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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Complex Congenital Heart Disease: Is Heart Transplantation an Option?
I Esteve-Ruiz1, A Grande-Trillo1, D Rangel-Sousa1
1Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, Spain.
Insights
Heart transplantation (HT) in patients with complex congenital heart disease (CHD) involves younger individuals with more prior surgeries and fewer cardiovascular risk factors. While the postoperative period is more challenging, long-term survival is achievable.
Area of Science:
- Cardiology
- Transplantation Medicine
- Congenital Heart Disease
Background:
- Congenital heart disease (CHD) is an infrequent underlying condition in heart transplant (HT) recipients.
- This study focuses on the complications and outcomes of CHD patients undergoing HT.
Purpose of the Study:
- To assess the complications and follow-up of patients with congenital heart disease (CHD) who underwent heart transplantation (HT).
Main Methods:
- Retrospective analysis of patients over 14 years old with CHD and HT.
- Evaluation of clinical and surgical variables.
Main Results:
- Ten CHD patients (2.2% of total HT series) were analyzed, younger than other HT recipients (median age 25 vs 53).
- CHD patients had significantly more prior cardiac surgeries (100% vs 14.4%) and fewer cardiovascular risk factors (0% vs 60%).
- Left ventricle ejection fraction differed significantly between groups; primary graft failure was more common in CHD patients.
Conclusions:
- Heart transplant recipients with CHD represent a distinct subgroup with unique comorbidities and pre-transplant profiles.
- These patients experience more complex postoperative courses, including longer extracorporeal circulation, intubation, and ICU stays.
- Despite initial challenges and lower 1-month survival, long-term survival in CHD patients after HT is comparable, supporting HT as a viable option.
Introduction:
Within the heart transplant (HT) population, few patients have complex congenital heart disease (CHD) underlying disease. Our objective is to assess the complications and follow-up of patients with CHD transplanted in our center (1991-present).
Material And Methods:
Retrospective analysis of patients older than 14 years old with CHD and HT. Clinical and surgical variables were analyzed.
Results:
Ten patients (age 25 ± 7 years old, 60% male) were analyzed, which represents 2.2% of the entire series of HT; 9 of the 10 patients were electively transplanted and 1 was under support with extracorporeal membrane oxygenation. Compared with the rest of the transplanted patients, patients with CHD had a lower median age (25 [25-36] vs 53 [15-69]; P < .009); more cardiac surgeries prior to HT (100% vs 14.4%; P < .001); a lower percentage of cardiovascular risk factors (CVRF; 0% vs 60%; P < .001). The left ventricle ejection fraction also showed statistically significant differences (33.5 [12-67] vs 20 [6-70]).
Conclusions:
Our patients with CHD and HT are younger and have less CVRF and more cardiac surgeries, which highlights that it is a subgroup with clear clinical differences in its comorbidity and pretransplantation assessment. They also require longer extracorporeal circulation time, more hours of intubation, and more days in the intensive care unit. Primary graft failure is more common in patients with CHD. Therefore, survival at 1-month follow-up is lower than the rest of the series and equalizes after the year of follow-up. This long-term survival reaffirms the possibility of HT in CHD despite the fact that its postoperative period is more difficult.
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