Contemporary Outcomes of Heart Transplantation in Adult Patients with Congenital Heart Disease and Prior Intracardiac Repair: Analysis from UNOS Database

PURPOSE Number of adult congenital heart disease (ACHD) patients who require heart transplantation (HT) has increased. However, transplant rate for these patients has remained low. The potential reason of this phenomenon could be surgical complexity related to anatomical abnormalities and multiple prior surgeries. In this study, we sought to determine the HT outcomes of ACHD patients who had prior cardiac surgery using United Network for Organ Sharing (UNOS) database. METHODS Between January 2008 and March 2019, ACHD patients who had prior cardiac surgery and subsequent HT were identified from the UNOS database. As a control group, adult patients without congenital heart disease who had prior sternotomy and subsequent HT were extracted.Propensity score matching (PSM) was used to compare outcomes between two groups. RESULTS There were 793 ACHD group and 8400 control. Unadjusted comparison shows that ACHD were younger (p<.0001), gender female (p<.0001), and less likely to have diabetes mellitus (p<.0001), history of smoking (p<.0001), automatic implantable cardioverter and defibrillator implantation (p<.0001), and ventricular assist device support (p<.0001). PSM compared 403 patients in each group. 30-day mortality was significantly higher in ACHD group compared to control (12% vs. 8%, Log-rank p=0.039). ACHD group had higher incidence of postoperative dialysis (22% vs. 14%, p=0.0042) and permanent pacemaker (5.2 %vs. 2.2 %, p=0.026). There was no difference in long-term survival between groups (ACHD 68% vs. non ACHD 61% at 10 years, Log-rank p=0.49). CONCLUSION ACHD patients with prior intracardiac repair carried higher operative risk but long-term outcome was equivalent to non-ACHD patients with prior sternotomy.