Impact of Congenital Heart Disease Versus Acquired Heart Disease: An Analysis of 181 Patients who Underwent Cardiac Transplantation

Abstract

Purpose

We reviewed all 181 patients with pediatric and/or congenital heart disease (CHD) who underwent cardiac transplantation at the University of Florida from January 1, 2011, to March 1, 2022, and compared those with CHD with those who had acquired heart disease (AHD).

Methods

Patient characteristics were assessed, stratified by CHD versus AHD. Continuous variables are presented as mean (SD); median[interquartile range](range). Categorical variables are presented as N (%). Univariable associations with long-term mortality were assessed with a Cox proportional-hazards model. The impact of CHD versus AHD on mortality was estimated with multivariable models. The Kaplan-Meier method was applied to estimate survival stratified by CHD versus AHD status.

Results

Congenital heart disease was present in 112/181 patients = 61.9% of the total cohort. Acquired heart disease was present in 69/181 = 38.1%. More patients with CHD had prior cardiac surgery (95/112 = 84.8% vs 35/69 = 50.7%, P < .0001) and pretransplant liver dysfunction (19/112 = 17.0% vs 4/69 = 5.8%, P = .037). Congenital heart disease patients had longer bypass times (minutes): 148 (55.2); 137 [113-174] (72-526) versus 108 (40.3);101 [81-125] (59-300), P < .0001; longer cross clamp time (minutes): 85.9 (21.2); 85 [73-100] (49-152) versus 66.3 (14.7); 65 [55-75] (44-106), P < .0001; and lower minimum temperature on bypass (°C): 27.4 (4.3); 28 [24-31] (19-34) versus 31.6 (3.1); 32 [31-34] (20-36), P < .0001. Posttransplant length of stay (days) was longer in CHD patients: 34.5 (26.8); 27 [19-40] (3-158) versus 29.7 (48.2); 18 [15-26] (0-343), P = .0001. In multivariable analysis, CHD remained a risk factor for mortality after controlling for all variables significant in univariable modeling. Overall Kaplan-Meier 5-year survival in all 181 patients (95% confidence interval) = 85.8% (80.0%-92.1%). Kaplan-Meier 5-year survival = 77.4% (68.4%-87.5%) in CHD and 98.5% (95.6%-99.9%) in AHD, P < .0001.

Conclusion

Congenital heart disease is a risk factor for mortality after cardiac transplantation. Efforts must be made to understand and mitigate this risk.