Original article: cardiovascular
Trends and Outcomes in Transplantation for Complex Congenital Heart Disease: 1984 to 2004

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
https://doi.org/10.1016/j.athoracsur.2004.04.012Get rights and content

Abstract

Background

Cardiac transplantation for patients with complex congenital heart disease poses several anatomic and physiologic challenges for the transplant surgeon. We undertook the current single center study to evaluate surgical outcomes and lessons learned through a nearly twenty year experience with cardiac transplantation for complex congenital heart disease.

Methods

A retrospective review was performed to evaluate all patients undergoing cardiac transplantation from January 1, 1984 through January 1, 2004. Donor and recipient demographic and intraoperative and postoperative variables were acquired and correlated with perioperative (30-day) and late mortality in both univariate and multivariate analyses, and with Kaplan-Meier survival estimates.

Results

One hundred and six patients underwent transplantation for complex congenital heart disease and were followed for a median of 56 months. Thirty-seven (34.9%) patients died. Male gender and later year of transplantation were protective, and neonatal age and pulmonary artery reconstruction detrimental in multivariable modeling of overall mortality. Transplantation to a physiologic or anatomic single lung did not impact on survival. Patients in the study cohort had comparable survival estimates when compared with all those in the entire cohort without complex congenital heart disease. When comparing patients by era of transplantation, both cohorts demonstrated improved survival with later transplantation.

Conclusions

Outcomes with transplantation for complex congenital heart disease have improved annually over the past twenty years. Transplantation to an anatomic or physiologic single lung did not impair overall survival. Pulmonary artery reconstruction imparted an increase in mortality both short and long term, a finding which merits further investigation.

Section snippets

Patient Population

A retrospective review was performed to evaluate all patients undergoing cardiac transplantation at the Columbia University Medical Center between January 1, 1984 and January 1, 2004. A total of 1,525 (1,151 male, 374 female) patients comprised this cohort, of whom 106 were patients transplanted with complex congenital heart disease; these patients form the basis of the current analysis of outcomes.

Hospital chart review was conducted on each identified patient and their donor, and the data

Results

Patient characteristics are shown in Table 1. Available follow-up in these patients ranged from 0 to 233.2 months (including patients who died immediately postoperatively) with a median of 56 months. Mantel-Haenszel χ2 analysis of patients grouped by age, and analyzed by era, demonstrated increased mortality with younger age (p = 0.044), particularly in the early era (p = 0.021). Cardiopulmonary bypass time, aortic cross-clamp time, and donor heart ischemic times were mean (range),

Comment

Orthotopic heart transplantation has evolved over the past four decades to become a standard treatment for neonates, children, and adults with end-stage heart disease. While significant advances have been made in the surgical repair and postoperative management of patients with complex congenital heart disease, transplantation still remains the “final therapeutic alternative” for those patients who ultimately develop irreversible myocardial failure. Such patients with complex congenital heart

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