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Updated: Jun 10, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Cardiac transplantation in adults with congenital heart disease
C Irving1, G Parry, J O'Sullivan
1Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon, UK. claire.irving@nuth.nhs.uk
Insights
Cardiac transplantation for adults with congenital heart disease (CHD) shows improving survival rates over time. Despite higher initial mortality, long-term outcomes are favorable for this growing patient population.
Area of Science:
- Cardiology
- Transplantation Medicine
- Adult Congenital Heart Disease
Background:
- Growing population of adult patients with complex congenital heart disease (CHD) require cardiac transplantation.
- Limited data exists on the outcomes of cardiac transplantation in this specific patient group.
Purpose of the Study:
- To review outcomes of cardiac transplantation in adult patients with congenital heart disease.
- To evaluate survival rates and identify factors influencing outcomes in this population.
Main Methods:
- Retrospective review of 38 orthotopic cardiac transplants in 37 adult patients (>=18 years) with CHD from 1988-2009.
- Analysis of medical records and transplant databases to assess patient demographics, surgical procedures, and survival data.
Main Results:
- 43% of patients died, with 12 early and 4 late deaths; 30-day survival was 70%, 1-year survival 68%, and 5-year survival 58%.
- Outcomes improved over time, with reduced 30-day mortality (50% to 18%) and increased 5-year survival (50% to 69%).
- Two patients developed post-transplant lymphoproliferative disease; none required long-term renal replacement therapy.
Conclusions:
- Cardiac transplantation for adult CHD has higher operative mortality than other groups but offers good long-term survival.
- Increasing institutional experience has led to improved early and long-term outcomes.
- Cardiac transplantation is a viable option for select adult patients with complex congenital heart disease.
Background:
Due to increasing success with repair or palliation in childhood, there is a rapidly growing population of adult patients with complex congenital heart disease who may require transplantation. There remains little data on outcomes of cardiac transplantation in this group.
Methods:
38 orthotopic cardiac transplants were performed in 37 patients (18 men) > or =18 years of age with congenital heart disease (CHD) from 1988 to 2009 in our institution. Outcomes were reviewed using medical records and transplant databases.
Results:
15 patients (41%) had univentricular and 22 (59%) biventricular physiology. The biggest group was transposition of the great arteries following atrial switch in eight patients (22%). Six (16%) had no previous surgical intervention. Mean age at transplant was 33.5 years (range 19.1-59.9 years). 11 patients (30%) required additional surgical procedures at transplant. 16 (43%) died, 12 early and 4 late deaths (1.8, 2.4, 2.7 and 7 years). Survival was 70% at 30 days, 68% at 1 year, 58% at 5 years and 53% at 10 and 15 years. Outcome improved in later eras with reduction in 30-day mortality from 50% to 18% and increase in 5-year survival from 50% to 69%. Two patients developed post-transplant lymphoproliferative disease. None required long-term renal replacement therapy. One patient was re-transplanted for cardiac allograft vasculopathy.
Conclusions:
While operative mortality following cardiac transplantation for adult congenital heart disease is higher than for other diagnostic groups, long-term survival is good and comparable to patients without CHD. Disappointing early results are improved with increasing experience.
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