Duke doctors perform first partial heart transplant

The procedure had only ever been performed on pigs, doctors told Tayler and Nick Monroe as they huddled around their dying newborn son.

If they chose to have the operation, their son would be the first person to undergo a partial heart transplant. If it worked, it could pave the way for thousands of newborns to receive similar procedures.

And it was probably the best bet to save the baby’s life, the doctors said.

“I got to the point where I said do whatever you have to do to save him,” Nick said.

During an eight-hour surgery in April, Duke University surgeons fused living arteries and valves from a donor heart to a human heart for the first time, potentially creating a new field of heart surgery.

It is not yet certain that Owen will face long-term complications. But months after the operation, the child seems to be thriving, his parents say. And doctors are optimistic they can help more children.

“I think this is really one of the most profound developments in pediatric heart surgery in a very, very long time,” said Dr. Joseph Turek, who led the surgery. “It will really change the way children are cared for in the future.”

At risk from birth

Owen Monroe was born with an extremely rare disease that fused the two main arteries of the heart. On top of that, the valve he had was leaking badly, allowing blood to pool in his heart.

“It’s like winning an unlucky lottery,” Nick Monroe said.

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Owen Monroe is being held by his parents Tayler and Nick right after he was born in April 2022. Monroe Family

Doctors initially presented Owen’s parents with two options.

The first was to replace her entire heart, which could take up to six months to find a donor organ. In all likelihood, Owen would die before a heart was available, said Turek, chief of pediatric cardiac surgery at Duke.

The second option was to use tissue from a corpse to repair his heart, an extremely risky procedure for babies with leaking valves.

Even if successful, the dead tissue would not grow with the rest of the heart, and Owen would have to undergo several more heart operations throughout his life, each more risky than the last.

Neither option seemed likely to save their son’s life, doctors said. Things got so bad that Tayler and Nick began to wonder if Owen, less than a week old, was destined to be an organ donor for another baby.

Then they heard about experimental surgery.

“Necessity really is the mother of invention,” said Dr. Michael Carboni, Owen’s pediatric transplant cardiologist.

A third option

One of the hardest parts of having heart surgery on a baby is that he and his heart eventually grow.

“When their valves need to be replaced or their arteries need to be replaced, we need those arteries and those valves to grow with them,” Turek said.

Previously, cardiac surgeons could either replace the organ entirely and condemn their patient to a life of anti-rejection drugs or frequently replace parts to accommodate the growing heart, subjecting patients to numerous open-heart surgeries.

Partial grafting promises to merge the benefits of each approach.

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Parents Tayler and Nick Monroe spend time with their son Owen at Duke Health. Owen, who was born with an extremely rare condition that fuses the two main arteries of the heart, is the first person to have a partial heart transplant. Duke Health

Unlike patients with an entirely new heart, patients with a small amount of donor tissue may not have to take as many anti-rejection drugs, which puts patients at risk for other diseases as the drugs suppress their system. immune.

Unlike the dead valve tissue that is usually implanted, the living valves used in the partial transplant can grow with a baby’s heart, which hopefully eliminates the need for future surgeries.

Partial transplants can allow doctors to tap into a pool of unused donor hearts due to deficiencies. Carboni estimated that about half of the hearts donated matched that bill.

The organ used in Owen’s procedure, for example, had been shelved because the heart muscle was too weak. The valves were completely intact, however.

This could have huge implications for nearly a quarter of babies on heart donor waiting lists who die before receiving an organ, Carboni said.

“You Would Have No Idea”

There are unknowns about partial transplants that doctors are trying to figure out.

They don’t know how much anti-rejection medicine Owen will need or if he could possibly be completely weaned off it. Turek said he hopes to continue clinical trials on patients who will have the surgery in the future to better understand this.

“The intellectual part of me means it’s a whole new world, and we’re entering an exciting new arena and all that,” Carboni said. “The real person inside of me says I don’t know what I’m doing and I hope I can do what’s best for Owen along the way.”

So far, so good, though. Owen Monroe, at home with his parents in Brunswick County, is no longer in the midst of a medical emergency.

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Owen Monroe smiles at home in August 2022. Monroe Family

Just like a normal five-month-old, he holds his head up, rolls over, and has started to venture into the solid food realm, Tayler said.

Echocardiograms showed that the implanted valves grew with the rest of his heart, as hoped. The thin scar running the length of his sternum has started to fade.

“If you just met him on the street, you would have no idea any of this happened,” Tayler said.

Teddy Rosenbluth covers science for The News & Observer in a post funded by Duke Health and the Burroughs Wellcome Fund. She has covered science and health care for Los Angeles Magazine, the Santa Monica Daily Press and the Concord Monitor. Her investigative reporting has taken her everywhere from the streets of Los Angeles to the hospitals of New Delhi. She graduated from UCLA with a bachelor’s degree in psychobiology.

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