Pediatrics Medical News about heart transplantation;congenital heart disease;age;previous surgery

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The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease
JACC - Journal of the American College of Cardiology, 07/02/09

Lamour JM et al. – Pts undergoing transplantation for congenital heart disease (CHD) have a good late survival if they survive the early post-operative period. Risk factors for reduced survival are older age at transplant and a previous Fontan operation.

Methods

Study of outcomes and risk factors for mortality after HT for CHD in infants, children, and adults
Analysis of 488 pts transplanted for CHD from combined Pediatric Heart Transplant Study (1993-2002, n = 367) and the Cardiac Transplant Registry Database (1990-2002, n = 121)
Primary diagnoses: single ventricle (36%), d-transposition of great arteries (12%), right ventricular outflow tract lesions (10%), l-transposition of great arteries (8%), ventricular/atrial septal defects (8%), left ventricular outflow obstruction (8%), and other (18%)
Before HT, ≥1 operation for 93% of pts

Results

Median age at HT: 12.4 yrs
Survival at 3 mo post-HT significantly worse in CHD pts versus children with cardiomyopathy, but not adults with cardiomyopathy (86%, 94%, and 91%, respectively)
No difference in conditional 3-mo survival among the 3 groups
5-yr survival: 80%
Risk factors for early mortality: older recipient age, older donors with longer ischemic times, and pre-HT Fontan operations
Predicted survival in Fontan pts lower (77% and 70% at 1 and 5 yrs) vs non-Fontan pts (88% and 81% at 1 and 5 yrs)
Risk factors for constant phase mortality: younger recipient age, higher transpulmonary gradient, cytomegalovirus mismatch at HT, and earlier classic Glenn operation

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