Long-term outcomes after heart transplantation in adult patients with univentricular versus biventricular congenital heart disease

Eur J Cardiothorac Surg. 2024 Feb 1;65(2):ezad410. doi: 10.1093/ejcts/ezad410.

Nabil Dib  1 Laurence Iserin  2 Shaida Varnous  3 Romain Guillemain  4 Sebastien Hascoet  5   6 Emre Belli  1 Sarah Cohen  5   7

PMID: 38078813 DOI: 10.1093/ejcts/ezad410


Objectives: Heart transplantation (HT) is the only life-extending therapy in adults with congenital heart disease (CHD) and end-stage heart failure. HT is considered at high risk in complex CHD given the anatomical complexity and past medical history. Little is known about long-term outcomes after HT in these patients. We aimed to evaluate early and long-term outcomes after HT in adult patients with univentricular versus biventricular CHD.

Methods: This multicentre retrospective cohort study included all adult CHD patients who underwent HT between 1988 and 2021 in 3 tertiary centres. Factors associated with early (<30 days) and conditional long-term survival were assessed in the entire cohort.

Results: Over a mean follow-up of 10.1 ± 7.8 years, 149 patients were included, of whom 55 (36.9%) had univentricular CHD. Sixty-four patients died during follow-up including 47 deaths before discharge from hospital. In multivariable analysis, univentricular physiology and female recipient gender were independently associated with a higher risk of early mortality (odds ratio 2.99; 95% confidence interval [1.33-6.74] and odds ratio 2.76; 95% confidence interval [1.23-6.20], respectively). For patients who survived the early period, conditional long-term survival was excellent for both groups and was not different between 2 groups (P = 0.764).

Conclusions: Adult CHD patients have a high incidence of overall mortality due to a high rate of early mortality. Univentricular physiology was associated with a significant increased risk of early death compared to biventricular physiology. However, late mortality was excellent and no longer different between the 2 physiologies.

Keywords: Adult congenital heart disease; Cardiac physiology; Heart transplantation.

Lire plus