Analysis of 112 Patients With Congenital Heart Disease Undergoing Cardiac Transplantation: Impact of Pretransplant Ventricular Assist Device

Abstract

Background

We reviewed our management strategy and outcome data for all 112 patients with congenital heart disease (CHD) who underwent cardiac transplantation at University of Florida from January 2011, to January 2022, and evaluated the impact of a pretransplant ventricular assist device (VAD).

Methods

Continuous variables are presented as mean (SD); median [interquartile range] (range); categorical variables are presented as N (%). Univariable associations with long-term survival were assessed with Cox proportional hazards models. The impact of pretransplant VAD on survival was estimated with multivariable models.

Results

Pretransplant VAD was present in 24 of 112 patients who underwent cardiac transplantation (21.4%). Patients with a VAD were younger (years): 3.0 (3.8); 1 [0.5,6] (0.1,14) versus 12.9 (14.9); 9 [0.6,19] (0.1,58), P = .008. More patients with a VAD had prior cardiac operations: 24 of 24 (100%) versus 71 of 88 (80.7%), P = .021 and were more likely to receive an ABO-incompatible transplant: 6 of 24 (25%) versus 7 of 88 (8%), P = .032.

Univariable associations with long-term mortality include:

Number of prior cardiac surgeries-hazard ratio (HR) multiplies by 1.2 for each additional surgery (1.02-1.44), P = .029.

Pretransplant renal dysfunction - HR = 2.8 (1.21-6.68), P = .017.

Cardiopulmonary bypass (CPB) time at transplant: HR multiplies by 1.1 for each 10 min increase above the minimum CPB time in this series (1.03-1.19), P = .008.

In multivariable analysis, pretransplant VAD does not impact survival when controlling for each one of the factors shown in univariable analysis to be associated with long-term survival. Kaplan-Meier five-year survival (95% confidence interval) is 77.4% (68.4%-87.5%) for all patients; 76.5% (66.7%-87.9%) without pretransplant VAD and 84.3% (69.3%-99.9%) with pretransplant VAD (P = .436).

Conclusion

Our single-institution analysis of 112 patients with CHD undergoing cardiac transplantation over 11.25 years reveals similar survival in patients with (n = 24) and without (n = 88) pretransplant VAD. The presence of a pretransplant VAD is not a risk factor for survival after transplantation in patients with CHD.