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Comments on the Pediatric Sessions of ISHLT 2016


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Martin Schweiger, MD
Children's Hospital Zurich
Zurich, Switzerland
Martinschweig88@hotmail.com



The Pediatric program at the 2016 scientific session remains memorable for its high interests with standing room only space in some of the sessions. Plenty of delegates made it to the pediatric heart transplant outcome session on Thursday morning. There the Edmonton group presented their study investigating quality of life after pediatric heart transplantation (pHTx). While the authors found that the quality of life assessed by the parents in children was not only lower compared to children without chronic conditions it was surprisingly also lower when compared to congenital heart disease (CHD) patients and patients after single ventricle palliation. Simon Urschel presented on behalf of the same group that days spent on ICU was the strongest predictor for worse neurocognitive outcome after transplantation. Matthew Bock presented a data analyses form the PHTS on cancer recurrence for anthracycline cardiomyopathy; the investigators did not find an increased recurrence rate or inferior survival. Likewise post-transplant outcome is not negatively influenced by the number of organ donor refusals as shown by David Morales. Finally, Tahmina Samad investigated coronary stenting as a prognostic indicator finding that long-term survival of these patients remains poor with 52% survival at 5 years after diagnosis. In the Wednesday morning session focusing on challenges form the surgeon's perspective the talk given by Jonathan Chen on complex connections in adult CHD recipients was remarkable.

During the whole meeting one could tell the increased interest in pediatric lung transplantation as well as the increased use of ventricular assist devices in patients suffering from CHD. The take home message of the pulmonary hypertension in CHD sunrise symposia was that devices might be helpful to improve symptoms but will not reserve pulmonary hypertension. In the pediatric MCS session the impressive largest series of implanted cf-VAD in children (> 150!) was presented by Jennifer Conway with comparable outcome to adults. Further we learned from Angela Lorts that the utilization of temporary VADs in pediatrics are expanding with favorable outcome.

Of course the new US heart transplant listing criteria have been debated in the pediatric community; there was a very good Pro/Con debate given by Drs.Crossland and Ross debating if VAD in Patients with CHD should get priority organ allocation.

I could not agree more with Jennifer Cowger chairing the session: "you get out what you put in" Saturday morning commenting after a great talk given by Leigh Readron presenting experimental work on MCS in the Fontan circulation: "...this is the research we really need in MCS...". Likewise Mike tree shared with us the experience of his group with a "failing fontan model" using partial support in different settings; to find the way to the "holy grail in CHD MCS" as Christina VanderPluym called it.

In the MCS core competency and other MCS sessions a bulk of questions addressed VAD therapy in the pediatric and "failing fontan" as well as adult CHD patients. We can certainly look forward to the FIRST Pediatric MCS Academy at the annual ISHLT scientific meeting taking place in San Diego next April to get some answers! ■

Disclosure Statement: The author has no conflicts of interest to disclose.




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