{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:54:56Z","timestamp":1781762096447,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Orthotopic heart transplantation is the standard treatment for pediatric end-stage heart disease. Due to the wide age range and high physiological heterogeneity among pediatric recipients, perioperative anesthesia management is particularly complex. Literature describing real-world perioperative practices for high-risk populations remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This descriptive study aims to summarize the perioperative anesthesia management strategies and short-term clinical outcomes for pediatric heart transplant recipients at a single center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective descriptive study enrolled 27 pediatric patients who underwent orthotopic heart transplantation at a single center from May 2022 to October 2025. Data on baseline characteristics, intraoperative variables, complications, and outcomes were collected. No control group was established, and no causal inference was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      he cohort included 27 patients (13 male, 14 female), aged 6 months to 16 years (weight 7.0\u201395.0\u2005kg). Dilated cardiomyopathy was the most common diagnosis (20\/27, 74.1%). All patients were NYHA class III\u2013IV; median LVEF was 28.5%. Preoperative ECMO support was used in 15 patients (55.6%). No major cardiovascular events occurred during induction or pre-CPB. Mean CPB time was 183.3\u2009\u00b1\u200955.6\u2005min; mean cold ischemia time was 249.5\u2009\u00b1\u2009101.1\u2005min. Mean postoperative mechanical ventilation was 7.7\u2009\u00b1\u20099.5 days. Postoperative ECMO was required in 11 patients (40.7%). At follow-up, 23 patients were alive and 4 died (survival 85.2%). Major complications included hypoxic-ischemic encephalopathy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094), AKI requiring CRRT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), and peripheral nerve injury (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among the pediatric heart transplant recipients with severe conditions in this cohort (including a high proportion of ECMO bridged cases), the perioperative anesthesia management strategy implemented included low-dose staged induction, invasive monitoring, and multidisciplinary collaboration. Pulmonary hypertension, primary graft dysfunction, and multi-organ complications were commonly observed in this cohort. This study is descriptive and observational; causal relationships cannot be inferred, and the findings require further validation in larger sample sizes or multicenter studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1842135","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:30:39Z","timestamp":1781760639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative anesthetic management in pediatric heart transplantation: a single-center descriptive study involving 27 patients"],"prefix":"10.3389","volume":"14","author":[{"given":"Ya-fei","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong-li","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-ru","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-qun","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-zhi","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Seventh Medical Center to Chinese PLA General Hospital","place":["Beijing, China"]},{"name":"The Second School of Clinical Medicine, Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"B1","first-page":"1271","article-title":"The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town","volume":"41","author":"Barnard","year":"1967","journal-title":"S Afr Med J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e14675","DOI":"10.1111\/petr.14675","article-title":"Pediatric heart transplantation: looking forward after five decades of learning","volume":"28","author":"Dipchand","year":"2024","journal-title":"Pediatr Transplant"},{"key":"B3","volume-title":"Report on The Development of Organ Donation and Transplantation in China (2024)","author":"Huang","year":"2025"},{"key":"B4","first-page":"136","article-title":"Chinese operating specifications for pediatric heart transplantation","volume-title":"Chin J Transplant","author":"Zhou","year":"2020"},{"key":"B5","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1161\/CIRCULATIONAHA.114.001377","article-title":"Changing indications for pediatric heart transplantation: complex congenital heart disease","volume":"131","author":"Hsu","year":"2015","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.3390\/children10091432","article-title":"Ultrasonographic evaluation of gastric content and volume in pediatric patients undergoing elective surgery: a prospective observational study","volume":"10","author":"Demirel","year":"2023","journal-title":"Children (Basel)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.3390\/medicina61122088","article-title":"Heparin resistance in cardiac surgery with cardiopulmonary bypass: mechanisms, clinical implications, and evidence-based management","volume":"61","author":"Rivera Jim\u00e9nez","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e70094","DOI":"10.1111\/petr.70094","article-title":"Early post-operative versus late arrhythmias after heart transplant at a pediatric center: incidence, management, and outcomes","volume":"29","author":"Dammeyer","year":"2025","journal-title":"Pediatr Transplant"},{"key":"B9","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/S0735-1097(21)01851-9","article-title":"Implementation of a standardized neonatal cardiac surgery protocol improves postoperative outcomes","volume":"77","author":"Gautam","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1213\/01.ANE.0000072545.13681.FA","article-title":"Adverse events after protamine administration following cardiopulmonary bypass in infants and children","volume":"97","author":"Seifert","year":"2003","journal-title":"Anesth Analg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1016\/j.healun.2021.07.022","article-title":"The international thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-fourth pediatric heart transplantation report\u20142021; focus on recipient characteristics","volume":"40","author":"Singh","year":"2021","journal-title":"J Heart Lung Transplant"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1016\/j.healun.2025.04.014","article-title":"The international thoracic organ transplant registry of the international society for heart and lung transplantation: 2025 annual report of heart and lung transplantation","volume":"44","author":"Singh","year":"2025","journal-title":"J Heart Lung Transplant"},{"key":"B13","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1093\/ejcts\/ezz092","article-title":"Clinical outcomes of paediatric patients supported by the Berlin heart EXCOR: a systematic review","volume":"56","author":"Rohde","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1111\/j.1460-9592.2011.03561.x","article-title":"Cardiomyopathy and heart failure in children: anesthetic implications","volume":"21","author":"Rosenthal","year":"2011","journal-title":"Paediatr Anaesth"},{"key":"B15","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jclinane.2018.06.022","article-title":"Induction techniques for pediatric patients with congenital heart disease undergoing noncardiac procedures are influenced by cardiac functional status and residual lesion burden","volume":"50","author":"Yuki","year":"2018","journal-title":"J Clin Anesth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1213\/01.ane.0000166764.99863.b417","article-title":"Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients","volume":"101","author":"Sarkar","year":"2005","journal-title":"Anesth Analg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.jtcvs.2009.08.020","article-title":"Acute right ventricular failure after pediatric cardiac transplant: predictors and long-term outcome in current era of transplantation medicine","volume":"139","author":"Hoskote","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1097\/ALN.000000000000462719","article-title":"Perioperative management of heart transplantation: a clinical review","volume":"139","author":"Nesseler","year":"2023","journal-title":"Anesthesiology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e14172","DOI":"10.1111\/petr.14172","article-title":"Acute kidney disease predicts chronic kidney disease in pediatric non-kidney solid organ transplant patients","volume":"26","author":"Patel","year":"2022","journal-title":"Pediatr Transplant"},{"key":"B20","doi-asserted-by":"publisher","first-page":"635631","DOI":"10.3389\/fped.2021.635631","article-title":"Impact of acute kidney injury on critically ill children and neonates","volume":"9","author":"Leghrouz","year":"2021","journal-title":"Front Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e14829","DOI":"10.1111\/petr.14829","article-title":"Acute kidney injury requiring dialysis after pediatric heart transplant","volume":"28","author":"Lipman","year":"2024","journal-title":"Pediatr Transplant"},{"key":"B22","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s00467-015-3252-x","article-title":"Acute kidney injury after heart transplant in young children: risk factors and outcomes","volume":"31","author":"MacDonald","year":"2016","journal-title":"Pediatr Nephrol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1842135\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:30:40Z","timestamp":1781760640000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1842135\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":22,"alternative-id":["10.3389\/fped.2026.1842135"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1842135","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"article-number":"1842135"}}