Outcomes of heart transplantation in adult congenital heart disease with prior intracardiac repair.

BACKGROUND The number of adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation has increased rapidly in past two decades. This study examines heart transplant outcomes of ACHD patients who had prior cardiac surgery using data from the United Network for Organ Sharing (UNOS) database. METHODS Between January 2008 and March 2019, ACHD patients who had prior cardiac surgery and subsequent heart transplant were identified from the UNOS database. As a control group, adult patients without congenital heart disease who had prior sternotomy and subsequent heart transplant were extracted. Propensity score matching was then used to compare outcomes between two groups. RESULTS There were 793 patients in the ACHD group and 8400 patients in the control group. Among well-matched groups of, 486 patients each, 30-day mortality (8.2% vs. 3.9%, p=0.004) and perioperative need of dialysis (22.7% vs. 13.3%, p<0.001) were significantly higher in ACHD group compared to control group. However, there was no difference in 10-year survival between groups (ACHD 66.0% vs. control 64.1%, log-rank p=0.353). CONCLUSIONS Compared with well-matched non-ACHD patients with prior sternotomy, ACHD patients with prior intracardiac repair had higher operative risk but similar 10-year survival.