World’s First Partial Heart Transplant Triumphs

The world’s first partial heart transplant has achieved what experts had hoped for for more than a year: functioning valves and arteries that develop with the young patient, as hypothesized by the procedure’s pioneering team at Duke Health.

The treatment was carried out on an infant who needed a heart valve replacement in the spring of 2022. The prior standard of care—using non-living valves—would not grow with the infant, necessitating repeated replacement and requiring surgical operations with a 50% death risk.
The new method of valve procurement used during the partial heart transplant resulted in two well-functioning valves and arteries that are growing in concert with the child as if they were native vessels, according to a study led by Duke Health physicians and published online Jan. 2 in the Journal of the American Medical Association (JAMA).

“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 study also discovered that the operation required only a fourth of the quantity of immunosuppressant medication as a full heart transplant, potentially saving patients from long-term negative effects.

Turek believes the breakthrough has paved the way for a domino heart transplant, in which one heart can save two lives. A patient with healthy valves but in need of stronger heart muscle undergoes a whole heart transplant during a domino heart transplant; their healthy valves are subsequently donated to another patient in need, generating 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.”

“If you introduce the donated hearts that weren’t being put to use into the supply chain and add the valves from domino heart transplants, that can create a substantial change,” Turek said.

The partial heart transplant surgery has been performed 13 times at four centers worldwide, including nine at Duke, with several of them being domino heart transplants.

Turek stated that bringing this idea to a clinical trial would be the next step in obtaining the volume in procedures that would significantly increase the availability of hearts.

“This innovation adds a lot to the whole donation community,” Turek said, “because it’s treating more kids, while also honoring the wishes of selfless donor parents who’ve given the ultimate gift. It allows them to offer hope to another child in the process.”