0135: Increasing severity and complexity in adults with congenital heart disease undergoing heart transplantation (ACHD): temporal trends – a collaborative study on 97 patients

Abstract

Residual abnormalities in cardiac structure and function predispose ACHD to late-onset heart failure and its complications. Therefore, heart transplantation (HT) in ACHD is increasingly used. Out of a multi-institutional (3 centers) series of 2257 HT from 1988 to 2012, 100 (4.4%) were performed in 97 ACHD (65 men). They represented 45% of ACHD recipients in France at that time. We investigated the role of temporal trends on profile and outcomes of ACHD recipients. Trends were compared between 2 eras: era 1 (1988-2005, n=48) and era 2 (2006-2012, n=49). Mean age at the time of HT was 29.8 years. Forty-three patients (44%) had univentricular physiology (1V). Severity of disease was categorized in terms of initial diagnosis (according to classification of 32th ACC Bethesda Conference): 74.2% had a great complexity cardiopathy while 21.7% had a moderate severity disease and 4.1% a simple CHD. In-hospital mortality was high (34%). Baseline characteristics did not differ significantly between the 2 eras. Era 2 recipients had less often right heart failure signs before HT. Their donors were older. They were more likely to be hospitalized, supported by inotropes and assist devices at the time of HT. The rate of 1V patients did not change over time: 50% in era 1 vs 39% in era 2 (p=0.27). The distribution of severity of disease changed significantly over time (p=0.048). The proportion of adult recipients with CHD of great complexity was higher in era 2 than era 1 (respectively 81.6% and 66.7%). In fact, transposition of the great arteries became the major provider of HT in adult in the recent era (30.6% in era 2 vs 8.3%, p=0.006), representing the only primary diagnosis whose proportion increased significantly. Multivariable factors associated with increased in-hospital mortality did not include transplant era. Despite a worse baseline risk profile, and increasing complexity of ACHD recipients in recent years, mortality after HT has not increased.