The Canadian journal of cardiology · 2025
Outcomes After Heart Transplantation in Adults With Congenital Heart Disease-A Single-Center Experience.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Younis Ahmed, ElZalabany Sara, Miranda William R, Connolly Heidi M, Dearani Joseph A, Villavicencio Mauricio T, Egbe Alexander C
Аннотация
BACKGROUND: The purpose of this study was to describe outcomes after heart transplantation in adults with congenital heart disease (CHD) based on the experience from a high-volume transplant centre.
METHOD: We undertook a retrospective cohort study of adults with CHD who underwent heart transplantation at Mayo Clinic, Rochester, Minnesota (2003-2024).
RESULTS: Of 89 patients (median age 40 years [interquartile range 9-66 years], 52% male) who underwent heart transplantation, 67 (75%) had biventricular physiology and 22 (25%) had Fontan physiology. Fifty (56%) and 39 (44%) received single organ vs multi-organ transplants, respectively. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late era (after December 31, 2013): 31% (21/67) vs 5% (1/22); P = 0.005. The 30-day, 1-year, and 5-year survival rates were 97% (95% CI 97%-99%), 91% (95% CI 87%-95%), and 87% (95% CI 82%-92%), respectively, and these rates were higher than the estimates from national registries. Patients with Fontan physiology had lower post-transplantation survival compared with those with biventricular physiology, but Fontan physiology was not an independent predictor of mortality. The predictors of post-transplantation mortality were longer cardiopulmonary bypass time, mechanical ventilation duration, and postoperative mechanical circulatory support.
CONCLUSIONS: We observed a higher post-transplantation survival compared with historical estimates. Post-transplantation mortality was related to operative and postoperative factors, and not to CHD physiology. There was a high proportion of patients requiring multi-organ transplantation, and a rising proportion of patients with Fontan physiology who underwent transplantation in the later part of the study. These findings highlight important demographic changes, the importance of institutional expertise, and the need for improvements in risk stratification and referral patterns to align with these changes.
METHOD: We undertook a retrospective cohort study of adults with CHD who underwent heart transplantation at Mayo Clinic, Rochester, Minnesota (2003-2024).
RESULTS: Of 89 patients (median age 40 years [interquartile range 9-66 years], 52% male) who underwent heart transplantation, 67 (75%) had biventricular physiology and 22 (25%) had Fontan physiology. Fifty (56%) and 39 (44%) received single organ vs multi-organ transplants, respectively. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late era (after December 31, 2013): 31% (21/67) vs 5% (1/22); P = 0.005. The 30-day, 1-year, and 5-year survival rates were 97% (95% CI 97%-99%), 91% (95% CI 87%-95%), and 87% (95% CI 82%-92%), respectively, and these rates were higher than the estimates from national registries. Patients with Fontan physiology had lower post-transplantation survival compared with those with biventricular physiology, but Fontan physiology was not an independent predictor of mortality. The predictors of post-transplantation mortality were longer cardiopulmonary bypass time, mechanical ventilation duration, and postoperative mechanical circulatory support.
CONCLUSIONS: We observed a higher post-transplantation survival compared with historical estimates. Post-transplantation mortality was related to operative and postoperative factors, and not to CHD physiology. There was a high proportion of patients requiring multi-organ transplantation, and a rising proportion of patients with Fontan physiology who underwent transplantation in the later part of the study. These findings highlight important demographic changes, the importance of institutional expertise, and the need for improvements in risk stratification and referral patterns to align with these changes.