Cardiac transplantation for end-stage congenital heart defects: the Mayo Clinic experience. Mayo Cardiothoracic Transplant Team.

Abstract

OBJECTIVE:

To review the outcome of cardiac transplantation undertaken in patients with congenital heart defects.

MATERIAL AND METHODS:

Between November 1991 and March 1998 at our institution, cardiac transplantation was performed in 16 patients with congenital heart disease (age range, 3 to 57 years; mean, 26.1). Preoperative diagnoses included univentricular heart (N = 4); complete transposition of the great arteries (N = 3); Ebstein's anomaly (N = 2); tetralogy of Fallot (N = 2); levotransposition (N = 2); dextrocardia, corrected transposition, ventricular and atrial septal defects, and pulmonary stenosis (N = 1); double-outlet right ventricle (N = 1); and hypertrophic obstructive cardiomyopathy (N = 1). All patients had undergone from one to five previous palliative operations.

RESULTS:

Four patients required permanent pacemaker implantation during the first month postoperatively because of bradycardia; more than 2 years later, another patient required a permanent pacemaker because of sick sinus syndrome. In addition, one patient had an automatic implantable cardioverter-defibrillator. Three patients required reconstruction of cardiovascular structures with use of prosthetic material (Teflon patches or donor tissue) at the time of cardiac transplantation. Actuarial 1-, 2-, and 5-year survival was 86.2 +/- 9.1%. During the first year after transplantation, two deaths occurred--one at 41 days of putative vascular rejection and the second at 60 days of severe cellular rejection. All other patients are alive and functionally rehabilitated; the mean follow-up period has been 26.1 months (range, 2 to 89.6).

CONCLUSION:

Cardiac transplantation for patients with congenital heart disease can be accomplished with a low perioperative mortality and an excellent medium-term survival despite the challenges presented by the technical difficulties during invasive diagnostic procedures and at operation and the need for adherence to long-term multiple-drug therapy in this patient population.

• Authors: G Speziali, D J Driscoll, G K Danielson, P R Julsrud, C J Porter, J A Dearani, R C Daly, C G McGregor
• Journal: Mayo Clinic proceedings (Mayo Clin Proc) Vol. 73 Issue 10 Pg. 923-8 (Oct 1998) ISSN: 0025-6196 [Print] England
• PMID: 9787738 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents

Topics

• Actuarial Analysis
• Adolescent
• Adult
• Child
• Child, Preschool
• Female
• Graft Survival
• Heart Defects, Congenital (surgery)
• Heart Transplantation
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Reoperation
• Survival Analysis
• Treatment Outcome