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Original research article
Outcome following heart transplant assessment in adults with congenital heart disease
  1. David Steven Crossland1,2,
  2. Katrijn Jansen1,
  3. Gareth Parry3,
  4. Andrew Harper4,5,
  5. Gianluigi Perri6,7,
  6. Alison Davidson1,
  7. Fabrizio De Rita1,
  8. Antony Hermuzi1,
  9. Mohamed Nassar1,8,
  10. Neil Seller1,
  11. Guy A MacGowan2,9,
  12. Asif Hasan1,
  13. John J O’Sullivan1,2,
  14. Louise Coats1,2
  1. 1 Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  2. 2 Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, UK
  3. 3 Cardiac Transplantation, Freeman Hospital Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4 Radcliffe Department of Medicine, University of Oxford, Oxford, UK
  5. 5 Wellcome Centre for Human Genetics, Oxford, UK
  6. 6 Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
  7. 7 Universita Cattolica del Sacro Cuore Sede di Roma, Rome, UK
  8. 8 Cardiodiothoracic Surgery Unit, Alexandria University, Alexandria, Egypt
  9. 9 Cardiology, Freeman Hospital Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Dr. David Steven Crossland, Adult Congenital and Pediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK; david.crossland{at}newcastle.ac.uk

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.

  • congenital heart disease surgery
  • heart transplantation
  • congenital heart disease
  • complex congenital heart disease

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors DSC, KJ, GP, AH, GP, AD, LC collected the data for the manuscript. DSC, KJ, LC analysed the data and prepared the manuscript. All authors edited the manuscript and approved the final version.

  • Funding The authors would like to thank the Children’s Heart Unit Fund (CHUF, www.chuf.org.uk) for funding the colour printing and open access availability of this paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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