Abstract 11335: Outcome of Fetal Listing for Heart Transplantation
Due to limited donor availability, fetal diagnosis and listing for heart transplantation (HTx) is utilized to maximize HTx opportunities for fetuses with severe heart disease. The purpose of this study was to review the outcomes of fetuses listed for HTx. A prospective, multicenter, event-driven data registry was used to determine the outcomes of fetuses listed for HTx from 1993-2009. 4365 children were listed for HTx during this period. Fetuses comprised 1% and neonates (0-30d) 19.8% of listed patients. The most common indication for fetal listing was congenital heart disease (45/46) with left-sided obstructive lesions predominating (41). Fetuses were listed for 18d (mean; range 1-36) prior to delivery. There was no difference in survival after listing between the fetal and neonatal group (p=0.2). The most common cause of waitlist mortality was multisystem failure in the fetal group vs cardiac failure in the neonatal group. Of those that survived to HTx (37), there was no difference between the fetal and neonatal groups in terms of the mean age at HTx (50 vs 66d), gender (78% vs 62% male) or race (89% vs 79% white). The median waitlist time to HTx after birth was 25d vs. 39d for neonates. At the time of HTx 2 fetal listed patients required ECMO, 9 were ventilated and 8 required inotropes. Figure 1 illustrates 3 competing outcomes curves: fetal listed patients from time of listing (a), from date of birth (b), and neonatal patients from listing (c). These curves demonstrate that a greater proportion of fetal listed patients achieve HTx earlier, as approximately 50% of these patients were transplanted after waiting for 1 month post-birth (b) vs 3 months (c) for neonatal patients (p=0.02). There was no difference in post-HTx survival between the 2 listing strategies (p=0.4) Fetal listing results in earlier time to HTx and comparable outcomes to neonatal listing. This strategy should be considered as a management option following in utero diagnosis of severe heart disease.
- © 2011 by American Heart Association, Inc.