Long‐Term outcomes in adult patients with congenital heart disease considered for transplantation: A single center study

Abstract

AbstractBackgroundAdult congenital heart disease (ACHD) patients pose unique challenges in identifying the time for transplantation and factors influencing outcomes.ObjectiveTo identify hemodynamic, functional, and laboratory parameters that correlate with 1‐ and 10‐year outcomes in ACHD patients considered for transplantation.MethodsA retrospective chart review of long‐term outcomes in adult patients with congenital heart disease (CHD) evaluated for heart or heart + additional organ transplant between 2004 and 2014 at our center was performed. A machine learning decision tree model was used to evaluate multiple clinical parameters correlating with 1‐ and 10‐year survival.ResultsWe identified 58 patients meeting criteria. D‐transposition of the great arteries (D‐TGA) with atrial switch operation (20.7%), tetralogy of Fallot/pulmonary atresia (15.5%), and tricuspid atresia (13.8%) were the most common diagnosis for transplant. Single ventricle patients were most likely to be listed for transplantation (39.8% of evaluated patients). Among a comprehensive list of clinical factors, invasive hemodynamic parameters (pulmonary capillary wedge pressure (PCWP), systemic vascular pressure (SVP), and end diastolic pressures (EDP) most correlated with 1‐ and 10‐year outcomes. Transplanted patients with SVP < 14 and non‐ transplanted patients with PCWP < 15 had 100% survival 1‐year post‐transplantation.ConclusionFor the first time, our study identifies that hemodynamic parameters most strongly correlate with 1‐ and 10‐year outcomes in ACHD patients considered for transplantation, using a data‐driven machine learning model.