Partial Heart Transplantation for Congenital Heart Disease. A Narrative Review of Current Knowledge and Future Directions
DOI:
https://doi.org/10.12775/QS.2026.54.70155Keywords
Partial Heart Transplantation, Congenital Heart Disease, Living Valve Transplantation, Valve Replacement, Allorafts, Immunosuppression TherapyAbstract
Background. Partial heart transplantation (PHT), also referred to as living valve replacement, is an emerging surgical strategy for irreparable valvular defects. By implanting viable donor valve tissue, PHT provides grafts capable of somatic growth, addressing a key limitation of conventional prosthetic valves in pediatric patients, in whom the lack of growth potential necessitates repeated reoperations.
Aim. This review aims to introduce the concept of partial heart transplantation to a broader clinical audience and to summarize current clinical experience. We discuss indications, technical considerations, and organizational challenges associated with PHT in infants, and outline potential applications in older children and adults.
Methods. A structured literature search was conducted in databases using selected keywords related to partial heart transplantation and congenital heart disease. Because the available evidence remains early and heterogeneous, a narrative review approach was adopted with SANRA quality criteria. The included literature consisted mainly of case reports, case series, and review articles.
Results. The largest reported case series included 19 patients who underwent PHT between April 2022 and December 2024. Replacement of semilunar valves was associated with significant annular growth and preserved valvular function during follow-up. At the time of publication, none of the transplanted valves required explantation due to graft failure. Early observations suggest that, owing to the relatively low immunogenicity of cardiac valves, immunosuppressive requirements after PHT may be lower than those required after orthotopic heart transplantation.
Conclusion. Evidence for PHT is currently limited to small cohorts with short follow-up. Multicenter collaboration and standardized registry-based data collection will be essential to define indications, evaluate long-term outcomes, and establish the role of PHT within contemporary valve replacement strategies.
References
1. GBD 2017 Congenital Heart Disease Collaborators (2020). Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. Child & adolescent health, 4(3), 185–200. https://doi.org/10.1016/S2352-4642(19)30402-X
2. Del Nido P. J. (2024). Congenital Heart Surgery: In Rapid Evolution. Circulation, 150(8), 583–585. https://doi.org/10.1161/CIRCULATIONAHA.124.
3. Contorno, E., Javed, H., Steen, L., Lowery, J., Zaghw, A., Duerksen, A., Henrich-Lobo, R., Reemtsen, B., & Rajab, T. K. (2025). Options for pediatric heart valve replacement. Future cardiology, 21(1), 47–52. https://doi.org/10.1080/14796678.2024.2445402
4. Rajab, T. K., Kalfa, D. M., Mery, C. M., Emani, S. M., & Reemtsen, B. L. (2025). Indications and Practical Considerations for Partial Heart Transplantation. The Annals of thoracic surgery, 120(4), 620–630. https://doi.org/10.1016/j.athoracsur.2025.01.037
5. Rajab, T. K., Ochoa, B., Zilinskas, K., Kwon, J., Taylor, C. L., Henderson, H. T., Savage, A. J., Kavarana, M., Turek, J. W., & Costello, J. M. (2023). Partial heart transplantation for pediatric heart valve dysfunction: A clinical trial protocol. PloS one, 18(2), e0280163. https://doi.org/10.1371/journal.pone.0280163
6. Pasquali, S. K., Cohen, M. S., Shera, D., Wernovsky, G., Spray, T. L., & Marino, B. S. (2007). The relationship between neo-aortic root dilation, insufficiency, and reintervention following the Ross procedure in infants, children, and young adults. Journal of the American College of Cardiology, 49(17), 1806–1812. https://doi.org/10.1016/j.jacc.2007.01.071
