Heart transplantation with or without prior mechanical circulatory support in adults with congenital heart disease

Bryan G. Maxwell, Jim K. Wong, Ahmad Y. Sheikh, Peter H.U. Lee, Robert L. Lobato

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Recent analyses establish that heart transplantation is increasing among adults with congenital heart disease (ACHD), but the effects of pretransplant mechanical circulatory support (MCS) on perioperative and post-transplant outcomes have not been examined in the ACHD population. METHODS: Scientific Registry of Transplant Recipients data on all adult heart transplants from September 1987 to September 2012 (n = 47 160) were classified based on primary diagnosis codes as CHD or non-CHD and MCS or non-MCS. Demographic, procedural, outcome and survival variables were compared between MCS and non-MCS ACHD patient groups. RESULTS: MCS was used in 83 (6.8%) ACHD patients compared with 8625 (18.8%) patients without CHD (P < 0.001). MCS as a fraction of ACHD transplants increased over time (P = 0.002). MCS patients spent more time on the wait list, had a higher baseline serum creatinine and were more likely to be male, status 1A, hospitalized, in the ICU and/or on a ventilator prior to transplant. However, MCS patients experienced equivalent short-term survival (30-day mortality = 10.8% in MCS vs 13.5% in non-MCS, P = 0.62) and overall survival by Kaplan-Meier analysis (P = 0.57). MCS patients had a longer post-transplant length of stay and were more likely to be transfused, but otherwise had no significant differences in adverse outcomes. CONCLUSIONS: MCS is less commonly used in adult CHD patients compared with all patients undergoing heart transplant, but has been increasing over time. Within the ACHD population, patients with MCS have a higher risk profile, but except for increased transfusion rate and longer length of stay, do not experience less favourable post-transplant outcomes.

Original languageEnglish (US)
Article numberezt498
Pages (from-to)842-846
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume45
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • Adult congenital heart disease
  • Congenital heart disease
  • Heart transplantation
  • Mechanical circulatory support
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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