Determinants of survival following heart transplantation in adults with congenital heart disease
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-Standa...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-02-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02509-0 |
| _version_ | 1797273359591931904 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Hüseyin Sicim |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T14:42:14Z |
| format | Article |
| id | doaj.art-f157ad6dcaea4c91b6ab733b588aca39 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-07T14:42:14Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-f157ad6dcaea4c91b6ab733b588aca392024-03-05T20:18:54ZengBMCJournal of Cardiothoracic Surgery1749-80902024-02-011911910.1186/s13019-024-02509-0Determinants of survival following heart transplantation in adults with congenital heart diseaseHüseyin Sicim0Pierre Emmanuel Noly1Suyash Naik2Vikram Sood3Richard G. Ohye4Jonathan W. Haft5Keith D. Aaronson6Francis D. Pagani7Ming-Sing Si8Paul C. Tang9Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Cardiac Surgery, Université de MontréalDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular CenterDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterDepartment of Surgery, Division of Cardiac Surgery, University of California Los AngelesDepartment of Cardiac Surgery, University of Michigan Frankel Cardiovascular CenterAbstract 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.https://doi.org/10.1186/s13019-024-02509-0Heart transplantHeart failureCongenital heart diseaseOutcomes |
| spellingShingle | 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 Determinants of survival following heart transplantation in adults with congenital heart disease Journal of Cardiothoracic Surgery Heart transplant Heart failure Congenital heart disease Outcomes |
| title | Determinants of survival following heart transplantation in adults with congenital heart disease |
| title_full | Determinants of survival following heart transplantation in adults with congenital heart disease |
| title_fullStr | Determinants of survival following heart transplantation in adults with congenital heart disease |
| title_full_unstemmed | Determinants of survival following heart transplantation in adults with congenital heart disease |
| title_short | Determinants of survival following heart transplantation in adults with congenital heart disease |
| title_sort | determinants of survival following heart transplantation in adults with congenital heart disease |
| topic | Heart transplant Heart failure Congenital heart disease Outcomes |
| url | https://doi.org/10.1186/s13019-024-02509-0 |
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