Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Curr Opin Organ Transplant. 2024 Oct 1;29(5):305-309. doi: 10.1097/MOT.0000000000001170. Epub 2024 Jul 31.
The number of adult congenital heart disease (ACHD) patients presenting for consideration of heart transplantation continues to grow. Comprehensive pretransplant assessment and thoughtful patient selection are of critical importance to mitigate perioperative and posttransplant morbidity and mortality in this population.
There is increasing evidence that patient outcomes after the onset of heart failure in the ACHD population are poor while overall transplant outcomes for ACHD patients have improved over time. Delineation of factors associated with better versus worse posttransplant outcomes is an area of ongoing research. Several studies have found that delayed patient referral, anatomic complexity and the presence of noncardiac organ dysfunction may increase peri-transplant and posttransplant risk.
Pretransplant assessment and patient selection in ACHD patients should focus on mitigating perioperative and early posttransplant risk. Anatomic complexity, noncardiac organ dysfunction, and referral timing after the onset of heart failure can contribute to poor posttransplant outcomes and should inform patient selection.
成人先天性心脏病（ACHD）患者接受心脏移植治疗的人数持续增加。全面的移植前评估和细致的患者选择对于减轻该人群围手术期和移植后发病率和死亡率至关重要。
越来越多的证据表明，ACHD 人群心力衰竭发作后患者的预后较差，而随着时间的推移，ACHD 患者的整体移植预后有所改善。确定与移植后更好或更差结果相关的因素是正在进行的研究领域。几项研究发现，患者转诊延迟、解剖结构复杂以及存在非心脏器官功能障碍可能会增加围手术期和移植后的风险。
ACHD 患者的移植前评估和患者选择应侧重于减轻围手术期和移植后早期的风险。解剖结构复杂、非心脏器官功能障碍以及心力衰竭发作后的转诊时机可能导致移植后预后不良，应告知患者选择。
