Abstract 16790: Outcome Following Assessment for Cardiac Transplant in Adults With Congenital Heart Disease
Introduction: There are no data describing the outcome of adults with congenital heart disease (ACHD) assessed for cardiac transplant.
Methods: The charts of all ACHD patients assessed for cardiac transplant at our institution between 1/1/2000 and 1/1/2012 were reviewed with outcome reported as of 1/1/2013.
Results: In total 101 ACHD patients (32 female, median age (IQR) 29 (22-38) years) were assessed for transplant over the 12 years. Thirty three had a systemic left ventricle (LV group), 32 a systemic right ventricle (RV group) and 36 patients had single ventricle physiology (SV group). Survival was 78% at 1 year and 62% at 5 years with no significant difference in survival between the 3 groups, p=0.23. Of the 46 patients listed for transplant, 39 were transplanted (79% 1yr and 75% 5 year survival), 6 died waiting and 1 is still waiting. The remaining 54 patients were not listed. Twenty two were too high risk or not suitable (8 pulmonary vascular resistance > 6wood units, 2 panel reactive antibody >90%, 12 due to associated co morbidities), 20 were too well, 8 were suitable but did not want to be listed, 2 died during assessment and in 3 conventional surgery was considered a better option. Sixteen patients underwent non transplant surgery (7 unsuitable for transplant, 6 too unwell to wait, 3 better option), comprising of 9 conventional operations and 7 ventricular assist devices (VAD), with a 1 year survival of 75%.
Conclusions: Over half of ACHD patients assessed for heart transplant are not listed, either because they are too well or are too high risk. Those too well need careful follow up to ensure that listing takes place at an appropriate time. Those too high risk raise important questions as to why referral was delayed and how factors precluding transplant can be minimised. Close liaison needs to exist between congenital heart units and the units who undertake ACHD transplantation. Assessment must include consideration of alternative strategies including conventional surgery and VAD.
- © 2013 by American Heart Association, Inc.