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. 2019 Nov;105(22):1741-1747.
doi: 10.1136/heartjnl-2019-314711. Epub 2019 Jul 5.

Outcome following heart transplant assessment in adults with congenital heart disease

David Steven Crossland  1   2 , Katrijn Jansen  1 , Gareth Parry  3 , Andrew Harper  4   5 , Gianluigi Perri  6   7 , Alison Davidson  1 , Fabrizio De Rita  1 , Antony Hermuzi  1 , Mohamed Nassar  1   8 , Neil Seller  1 , Guy A MacGowan  2   9 , Asif Hasan  1 , John J O'Sullivan  1   2 , Louise Coats  1   2
Affiliations

Outcome following heart transplant assessment in adults with congenital heart disease

David Steven Crossland et al. Heart. 2019 Nov.

Abstract

Objectives: Adults with congenital heart disease (ACHD) are a growing group with end-stage heart failure. We aim to describe the outcomes of ACHD patients undergoing assessment for orthotopic heart transplant (OHT).

Methods: Case notes of consecutive ACHD patients (>16 years) assessed for OHT between 2000 and 2016 at our centre were reviewed. Decision and outcome were reported as of 2017. Data were analysed in three groups: systemic left ventricle (LV), systemic right ventricle (RV) and single ventricle (SV).

Results: 196 patients were assessed (31.8 years, 27% LV, 29% RV, 44% SV). 89 (45%) patients were listed for OHT and 67 (34%) were transplanted. 41 (21%) were unsuitable or too high risk and 36 (18%) were too well for listing. Conventional surgery was undertaken in 13 (7%) and ventricular assist device in 17 (9%) with 7 (4%) bridged to candidacy. Survival from assessment was 84.2% at 1 year and 69.7% at 5 years, with no difference between groups. Patients who were considered unsuitable for OHT (HR 11.199, p<0.001) and listed (HR 3.792, p=0.030) were more likely to die than those who were considered too well. Assessments increased over the study period.

Conclusions: The number of ACHD patients assessed for OHT is increasing. A third are transplanted with a small number receiving conventional surgery. Those who are unsuitable have a poor prognosis.

Keywords: complex congenital heart disease; congenital heart disease; congenital heart disease surgery; heart transplantation.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trends in assessments and transplants over time. Increased number of assessments when comparing each 4 year period with growth in both the total number of single ventricle patients assessed and the proportion of single ventricle patients assessed. The total number of transplants has remained fixed when comparing the two most recent periods. LV, left ventricle group; RV, right ventricle group; SV, single ventricle group.
Figure 2
Figure 2
Death-free survival at long term follow-up of 196 patients assessed for orthotopic heart transplant (OHT) following assessment according to the decision made by the multidisciplinary team.
Figure 3
Figure 3
Death-free survival at long term follow-up of 196 patients assessed for orthotopic heart transplant following assessment by diagnostic group. LV, left ventricle; RV, right ventricle; SV, single ventricle.
Figure 4
Figure 4
Death-free survival at long term follow-up of 89 patients listed for orthotopic heart transplant following listing by diagnostic group. LV, left ventricle; RV, right ventricle; SV, single ventricle.
Figure 5
Figure 5
Competing interest curve following listing for transplant. All patients start on the curve as listed with the timing of possible outcomes transplant or death on the waiting list shown by the other curves. No patients were removed from the list for clinical deterioration.
Figure 6
Figure 6
Death-free survival at long term follow-up of 67 patients following orthotopic heart transplant by diagnostic group. LV, left ventricle; RV, right ventricle; SV, single ventricle.
See this image and copyright information in PMC

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