Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA.
Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA.
Clin Transplant. 2021 Apr;35(4):e14229. doi: 10.1111/ctr.14229. Epub 2021 Mar 6.
Adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation are surgically complex due to anatomical abnormalities and multiple prior surgeries. In this study, we investigated these patients' outcomes using our institutional database.
ACHD patients who had prior intracardiac repair and subsequent heart transplant were included (2008-2018). Adult patients without ACHD were extracted as a control. A comparison of patients with functional single ventricular (SV) and biventricular (BV) hearts was performed.
There were 9 SV and 24 BV patients. The SV group had higher central venous pressure/pulmonary capillary wedge pressure (P = .028), hemoglobin concentration (P = .010), alkaline phosphatase (P = .022), and were more likely to have liver congestion (P = .006). Major complications included infection in 16 (48.5%), temporary dialysis in 12 (36.4%), and graft dysfunction requiring perioperative mechanical support in 7 (21.2%). Overall in-hospital mortality was 15.2%. Kaplan-Meier analysis showed a higher, but not statistically significant, survival after 10 years between the ACHD and control groups (ACHD 84.9% vs. control 67.5%, P = .429). There was no significant difference in 10-year survival between SV and BV groups (78% vs. 88%, P = .467).
Complex ACHD cardiac transplant recipients have a high incidence of early morbidities after transplantation. However, long-term outcomes were acceptable.
需要进行心脏原位移植的成人先天性心脏病（ACHD）患者由于解剖异常和多次既往手术而手术复杂。在这项研究中，我们使用机构数据库研究了这些患者的结局。
纳入了既往行心内修复术且随后行心脏移植的 ACHD 患者（2008-2018 年）。提取无 ACHD 的成人患者作为对照。比较了具有功能性单心室（SV）和双心室（BV）心脏的患者。
共有 9 例 SV 患者和 24 例 BV 患者。SV 组的中心静脉压/肺毛细血管楔压（P =.028）、血红蛋白浓度（P =.010）、碱性磷酸酶（P =.022）更高，且更有可能出现肝淤血（P =.006）。主要并发症包括 16 例（48.5%）感染、12 例（36.4%）临时透析和 7 例（21.2%）移植功能障碍需要围手术期机械支持。总住院死亡率为 15.2%。Kaplan-Meier 分析显示，ACHD 组和对照组 10 年后的生存率虽然较高，但无统计学意义（ACHD 84.9% vs. 控制组 67.5%，P =.429）。SV 和 BV 组 10 年生存率无显著差异（78% vs. 88%，P =.467）。
复杂 ACHD 心脏移植受者在移植后早期有很高的发病率。然而，长期结果是可以接受的。
