Listing and transplanting adults with congenital heart disease

Ryan R Davies, Mark J. Russo, Jonathan Yang, Jan M. Quaegebeur, Ralph S. Mosca, Jonathan M. Chen

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

BACKGROUND - An increasing number of patients with congenital heart disease (CHD) are reaching adulthood and may require heart transplantation. The survival of these patients after listing and transplantation has not been evaluated. METHODS AND RESULTS - A total of 41 849 patients (aged >18 years) were listed for primary transplantation during 1995-2009. Patients with a history of CHD (n=1035; 2.5%) were compared with those with other causes (non-CHD group) (n=40 814; 97.5%); 26 055 (62.3%) reached transplantation and were subdivided into those with (reoperation group; n=10 484; 40.2%) and without (nonreoperation group; n=15 571; 59.8%) a previous sternotomy. Survival on the waiting list was similar between groups, but mechanical ventricular assistance was not associated with superior survival to transplantation among CHD patients. CHD patients were more likely to have body mass index <18.5 at transplantation (P<0.0001), were younger, and had fewer comorbidities. Early mortality among patients with CHD was high (reoperation, 18.9% versus 9.6%; P<0.0001; nonreoperation, 16.6% versus 6.3%; P<0.0001), but by 10 years, overall survival was equivalent (53.8% versus 53.6%). Analysis was limited by the lack of specific information regarding the CHD diagnosis in most patients. CONCLUSIONS - Adults with CHD have high 30-day mortality but better late survival after heart transplantation. Mechanical circulatory assistance does not improve waiting list survival in these patients. This may be due to a combination of highly complex reoperative surgery and often poor preoperative systemic health.

Original languageEnglish (US)
Pages (from-to)759-767
Number of pages9
JournalCirculation
Volume123
Issue number7
DOIs
StatePublished - Feb 22 2011

Keywords

  • heart defects, congenital
  • surgery
  • survival
  • transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Davies, R. R., Russo, M. J., Yang, J., Quaegebeur, J. M., Mosca, R. S., & Chen, J. M. (2011). Listing and transplanting adults with congenital heart disease. Circulation, 123(7), 759-767. https://doi.org/10.1161/CIRCULATIONAHA.110.960260