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Heart Transplantation In Adults With Congenital Heart Disease: A Single Center 38 Year Experience With 73 Achd Patients Undergoing Cardiac Transplantation
Mark S. Bleiweis, Giles J. Peek, MD, Jeffrey P. Jacobs.
University of Florida, Gainesville, FL, USA.
Objectives:(1) Review our single center experience over 38 years of cardiac transplantation in ACHD (n=73 ACHD patients)
(2) Compare risk factors and outcomes of those with biventricular ACHD (n=40) to those with functionally univentricular ACHD (n=33).
Methods: We performed a review of all ACHD patients at our institution undergoing heart transplantation (1987-2025). Patients with prior heart transplants (n=3) were omitted. Patients were stratified by biventricular ACHD versus univentricular ACHD based on pre-transplant diagnosis.
Results: 73 ACHD patients underwent heart transplantation: 40/73=54.8% with biventricular ACHD and 33/73=45.2% with univentricular CHD. Median age at transplantation was 29.4 years [IQR=20.8-42.6]. Median number of prior cardiac surgeries was 2 [IQR:1-3]. • 12/73=16.4% were supported with mechanical ventilation at transplantation. • 8/73=10.9% were supported with mechanical circulatory support at transplantation (6/73=8.2% with VAD and 2/73=2.7% with ECMO). • 13/73=17.8% were multiorgan transplants, (7/73=9.6% heart+lung, 5/73=6.8% heart+liver and 1/73=1.4% heart+liver+kidney).
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Overall Kaplan-Meier 1-year and 5-year survival was 86.3% (95%CI=78.8%-94.6%) and 75.1% (95%CI=65.4%-86.3%). No significant difference was observed in longitudinal survival between biventricular and univentricular ACHD patients at up to 15 years. Univentricular heart was not significantly associated with an increased risk of post-transplant mortality (HR=0.94 [95%CI=0.42-2.08],
p=0.872).
Conclusion: Univentricular patients had more prior cardiac operations, pre-transplant renal insufficiency, and pre-transplant liver dysfunction. Nevertheless, survival after cardiac transplantation is similar in the subsets of patients with biventricular ACHD and univentricular ACHD
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