Long-term outcomes after heart transplantation in adult patients with univentricular versus biventricular congenital heart disease

Abstract

Abstract OBJECTIVE Heart transplantation (HT) is the only life-extending therapy in adults with congenital heart disease (CHD) and end-stage heart failure. HT is considered at high risk in complex CHD given the anatomical complexity and past medical history. Little is known about long-term outcomes after HT in these patients. We aimed to evaluate early and long-term outcomes after HT in adult patients with univentricular versus biventricular CHD. METHODS This multicentre retrospective cohort study included all adult CHD patients who underwent HT between 1988 and 2021 in 3 tertiary centers. Factors associated with early (<30 days) and conditional long-term survival were assessed in the entire cohort. RESULTS Over a mean follow-up of 10.1 ± 7.8 years, 149 patients were included, of whom 55 (36.9%) had univentricular CHD. Sixty-four patients died during follow-up including 47 deaths before discharge from hospital. In multivariable analysis, univentricular physiology and female recipient gender were independently associated with a higher risk of early mortality (OR 2.99; 95% CI [1.33– 6.74] and OR 2.76; 95% CI [1.23– 6.20], respectively). For patients who survive the early period, conditional long-term survival was excellent for both groups and was not different between two groups (p = 0.764). CONCLUSION Adult CHD patients have a high incidence of overall mortality due to a high rate of early mortality. Univentricular physiology was associated with a significant increased risk of early death compared to biventricular physiology. However late mortality was excellent and no longer different between the two physiologies.