In a groundbreaking first for the Midwest, a collaborative surgical team from WashU Medicine and St. Louis Children’s Hospital has successfully completed a pediatric “domino” partial heart transplant. This makes their center one of only eight in the United States to offer this rare, lifesaving procedure.
The operation, carried out this summer, required a level of coordination and expertise rarely seen in pediatric transplantation. More than 20 specialists — including pediatric heart transplant surgeons, cardiologists, intensivists, anesthesiologists, nurses, perfusionists, and transplant coordinators — worked across two operating rooms to execute the multi-step surgery.
The domino transplant technique hinges on leveraging healthy components of one patient’s heart to benefit another. In this case, the first child in need received a full donor heart. Even though the diseased heart was no longer viable in its entirety, its aortic valve remained functional. Surgeons then harvested this valve and transplanted it into a second young patient whose aortic valve was failing. In effect, one donor gift resulted in two life-saving surgeries. (WashU Medicine)
“This was a remarkable team effort,” said Dr. Jacob Miller, a WashU pediatric heart surgeon at St. Louis Children’s Hospital. “One donor gave the gift of life that ultimately helped two children. It was incredible to witness how everyone came together to perform such an innovative procedure.”
Traditional options for children requiring heart valve replacement usually involve prosthetic devices or cryopreserved valves from deceased donors. Yet both approaches come with limitations: prosthetic valves cannot grow, and cryopreserved valves may degrade or require replacement as the child grows. By contrast, a partial heart transplant — or valve transplant — holds significant promise, as transplanted tissues may grow with the recipient, potentially minimizing the need for repeated surgeries.
Planning for such a domino partial transplant was years in the making. Dr. Lakshmi Gokanapudy Hahn, a pediatric transplant cardiologist, and Dr. Pirooz Eghtesady, chief of Pediatric Cardiothoracic Surgery at WashU, led the preparations. The hospital also established in-house tissue processing capabilities to support timely valve preparation.
“Everything must line up perfectly for a domino transplant,” remarked Dr. Janet Scheel, medical director of the pediatric transplant program. “The timing is incredibly precise, and the expertise of the entire team was essential to making it possible.”
Both children are currently reported to be doing well. The team will closely monitor their recoveries, with particular attention to the growth and performance of the transplanted valve. They are also evaluating additional candidates for living valve transplantation in the future.
This achievement adds to St. Louis Children’s and WashU Medicine’s reputation for leadership in pediatric organ transplants. In 2024 alone, the center became the first pediatric heart transplant program in the U.S. to surpass 600 procedures.
“This is a milestone for our team and for patients and families hoping for long-term solutions,” said Dr. Eli Fredman. “None of this would be possible without the trust of families and the profound generosity of donor families, whose decisions give hope to others.”
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