Indications for heart transplantation in children

The indications for heart transplantation in children generally include heart failure refractory to medical therapy, unreconstructible congenital heart disease, and arrhythmias refractory to medical therapy. Whereas medical therapy for heart failure has evolved to some degree over the past two decades the mortality for cardiomyopathy has not improved much. Surgical therapy for congenital heart disease continues to improve such that unreconstructible congenital heart disease is seldom an indication. Failed surgical palliation and heart failure following repair of congenital heart disease, however, remain prominent reasons to pursue transplantation. Arrhythmias refractory to medical or device therapy are extremely unusual. The contraindications to heart transplantation have changed over the years also to include higher risk candidates. This paper reviews these issues as applied to children.