Analysis of 186 Transplants for Pediatric or Congenital Heart Disease: Impact of Pre-Transplant VAD

We reviewed our management strategy and outcome data for all 181 patients with pediatric and/or congenital heart disease who underwent 186 heart transplants from 01/01/2011-03/01/2022 and evaluated the impact of pre-transplant VAD.Continuous variables are presented as mean(SD); median[interquartile range](range); categorical variables are presented as N(%). Univariate associations with long-term survival were assessed with Cox proportional hazards models. Impact of pre-transplant VAD on survival was estimated with multivariable models.Pre-transplant VAD was present in 53/186 transplants(28.5%). Patients with VAD were younger (years): 4.8(5.6);1[0.5,8](0.1,18) versus 12.1(12.7);10[0.7,17](0.1,58),P=0.0001. Patients with VAD had a higher number of prior cardiac operations: 3.0(2.3); 2[1,4](1,12) versus 1.8(1.9); 2[0,3](0,8),P=0.0003; and were more likely to receive an ABO-incompatible transplant: 10/53(18.9%) versus 9/133(6.8%),P=0.028. Univariate associations with long-term mortality include: • Prior cardiac surgery-HR=6.0(1.41-25.4),P=0.015 • Number of prior cardiac surgeries-HR multiplies by 1.3 for each additional surgery (1.12-1.50),P=0.0004 • Functionally univentricular heart-HR=2.4(1.05-5.49),P=0.038 • Congenital heart disease (versus acquired)-HR=5.7(1.69-18.9),P=0.005 • Pre-transplant renal dysfunction-HR=3.4(1.54,7.48),P=0.003 In multivariate analysis, pre-transplant VAD does not impact survival when controlling for each one of the factors shown in univariable analysis to be associated with long-term survival. Kaplan-Meier 5-year survival (95% Confidence Interval) is 85.8%(80.0%-92.1%) for all patients, 84.3%(77.2%-92.0%) without pre-transplant VAD, and 91.1%(83.1%-99.9%) with pre-transplant VAD.Our single-institution analysis of 181 patients undergoing 186 cardiac transplants for pediatric and/or congenital heart disease over 11.25 years reveals similar survival in patients with (n=51) and without (n=130) pre-transplant VAD. The presence of a pre-transplant VAD is not a risk factor for survival after transplantation for pediatric and/or congenital heart disease.