A year after doctors at Duke Health transplanted some valves and arteries into the heart of a sick child, they announced success on Tuesday in the Journal of the American Medical Association.
The hope was that transplanted parts of the heart will grow together with the child’s heart so that further surgeries could be avoided as he grows.
“This publication is proof that this technology works, this idea works, and can be used to help other children,” said Joseph W. Turek, M.D., Ph.D., first author of the study and Duke’s chief of pediatric cardiac surgery, who led the landmark procedure.
The procedure was performed in the spring of 2022, when Owen Monroe was just 17 days old. He had been born with truncus arteriosus, a condition where the two main heart arteries were fused together. Doctors said Owen’s one vessel also had a leaky valve, which meant it was unlikely he could survive the wait for a full heart transplant.
The tissue used in Owen’s surgery was from a donor heart that had strong valves but could not be used for a full transplant because of the muscle’s condition.
In previous cases, doctors would insert valves that were non-living and would not grow along with the child. Those valves would have required frequent replacement, and each surgery is risky.
In the partial heart transplant, Owen got living arteries and valves from the donor heart, which were fused into Owen’s heart.
““How lucky and blessed we really are to have this opportunity, because almost 21 months ago, we were not sure he was going to make it to the next day,” said Tayler Monroe, Owen’s mom. “It’s really the greatest gift, knowing how precious life is.
“And I think, because of the situation, [my husband] Nick and I don’t take a day for granted.”
The Duke study found that the valves were growing as it they were his own. It also found that the procedure could be done using about a quarter of the amount of immunosuppressant medication required for a full heart transplant, potentially saving patients from the side effects of those drugs.
Turek said the innovation has paved the way for a domino heart transplant, where one heart is able to save two lives. During a domino heart transplant, a patient who has healthy valves but is in need of stronger heart muscle receives a full heart transplant; their healthy valves are then donated to another patient in need, creating a domino effect.
“You could potentially double the number of hearts that are used for the benefit of children with heart disease,” Turek said. “Of all the hearts that are donated, roughly half meet the criteria to go on to be used for full transplant, but we believe there’s an equal number of hearts that could be used for valves.”
The partial heart transplant procedure has been performed 13 times at four centers around the world, including nine at Duke, several of which have been domino heart transplants.
Owen’s operation is groundbreaking for a few reasons.
Up until now, Owen’s more likely option would have been the same procedure but with tissue from a cadaver. That tissue won’t ever grow – so, as Owen got bigger and his heart grew – he’d need repeated surgeries, increasing the risks for complications each time.
However, with this surgery, the tissue grows with him.
“This has created a new field in cardiac surgery,” said Duke Children’s Hospital Chiefof Children’s Cardiac Surgery Dr. Joseph Turek. “On one level, you have a baby like Owen whose life has really been transformed by having this operation, and then on another level, there’s going to be thousands of children in the future that are going to be able to benefit from this procedure.”
The next step for Duke doctors is clinical trials that would involve more patients.
In addition to Turek, study authors include Lillian Kang, Douglas Overbey, Michael P. Carboni and Taufiek K. Rajab.