Transplantation in Congenital Heart Disease: A Challenge

Hemodynamic Melody of Postnatal Cardiac and Pulmonary Development in Children with Congenital Heart Diseases

Hemodynamics is the eternal theme of the circulatory system. Abnormal hemodynamics and cardiac and pulmonary development intertwine to form the most important features of children with congenital heart diseases (CHDs), thus determining these children's long-term quality of life. Here, we review the varieties of hemodynamic abnormalities that exist in children with CHDs, the recently developed neonatal rodent models of CHDs, and the inspirations these models have brought us in the areas of cardiomyocyte proliferation and maturation, as well as in alveolar development. Furthermore, current limitations, future directions, and clinical decision making based on these inspirations are highlighted. Understanding how CHD-associated hemodynamic scenarios shape postnatal heart and lung development may provide a novel path to improving the long-term quality of life of children with CHDs, transplantation of stem cell-derived cardiomyocytes, and cardiac regeneration.

Heart transplantation in adults with congenital heart disease: a 17-year single center experience

BACKGROUND

Heart transplantation (HTx) in adults with congenital heart disease (ACHD) remains challenging because of structural anomalies and often previous procedure. The aim of this retrospective study was to describe the outcomes of heart transplantation (HTx) in a cohort of ACHD patients at our tertiary centre.

PATIENTS AND METHODS

Between January 1993 and December 2010, 223 consecutive adult patients (age > 18 years) underwent HTx at our institution. Fifteen (6.7%) were ACHD patients. Outcomes were reviewed using our institution's HTx database. We looked at 30-day, 1, 5 and 10-years survival, as well as post-transplantation complications.

RESULTS

The mean age at HTx of the groups of ACHD was 42 ± 14.4 years, vs 54.2 ± 9.8 years for the non-CHD patients. Prior to transplant, thirteen of the fifteen ACHD had undergone one or more surgical procedures including palliative or corrective open-heart procedures in 66.6% of them. Seven of the fifteen ACHD (47%) required additional surgical procedures at transplantation. The mean follow-up was 95,44 ± 84.3 months. There was no significant difference in survival (ACHD vs non-CHD) at 30 days (87% vs. 90%), 1 year (73% vs. 74.5%) or 5 years (53% vs. 55%). Survival at 10 years was respectively 53% and 41% for ACHD patients and non-CHD patients.

CONCLUSION

Despite the surgical challenge, HTx in ACHD has a good long-term result. However, the small sample size of our cohort limits any definitive conclusions.