Heart-valve implants can help treat patients with congenital heart disease, but doing so in children is a challenge because these implants do not grow as the patients do, as noted in a study published this week in JAMA®.
“Partial heart transplant was introduced as a solution for delivering growing heart valves to address this unmet need in congenital cardiac surgery,” says the study. “The approach involves implanting freshly procured donor tissue and maintaining viability with some degree of immunosuppression. Partial heart transplants are potentially curative and have the possibility to allow for adaptive growth in recipient children, akin to heart transplant.”
But, so far, experience with this is minimal and, wrote the team of congenital heart surgery researchers, “there is a need for robust assessment of the associated risks and benefits before its universal application.”
Here are the key points that cardiovascular surgeons and other physicians need to know, as outlined in the JAMA study, “Partial Heart Transplant for Congenital Heart Disease.”
Question: Does partial heart transplant provide a safe and effective valve replacement option that also has capacity for growth in patients with congenital heart disease?
Findings: In this case series of 19 patients who underwent partial heart transplant, all valves demonstrated functional durability and growth over time with maintenance immunosuppression. No patient experienced valve-related reintervention, and leaflet measurements confirmed true tissue growth.
Meaning: Partial heart transplant appears to be a safe and feasible procedure that enables valve growth, representing a promising solution to overcome the limitations of current nongrowing valve replacement options.
A JAMA editorial published alongside the study lends perspective on the findings.
“Partial heart transplant for treatment of congenital heart valve disease has opened a new pathway to utilize viable valves to better meet the needs of growing children,” says the editorial. “Collaboration regarding allocation, regulation, and appropriate immunosuppression strategies is urgently needed to optimize this innovative therapy.”
AMA members can explore an entire range of cutting-edge, peer-reviewed research and clinical information. The JAMA Network™ is a world-class resource for the whole medical community. If you are an AMA member or interested in becoming one, learn how to access these educational materials and innovative tools.
Other findings of note this week
“Use of Glucagon-Like Peptide-1 Agonists Among Individuals Undergoing Bariatric Surgery in the US,” published in JAMA Surgery.
In this retrospective cohort study using a nationwide database, among a cohort of U.S. adults undergoing bariatric surgery, about one in 10 initiated a glucagon-like peptide-1 receptor agonist (GLP-1 RA). Initiation was greater among women, those undergoing sleeve gastrectomy, and individuals with larger body-mass index regain than among their counterparts. Also listen to this JAMA Surgery podcast interview with the authors.
“Body Composition, Fitness, and Mental Health in Preadolescent Children,” published in JAMA Network Open.
In this cross-sectional study of preadolescent children, greater lean mass and higher fitness were associated with fewer anxiety and depression symptoms, while higher visceral adipose tissue was associated with increased symptoms of both.
Body fat percentage was only associated with greater anxiety. These findings highlight the roles of body composition in mental health and underscore the value of early identification of physical health markers to support children’s well-being and development.
“Global Inequities in Diabetes Technology and Insulin Access and Glycemic Outcomes,” published in JAMA Network Open.
This cross-sectional study found that HbA1c levels were associated with the accessibility of modern diabetes technologies and insulin. Efforts to ensure universal accessibility are required to reduce global inequities and glycemic outcomes for children with type 1 diabetes.
What AMA members get with JAMA Network
The subscription cost of JAMA® is included with your AMA membership, plus unlimited online and mobile access to all JAMA Network journals, including: JAMA, JAMA Network Open, JAMA Cardiology, JAMA Dermatology, JAMA Internal Medicine, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Otolaryngology–Head and Neck Surgery, JAMA Pediatrics, JAMA Psychiatry, and JAMA Surgery.
The online journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications.
There are several ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:
- Take CME courses and earn AMA PRA Category 1 Credit™.
- Fulfill maintenance of licensure (MOL) and CME requirements on JN Learning™, the new home for all JAMA Network CME.
- Read concise summaries of clinical guidelines and recommendations in a streamlined format designed for today’s busy physicians.
- Access one-page articles that present key facts in patient-friendly terms to support you and your patients.