7. Moroi, M. K., Bacha, E. A., & Kalfa, D. M. (2021). The Ross procedure in children: a systematic review. Annals of cardiothoracic surgery, 10(4), 420–432. https://doi.org/10.21037/acs-2020-rp-23
8. Wolf, S. E. M., Aykut, B., Medina, C. K., Kucera, J. A., Ghandour, H. Z., Turek, J. W., & Overbey, D. M. (2025). Partial Heart Transplant Update: Where Are We In 2025?. Seminars in thoracic and cardiovascular surgery, 37(2), 174–179. https://doi.org/10.1053/j.semtcvs.2025.03.002
9. Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA-a scale for the quality assessment of narrative review articles. Research integrity and peer review, 4, 5. https://doi.org/10.1186/s41073-019-0064-8
10. Turek, J. W., Kang, L., Overbey, D. M., Carboni, M. P., & Rajab, T. K. (2024). Partial Heart Transplant in a Neonate With Irreparable Truncal Valve Dysfunction. JAMA, 331(1), 60–64. https://doi.org/10.1001/jama.2023.23823
11. Overbey, D. M., Aykut, B., Kucera, J. A., Medina, C. K., Sethi, N. J., Barker, P. C. A., Shea, E. V., & Turek, J. W. (2025). Partial Heart Transplant for Congenital Heart Disease. JAMA, 334(12), 1077–1083. https://doi.org/10.1001/jama.2025.13580
12. Hawley, K. Elias is first child in Texas to undergo a partial heart transplant, seventh in the world. Austin American-Statesman [Internet]. 2023 [cited 2026 Mar 2]. Available from: https://www.statesman.com/picture-gallery/news/2023/07/28/pediatric-partial-heart-transplant-austin-dell-childrens-medical-center-performed-in-texas/12280908002/
13. Razzouk, A. First pediatric partial heart transplant in southern California at LLU Children’s [Internet]. 2025 [cited 2026 Mar 2]. Available from: https://news.llu.edu/patient-care/first-pediatric-partial-heart-transplant-southern-california-llu-childrens-hospital
14. McKeon A. Eight years of preparation for a surgical first: a partial heart transplant [Internet]. 2024 [cited 2026 Mar 2]. Available from: https://answers.childrenshospital.org/new-aortic-valve-treatment/
15. Bautista-Fryer C. From NYP’s Health Matters – One Heart Saves Three Lives: Innovative Partial Heart Transplant Performed at Columbia/NYP [Internet]. 2025 [cited 2026 Mar 2]. Available from: https://columbiasurgery.org/news/nyps-health-matters-one-heart-saves-three-lives-innovative-partial-heart-transplant-performed
16. Aykut, B., Overbey, D. M., Medina, C. K., Omer, T. M., Rajab, T. K., Ngeve, S. M., Beckerman, Z., & Turek, J. W. (2024). Partial Heart Transplantation Promotes Organ Stewardship: Domino Hearts and Split Roots. Annals of thoracic surgery short reports, 3(1), 86–91. https://doi.org/10.1016/j.atssr.2024.07.033
17. Aykut, B., Ghandour, H., Mensah-Mamfo, M., Ngeve, S. M., Baldwin, T., Medina, C. K., Kucera, J. A., Wolf, S. E., Omer, T. M., Cook, J. K., Jeffs, S. E., Parker, L. E., Evans, A., Miller, S. G., Turek, J. W., & Overbey, D. M. (2025). Partial heart transplant valves demonstrate growth in piglets despite prolonged cold storage. The Journal of thoracic and cardiovascular surgery, 170(4), 1119–1124.e1. https://doi.org/10.1016/j.jtcvs.2025.03.018
18. Kesseli, S., Wolf, S. E. M., Schroder, J. N., Beckerman, Z., Overbey, D. M., & Turek, J. W. (2025). The Living Ross Procedure: A New Paradigm in Partial Heart Transplantation. The Annals of thoracic surgery, 120(2), 412–414. https://doi.org/10.1016/j.athoracsur.2025.04.039
19. Kalfa, D., Rajab, T. K., Cordoves, E., Emani, S., Bacha, E., Jaggers, J., Goldstone, A., Eghtesady, P., & Turek, J. (2024). Living allogenic heart valve transplantation: Relative advantages and unanswered questions. The Journal of thoracic and cardiovascular surgery, 167(5), 1543–1546. https://doi.org/10.1016/j.jtcvs.2023.09.036
20. Kalfa D, Cordoves E, Overbey D, et al. Current experience and out-comes following allogeneic heart valve transplantation in the US: anation-wide multicenter study. Paper presented at the 105th Annual Meeting of The American Association for Thoracic Surgery; May 4, 2025; Seattle, WA.
