Determinants of survival following heart transplantation in adults with congenital heart disease

Hüseyin Sicim; Pierre Emmanuel Noly; Suyash Naik; Vikram Sood; Richard G Ohye; Jonathan W Haft; Keith D Aaronson; Francis D Pagani; Ming-Sing Si; Paul C Tang

doi:10.1186/s13019-024-02509-0

Determinants of survival following heart transplantation in adults with congenital heart disease

J Cardiothorac Surg. 2024 Feb 10;19(1):83. doi: 10.1186/s13019-024-02509-0.

Authors

Hüseyin Sicim^{1

2}, Pierre Emmanuel Noly³, Suyash Naik¹, Vikram Sood¹, Richard G Ohye¹, Jonathan W Haft¹, Keith D Aaronson⁴, Francis D Pagani¹, Ming-Sing Si⁵, Paul C Tang^{6

7}

Affiliations

¹ Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.
² Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
³ Department of Cardiac Surgery, Université de Montréal, Montréal, QC, Canada.
⁴ Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.
⁵ Department of Surgery, Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA. tang.paul2@mayo.edu.
⁷ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA. tang.paul2@mayo.edu.

Abstract

Background: Adult patients surviving with congenital heart disease (ACHD) is growing. We examine the factors associated with heart transplant outcomes in this challenging population with complex anatomy requiring redo-surgeries.

Methods: We reviewed the United Network for Organ Sharing-Standard Transplant Analysis and Research database and analyzed 35,952 heart transplants from January 1st, 2000, to September 30th, 2018. We compared transplant characteristics for ischemic cardiomyopathy (ICM) (n = 14,236), nonischemic cardiomyopathy (NICM) (n = 20,676), and ACHD (n = 1040). Mean follow-up was 6.20 ± 4.84 years. Kaplan-Meier survival curves and Cox-proportional hazards analysis were used to analyze survival data.

Results: Multivariable analysis confirmed that ACHD was associated greater in-hospital death compared to ICM (HR = 0.54, P < 0.001) and NICM (HR = 0.46, P < 0.001). Notable factors associated with increased mortality were history of cerebrovascular disease (HR = 1.11, P = 0.026), prior history of malignancy (HR = 1.12, P = 0.006), pre-transplant biventricular support (HR = 1.12, P = 0.069), postoperative stroke (HR = 1.47, P < 0.001) and postoperative dialysis (HR = 1.71, P < 0.001). ACHD transplants had a longer donor heart ischemic time (P < 0.001) and trend towards more deaths from primary graft dysfunction (P = 0.07). In-hospital deaths were more likely with ACHD and use of mechanical support such as use of right ventricular assist device (HR = 2.20, P = 0.049), biventricular support (HR = 1.62, P < 0.001) and extracorporeal membrane oxygenation (HR = 2.36, P < 0.001). Conditional survival after censoring hospital deaths was significantly higher in ACHD (P < 0.001).

Conclusion: Heart transplant in ACHD is associated with a higher post-operative mortality given anatomical complexity but a better long-term conditional survival. Normothermic donor heart perfusion may improve outcomes in the ACHD population by reducing the impact of longer ischemic times.

Keywords: Congenital heart disease; Heart failure; Heart transplant; Outcomes.

Publication types

Review

MeSH terms

Adult
Cardiomyopathies* / complications
Heart Defects, Congenital* / complications
Heart Defects, Congenital* / surgery
Heart Transplantation*
Hospital Mortality
Humans
Retrospective Studies
Tissue Donors

Abstract

Publication types

MeSH terms

Grants and funding