Outcomes of Adult Patients With Congenital Heart Disease After Heart Transplantation: Impact of Disease Type, Previous Thoracic Surgeries, and Bystander Organ Dysfunction

Matthew Lewis, Jonathon Ginns, Christian Schulze, Matt Lippel, Paul Chai, Emile Bacha, Donna Mancini, Marlon Rosenbaum, Maryjane Farr

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background Adults with congenital heart disease (CHD) are at increased risk for adverse outcomes after heart transplantation (HT). However, small cohorts have constrained the identification of factors associated with poor prognosis. We hypothesized that number of sternotomies and bystander organ dysfunction would be associated with an increased risk for early death after HT. Methods and Results We performed a retrospective observational study of all adult CHD patients who underwent HT at our institution from January 1997 to January 2014. Forty-eight adult CHD patients were followed for a mean of 5 years. Diagnoses included tetralogy of Fallot/pulmonary atresia/double-outlet right ventricle in 15 (31%), D-transposition of the great arteries (TGA) in 10 (21%), tricuspid atresia/double-inlet left ventricle in 9 (19%), ventricular or atrial septal defect in 4 (8%), heterotaxy in 3 (6%), congenitally corrected TGA in 2 (4%), and other diagnoses in 5 (10%). Survival at both 1 and 5 years was 77%. According to multivariate analysis, ≥3 sternotomies (hazard ratio [HR] 8.5; P =.02) and Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score >18 (HR 6.2; P =.01) were significant predictors of mortality. Failed Fontan surgery was not a significant predictor of death (P =.19). Conclusions In our cohort of adult CHD patients undergoing HT, ≥3 sternotomies and MELD-XI score >18 were significantly associated with death. These findings may be important in patient selection and decision regarding tolerable number of CHD surgeries before considering HT.

Original languageEnglish (US)
Pages (from-to)578-582
Number of pages5
JournalJournal of Cardiac Failure
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Congenital heart disease
  • heart transplantation
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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