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Bleiweis MS, Stukov Y, Sharaf OM, Fricker FJ, Peek GJ, Gupta D, Shih R, Pietra B, Purlee MS, Brown C, Kugler L, Neal D, Jacobs JP. An Analysis of 186 Transplants for Pediatric or Congenital Heart Disease: Impact of Pretransplant VAD. Ann Thorac Surg 2024; 117:1035-1043. [PMID: 37094611 DOI: 10.1016/j.athoracsur.2023.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND We reviewed our management strategy and outcome data for all 181 patients with pediatric or congenital heart disease who received 186 heart transplants from January 1, 2011, to March 1, 2022, and evaluated the impact of pretransplant ventricular assist device (VAD). METHODS Continuous variables are presented as mean (SD); median [interquartile range] (range). Categorical variables are presented as number (percentage). Univariable associations with long-term mortality were assessed with Cox proportional hazards models. Impact of pretransplant VAD on survival was estimated with multivariable models. RESULTS Pretransplant VAD was present in 53 of 186 transplants (28.5%). Patients with VAD were younger (years): 4.8 (5.6); 1 [0.5-8] (0.1-18) vs 12.1 (12.7); 10 [0.7-17] (0.1-58); P = .0001. Patients with VAD had a higher number of prior cardiac operations: 3.0 (2.3); 2 [1-4] (1-12) vs 1.8 (1.9); 2 [0-3] (0-8); P = .0003. Patients with VAD were also more likely to receive an ABO-incompatible transplant: 10 of 53 (18.9%) vs 9 of 133 (6.8%); P = .028. Univariable associations with long-term mortality included: In multivariable analysis, pretransplant VAD did not impact survival while controlling for each one of the factors shown in univariable analysis to be associated with long-term mortality. Kaplan-Meier 5-year survival (95% CI) was 85.8% (80.0%-92.1%) for all patients, 84.3% (77.2%-92.0%) without pretransplant VAD, and 91.1% (83.1%-99.9%) with pretransplant VAD. CONCLUSIONS Our single-institution analysis of 181 patients receiving 186 heart transplants for pediatric or congenital heart disease over 11.25 years reveals similar survival in patients with (n = 51) and without (n = 130) pretransplant VAD. The presence of a pretransplant VAD is not a risk factor for mortality after transplantation for pediatric or congenital heart disease.
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Affiliation(s)
- Mark Steven Bleiweis
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida.
| | - Yuriy Stukov
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Omar M Sharaf
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Frederick J Fricker
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Giles J Peek
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Dipankar Gupta
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Renata Shih
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Biagio Pietra
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Matthew S Purlee
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Colton Brown
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Liam Kugler
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Dan Neal
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Jeffrey Phillip Jacobs
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida
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Emerson D, Kim RW. Sensitization in Congenial Heart Transplantation: Moving the Needle. Ann Thorac Surg 2023; 115:742. [PMID: 36375496 DOI: 10.1016/j.athoracsur.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA 90048.
| | - Richard W Kim
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA 90048
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