑cell deficiency who requires a heart transplant, the combined heart–thymus transplantation allows for very low‑doses of immunosuppression drugs.
"We're actively exploring this, but the promise is that we could lower the required dose of immunosuppression therapy, or even eliminate it, and prolong the survival of the grafts as well," he said.
Emerging Innovations Offer Hope to Young Heart Patients
Duke, along with other transplant centers, is also performing pediatric DCD heart transplants and recently introduced 'on‑table reanimation,' in which the heart is removed and briefly reanimated on a back‑table circuit to assess function.
Dr. Turek rounded out his session discussing early‑stage xenotransplantation work in animal models, underscoring a long‑term vision for overcoming organ scarcity.
"Some of these technologies are still emerging," Dr. Turek said. "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."
The annual meeting and scientific sessions of the ISHLT are being held from 22-25 April at the Metro Toronto Convention Centre in Toronto, ON, Canada.
