Cardiac transplantation in adult patients with congenital heart disease

Introduction and objectives: Adult patients with congenital heart disease represent a small proportion of the heart transplant patient population. This group of patients has been traditionally associated with higher early mortality. In our institution the number of patients referred for cardiac transplant has increased in the last few years. A report of our experience is presented. Methods: A total of 508 cardiac transplants were performed in our institution between 1984 and 2014, with 16 (3%) of them being performed on adult patients with congenital heart disease. Characteristics of these patients were analysed and compared with transplants performed on patients with non-congenital heart disease. Results: Transposition of the great arteries was the most frequent disease in the group of patients with congenital heart disease. This group was younger, with less cardiovascular risk factors, and with higher incidence of previous cardiac surgery than the non-congenital group, all of them with statistically significant differences (P<.001 in all the cases). The survival of heart transplant patients with congenital heart disease was 87.5% (95% Cl: 58.60%-96.72%) at 1 year, 78.6% (95% Cl, 46.62%-92.79%) at 5 years, and 57.4% (95% CI; 24.07-80.57%) at 10 years. There was no differences between this group and the non-congenital group (P=.23). Conclusions: Although the number of patients with congenital heart disease referred to transplant programs has increased, they still represent a small proportion of heart transplant recipients. An accurate selection of candidates, surgical planning, and strictly controlled postoperative care, will contribute to reduce early mortality in heart transplantation in adult patients with congenital heart disease. (C) 2017 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cirugia Torkica-Cardiovascular. This is an open access article under the CC BY-NC-ND license