Trending Heart Transplantation Outcomes In Complex Congenital Heart Disease Patients Over 38 Years
Jennifer Y. Yao, MD1, Warren A. Zuckerman, MD1, V. Reed LaSala, MD2, Marc E. Richmond, MD1, Andrew B. Goldstone, MD1, Emile A. Bacha, MD1, David Kalfa, MD1
1NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA, 2SUNY Downstate, New York, NY, USA.
Objective(s): Heart transplantation (HT) in patients with complex congenital heart disease (CCHD) carries unique challenges due to anatomical and clinical complexities. We reviewed long-term HT outcomes in pediatric CCHD patients from a single center.
Methods: Retrospective review was conducted on pediatric HT patients with CCHD and a comparison group of cardiomyopathy and non-complex CHD (primary septal defects and coarctation). Kaplan-Meier survival estimates through 3 eras (1984-2003, 2004-2012, 2013-2022) were performed. Within the CCHD group, multivariate analyses correlated demographic, intraoperative, and postoperative variables with mortality.
Results: Over 38 years, 189 pediatric CCHD and 365 non-CCHD patients underwent primary HT. Of the CCHD patients, 76% had single ventricle disease, 47% of patients required pulmonary artery reconstruction during HT, and median prior open-heart surgeries were 2 (1-3). Median patient survival was 26.7 years for non-CCHD and 15.7 years for CCHD patients (figure 1, p<0.01). CCHD patients in eras 2 and 3 had significantly higher mortality than non-CCHD patients (p<0.01). Multivariate analysis demonstrated female sex (HR 1.67 p<0.05), cardiopulmonary bypass (CPB) time (HR 1.006, p<0.01), and post-operative mechanical circulatory support (HR 4.15, p<0.01) significantly correlated with post-HT mortality in CCHD patients.
Conclusions: While pediatric HT outcomes continue to improve, CCHD patients continue to be a challenging population. Although longer CPB time was a mortality risk, factors such as age, pulmonary artery reconstruction, and number of prior open-heart surgeries were not. 
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