Little
Nayara's case
is unique in the world for three reasons.
On the one hand, because it is a donor and recipient of very small children.
On the other hand, because the heart graft, obtained with the procedure described, was implanted after several hours of cold ischemia in a center far from the donor hospital, something exceptionally described.
Finally, it was an ABO incompatible transplant, which further increases
the complexity of the transplant
.
The
Gregorio Marañón
University General Hospital
has carried out the first infant heart transplant from a donor in asystole in a baby of a few months and with blood incompatibility with his world donor.
Before
Nayara
was
born
, problems were detected in her heart, which is why, from her autonomous community, her mother was referred to the Children's Heart Area of the Gregorio Marañón Hospital, as a national reference center for congenital heart disease from the fetus. In the center, all the follow-up was done, but
the situation worsened
and the delivery had to be advanced since the situation of the Nayara heart was in a very difficult situation. Doctors from the Neonatology and Infant Cardiology services managed to stabilize the little girl despite the complexity of her condition.
"The little girl was able to evolve and we managed to make the rest of the organs mature enough to consider the possibility of
Nayara entering the transplant list
. We explained to the parents that there were very few possibilities because there are few donors at that age, so extremely small. However, thanks to the immense generosity of other parents, the opportunity came, a little heart arrived for
Nayara
", explains Manuela Camino, head of the Infant Heart Transplantation Unit at Hospital Gregorio Marañón." It was a very important moment, because we were faced with the heart transplant that we had performed on the smallest baby so far, and because 24 hours before Naiara had gotten a lot worse.
If that heart had not reached, there would have been little chance of survival ", recalls Manuela Camino.
Nayara was born premature
, weighing less than two kilos, and the transplant came after two months, when her weight was 3.2 kilos.
Being
one of the smallest babies who has received a heart transplant
at the Gregorio Marañón Hospital.
This fact,
unusual until now
, would have been unthinkable just three years ago, since it was not until 2018 that the Marañón began in
Spain
the program that allows heart transplants to be performed in children with incompatible blood groups, which is now added to the fact that for the first time Once in Spain, a heart graft from an asystole donor has been performed in a girl as young as two months.
The donation took place in a hospital in another autonomous community, which involved the transfer of the heart team from
Hospital Gregorio Marañón
by air. In the procedure used, the deceased donor's heart was recovered before extraction through
an extracorporeal circulation system
that allows the organs susceptible to transplantation to be kept oxygenated and to assess cardiac function. After verifying adequate function with this
"made in Spain
"
technique
, the heart was extracted and implanted in the recipient.
"The
Gregorio Marañón Hospital
was the first in Spain to perform a
pediatric
heart transplant between
two children with incompatible blood groups
, which is known as AB0 incompatible, and now it has become the first in the world to carry out this type of procedure. transplantation with an
asystole heart
, combining both techniques, which are so recent in medicine that only three years ago they were unfeasible. This means significantly increasing the chances of recovering a heart for the youngest children, babies as young as a few months, to those with few donations "points out
Juan Miguel Gil Jaurena
, head of Children's Cardiac Surgery at the Gregorio Marañón Hospital.
"The difference in a donation in asystole is that
the surgeon finds a stopped heart
, it has not been beating for a few minutes, it is in hot ischemia. At that moment what you have to do is recover the heartbeat, and that is done by connecting the heart to an extracorporeal circulation system. After recovery, the steps are the same as a traditional extraction ", explains Gil Jaurena. "Not long ago no one would have considered that people with a stopped heart, if we can recover it, can become donors, which
can increase this type of donation for babies,
" adds the Marañón heart surgeon.
Given the uniqueness of the donation, a large part of the
Children's Heart Surgery
team
traveled to the donor's hospital. "The process of recovery, verification of viability and extraction went perfectly. All
thanks to the incredible help and collaboration of the professionals
of the donor hospital, with whom we work as a single team", indicates Gil Jaurena. "Despite the fact that another challenge was distance and time, being in different hospitals and having to apply a cold ischemia protocol, we arrived at the Gregorio Marañón Hospital with the organ in good condition and
after implantation the heart began to beat strong and stable
", explains the surgeon.
Asystole donation from a donor in a different center for a baby as small as
Nayara
may become the only possibility of survival, since for these very young children there is no possibility of ventricular assist machines that can serve as support until arrival transplantation, as it does in older children and adults, who also have a greater chance of getting donors. In addition, if we add for these babies, the possibility of a donor of any blood group opens a great window of opportunity for this group of children so young that they need a heart.
After a few weeks in the ICU,
Nayara
has already been transferred to the ward, where she is recovering and evolving favorably under the care of the professionals from the Children's Heart Area of the Gregorio Marañón Hospital.
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