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Updated: Aug 21, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Trends and outcomes in transplantation for complex congenital heart disease: 1984 to 2004
Jonathan M Chen1, Ryan R Davies, Seema R Mital
1Division of Pediatric Cardiac Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA. jmc23@columbia.edu
Insights
Cardiac transplantation outcomes for complex congenital heart disease have improved significantly over two decades. While male gender and later transplant year were protective, neonatal age and pulmonary artery reconstruction increased mortality risk.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Pediatric Cardiology
Background:
- Complex congenital heart disease (CCHD) presents unique surgical challenges for cardiac transplantation.
- This study evaluates outcomes and lessons from a nearly 20-year experience with CCHD cardiac transplants.
Purpose of the Study:
- To assess surgical outcomes and mortality in patients with CCHD undergoing cardiac transplantation.
- To identify factors influencing perioperative and long-term survival in this patient population.
Main Methods:
- Retrospective review of 106 patients undergoing cardiac transplantation for CCHD between 1984 and 2004.
- Analysis of demographic, intraoperative, and postoperative variables.
- Univariate, multivariate, and Kaplan-Meier survival analyses were employed.
Main Results:
- Thirty-seven percent of patients died during a median follow-up of 56 months.
- Male gender and later transplant year were associated with better survival.
- Neonatal age and pulmonary artery reconstruction were linked to increased mortality.
Conclusions:
- Cardiac transplantation for CCHD has shown annual outcome improvements over 20 years.
- Transplantation to a single lung (anatomic or physiologic) did not negatively impact survival.
- Pulmonary artery reconstruction was associated with increased short- and long-term mortality, warranting further investigation.
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.
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