21. Alexander, V. S., Vogel, A. D., Silvano, Z. T., Javed, H., Mitta, A., & Rajab, T. K. (2024). Organizational challenges for partial heart transplantation. Future cardiology, 20(13), 719–728. https://doi.org/10.1080/14796678.2024.2404775
22. Wolf, S. E. M., Kucera, J. A., Mensah-Mamfo, M., Cook, J. K., Pitchon, D. R., Reynolds, L. M., Odei, A. D., Overman, R. E., Sinha, P., d'Udekem, Y., Turek, J. W., & Overbey, D. M. (2025). Shaping the Future of Partial Heart Transplantation: Innovations and Emerging Applications. Innovations (Philadelphia, Pa.), 20(5), 427–431. https://doi.org/10.1177/15569845251375996
23. Patel, N. D., Friedman, C., Herrington, C., Wood, J. C., & Cheng, A. L. (2021). Progression in Fontan conduit stenosis and hemodynamic impact during childhood and adolescence. The Journal of thoracic and cardiovascular surgery, 162(2), 372–380.e2. https://doi.org/10.1016/j.jtcvs.2020.09.140
24. Turbendian, H. K., et al. (2025). Partial heart transplantation can provide a pulsatile and growing Fontan conduit: A rightward shift for a better Fontan. Medical Hypotheses, 201, 111694. https://doi.org/10.1016/j.mehy.2025.111694
25. Hill, M. A., Kwon, J. H., Gerry, B., Hardy, W. A., Walkowiak, O. A., Kavarana, M. N., Nadig, S. N., & Rajab, T. K. (2021). Immune Privilege of Heart Valves. Frontiers in immunology, 12, 731361. https://doi.org/10.3389/fimmu.2021.731361
26. Quintao, R., Kwon, J. H., Bishara, K., & Rajab, T. K. (2023). Donor supply for partial heart transplantation in the United States. Clinical transplantation, 37(10), e15060. https://doi.org/10.1111/ctr.15060
27. Javed, H., Rajab, T., Haregu, F., Reemtsen, B., Rogers, M., & Contorno, E. (2025). Suitability of Infant Heart Transplant Recipients to Serve as Domino Partial Heart Transplant Donors. Pediatric Transplantation, 29(1), e70007. https://doi.org/10.1111/petr.70007
28. Singh TP, Cherikh WS, Hsich E i wsp. The International thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-fifth pediatric heart transplantation report-2022; focus on infant heart transplantation. J Heart Lung Transpl. 2022;41(10):1357–65. doi:10.1016/j.healun.2022.07.019
29. Rajab, T. K., Kang, L., Hayden, K., Andersen, N. D., & Turek, J. W. (2023). New operations for truncus arteriosus repair using partial heart transplantation: Exploring the surgical design space with 3-dimensional printed heart models. JTCVS techniques, 18, 91–96. https://doi.org/10.1016/j.xjtc.2023.02.005
30. McCulloch, P., Altman, D. G., Campbell, W. B., Flum, D. R., Glasziou, P., Marshall, J. C., Nicholl, J., Balliol Collaboration, Aronson, J. K., Barkun, J. S., Blazeby, J. M., Boutron, I. C., Campbell, W. B., Clavien, P. A., Cook, J. A., Ergina, P. L., Feldman, L. S., Flum, D. R., Maddern, G. J., Nicholl, J., … Vandenbroucke, J. (2009). No surgical innovation without evaluation: the IDEAL recommendations. Lancet (London, England), 374(9695), 1105–1112. https://doi.org/10.1016/S0140-6736(09)61116-8
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Katarzyna Widomska, Mateusz Bernad, Aleksandra Bender, Paulina Walczak, Małgorzata Niewęgłowska, Bartłomiej Szymulewicz, Kacper Dąbrowski, Jakub Łukaszewicz, Oliwia Krazińska, Magdalena Gałach, Aniela Figiel, Paweł Zaborek, Justyna Pestka, Robert Marguła
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 74
Number of citations: 0
