Increasing Complexity of Heart Transplantation in Patients with Congenital Heart Disease

• Published in: Seminars in thoracic and cardiovascular surgery Vol. 28; no. 2; pp. 487 - 497
• Main Authors: Shi, William Y., MBBS, Saxena, Pankaj, PhD, FRACS, Yong, Matthew S., MBBS, Marasco, Silvana F., MBBS, FRACS, McGiffin, David C., MBBS, FRACS, Shipp, Anne, RN, Weintraub, Robert G., MBBS, FRACP, d’Udekem, Yves, MD, PhD, FRACS, Brizard, Christian P., MD, Konstantinov, Igor E., MD, PhD, FRACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2016
• Subjects: Adolescent; Adult; cardiac; Cardiothoracic Surgery; Child; Child, Preschool; congenital heart disease; Female; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; heart failure; Heart Transplantation - adverse effects; Hospital Mortality; Humans; Infant; Infant, Newborn; Kaplan-Meier Estimate; Male; Middle Aged; pediatric; Postoperative Complications - etiology; Postoperative Complications - mortality; Reoperation; Retrospective Studies; Risk Factors; surgery; Time Factors; transplantation; Treatment Outcome; Victoria; Young Adult; Hypoplastic left heart syndrome; IABP; RV; Extra-corporeal membrane oxygenation; Transposition of the great arteries; Congenital heart disease; LV; Ventricular-assist device; Transplantation; ASD; Surgery; Atrial septal defect; BCPS; Odds Ratio; Congenitally-corrected transposition of the great arteries; ECMO; Tetralogy of Fallot; Heart failure; bidirectional cavopulmonary shunt; OR; panel-reactive antibody; Ventricular septal defect; CI; Right ventricle; VSD; Cardiac; TOF; HLHS; Left ventricle; Pulmonary artery; Confidence interval; DILV; DORV; TGA; ccTGA; Cardiopulmonary bypass; Double-outlet right ventricle; PA; CPB; RCH; Intra-aortic balloon pump; VAD; Double-inlet left ventricle; Pediatric; CHD; PRA; Royal Children’s Hospital, Melbourne; congenital heart disease; heart failure; transplantation; cardiac; surgery; pediatric
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2015.09.007

Objectives Due to improved surgical results, there is a growing population of patients with repaired congenital heart disease (CHD) requiring heart transplantation. We reviewed our experience with these patients. Methods A retrospective review of the outcomes of heart transplantation in patients with CHD ( n =77) between 1988 and 2014 was performed. Outcomes of early (1988-1999) and late (2000-2014) eras were compared. Results The mean age was 18±14 years (range 16 days-58 years). Seventy (91%) patients underwent a mean of 2.6±1.3 (range 1-6) cardiac operations prior to transplantation, while 7 were primary transplants. Univentricular palliation had been performed in 44 (57%) patients. CHD patients in the later era had longer mean cardiopulmonary bypass (CPB) time (early: 190±70 min vs. late: 271±115 min, p <0.001), ischaemic times (early: 222±98 min vs. late: 275±102 min, p =0.039), and more often required reconstruction of the great arteries at the time of transplantation (8% vs. 28%, p =0.036). In those with prior univentricular palliations, the ratio of ischaemic to cardiopulmonary bypass time decreased in the later era (early: 1.41±0.60 vs. late: 0.99±0.37, p =0.016), reflecting increased intraoperative complexity. Following transplantation, hospital mortality was 13% (10/77; 7 due to primary graft failure). There was no difference in in-hospital mortality between the 2 eras ( p =0.52), however, patients in the later era more often required post-operative ECMO (early: 8%, 3/38 vs. late: 28%, 11/39, p =0.036). In patients with prior univentricular palliations, those in the late era were more likely to experience post-operative renal impairment (early: 1/21, 5% vs. late: 9/23, 39%, p =0.01). Patients with CHD had higher 30-day mortality (CHD: n =8, 10% versus non-CHD: n =17, 3.8%, p =0.021), but similar survival at 10 years (67 ± 12% vs. 70 ± 4.7%, p =0.87) compared to those without CHD. Conclusions Patients with CHD undergoing cardiac transplantation in the recent era became more complex. They had a greater number of prior cardiac operations, more often underwent complex vascular reconstructions and required more prolonged intra-operative preparation. Mini-Abstract Patients with CHD undergoing cardiac transplantation in the recent era became more complex. They had a greater number of prior cardiac operations, more often underwent complex vascular reconstructions and required more prolonged intra-operative preparation.