Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience
OBJECTIVES Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality. ME...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2013-03, Vol.43 (3), p.605-611 |
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| container_title | European journal of cardio-thoracic surgery |
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| creator | Seddio, Francesco Gorislavets, Natalyia Iacovoni, Attilio Cugola, Diego Fontana, Alessandra Galletti, Lorenzo Terzi, Amedeo Ferrazzi, Paolo |
| description | OBJECTIVES
Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality.
METHODS
Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: 18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg.
RESULTS
Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67- and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors.
CONCLUSIONS
We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest thems |
| doi_str_mv | 10.1093/ejcts/ezs350 |
| format | Article |
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Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality.
METHODS
Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: <1 year (8 patients, Group I), 1-10 years (20 patients, Group II), 11-18 years (24 patients, Group III) and >18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg.
RESULTS
Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67- and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors.
CONCLUSIONS
We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezs350</identifier><identifier>PMID: 22733841</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Adolescent ; Adult ; Age Factors ; Analysis of Variance ; Child ; Child, Preschool ; Female ; Fontan Procedure ; Heart Defects, Congenital - epidemiology ; Heart Defects, Congenital - surgery ; Heart Transplantation - methods ; Heart Transplantation - mortality ; Humans ; Infant ; Italy - epidemiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2013-03, Vol.43 (3), p.605-611</ispartof><rights>The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-63dac59ce63a003690e99136b5bde1e2cb137df9630ed6a91ccee64936d1c1843</citedby><cites>FETCH-LOGICAL-c361t-63dac59ce63a003690e99136b5bde1e2cb137df9630ed6a91ccee64936d1c1843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22733841$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seddio, Francesco</creatorcontrib><creatorcontrib>Gorislavets, Natalyia</creatorcontrib><creatorcontrib>Iacovoni, Attilio</creatorcontrib><creatorcontrib>Cugola, Diego</creatorcontrib><creatorcontrib>Fontana, Alessandra</creatorcontrib><creatorcontrib>Galletti, Lorenzo</creatorcontrib><creatorcontrib>Terzi, Amedeo</creatorcontrib><creatorcontrib>Ferrazzi, Paolo</creatorcontrib><title>Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVES
Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality.
METHODS
Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: <1 year (8 patients, Group I), 1-10 years (20 patients, Group II), 11-18 years (24 patients, Group III) and >18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg.
RESULTS
Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67- and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors.
CONCLUSIONS
We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Analysis of Variance</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Fontan Procedure</subject><subject>Heart Defects, Congenital - epidemiology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Transplantation - methods</subject><subject>Heart Transplantation - mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Italy - epidemiology</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90D1PwzAQBmALgWgpbMzIGwyE2nHi1BOqKr6kSiwgsUWOfSmpEjvYjtTy60mbwsh0Nzz3SvcidEnJHSWCTWGtgp_Ct2cpOUJjOstYlLHk47jfCSVRJhIyQmferwkhnMXZKRrFccbYLKFjZF88_gTpAg5OGt_W0gQZKmtwaR1Wtmlr2PTTrMBUQdYHrCsP0gOWeGWtxrbdndzjOY7TaNsL7CuzqgErMMEBhk0LrgKj4BydlLL2cHGYE_T--PC2eI6Wr08vi_kyUozTEHGmpUqFAs4kIYwLAkJQxou00EAhVgVlmS4FZwQ0l4IqBcATwbimis4SNkE3Q27r7FcHPuRN5RXU_X9gO5_TeMZFkvI9vR2octZ7B2XeuqqRbptTku8qzvcV50PFPb86JHdFA_oP_3bag-sB2K79P-oHi0SH0w</recordid><startdate>201303</startdate><enddate>201303</enddate><creator>Seddio, Francesco</creator><creator>Gorislavets, Natalyia</creator><creator>Iacovoni, Attilio</creator><creator>Cugola, Diego</creator><creator>Fontana, Alessandra</creator><creator>Galletti, Lorenzo</creator><creator>Terzi, Amedeo</creator><creator>Ferrazzi, Paolo</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201303</creationdate><title>Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience</title><author>Seddio, Francesco ; Gorislavets, Natalyia ; Iacovoni, Attilio ; Cugola, Diego ; Fontana, Alessandra ; Galletti, Lorenzo ; Terzi, Amedeo ; Ferrazzi, Paolo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-63dac59ce63a003690e99136b5bde1e2cb137df9630ed6a91ccee64936d1c1843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Analysis of Variance</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Fontan Procedure</topic><topic>Heart Defects, Congenital - epidemiology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Transplantation - methods</topic><topic>Heart Transplantation - mortality</topic><topic>Humans</topic><topic>Infant</topic><topic>Italy - epidemiology</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seddio, Francesco</creatorcontrib><creatorcontrib>Gorislavets, Natalyia</creatorcontrib><creatorcontrib>Iacovoni, Attilio</creatorcontrib><creatorcontrib>Cugola, Diego</creatorcontrib><creatorcontrib>Fontana, Alessandra</creatorcontrib><creatorcontrib>Galletti, Lorenzo</creatorcontrib><creatorcontrib>Terzi, Amedeo</creatorcontrib><creatorcontrib>Ferrazzi, Paolo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seddio, Francesco</au><au>Gorislavets, Natalyia</au><au>Iacovoni, Attilio</au><au>Cugola, Diego</au><au>Fontana, Alessandra</au><au>Galletti, Lorenzo</au><au>Terzi, Amedeo</au><au>Ferrazzi, Paolo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2013-03</date><risdate>2013</risdate><volume>43</volume><issue>3</issue><spage>605</spage><epage>611</epage><pages>605-611</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>OBJECTIVES
Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality.
METHODS
Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: <1 year (8 patients, Group I), 1-10 years (20 patients, Group II), 11-18 years (24 patients, Group III) and >18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg.
RESULTS
Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67- and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors.
CONCLUSIONS
We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>22733841</pmid><doi>10.1093/ejcts/ezs350</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Age Factors Analysis of Variance Child Child, Preschool Female Fontan Procedure Heart Defects, Congenital - epidemiology Heart Defects, Congenital - surgery Heart Transplantation - methods Heart Transplantation - mortality Humans Infant Italy - epidemiology Kaplan-Meier Estimate Male Middle Aged Retrospective Studies Risk Factors Treatment Outcome |
| title | Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience |
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