Vidang P Nguyen1, Stephen J Dolgner2, Todd F Dardas3, Edward D Verrier4, D Michael McMullan5, Eric V Krieger6. 1. Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington. Electronic address: vidangnguyen@gmail.com. 2. Department of Pediatrics, University of Washington, Seattle, Washington; Division of Cardiology, Seattle Children's Hospital, Seattle, Washington. 3. Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington. 4. Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington. 5. Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington. 6. Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington; Division of Cardiology, Seattle Children's Hospital, Seattle, Washington.
Abstract
BACKGROUND: The number of adult congenital heart disease (CHD) patients undergoing heart transplantation is increasing rapidly. CHD patients have higher surgical risk at transplantation. High-volume adult CHD transplant centers may have better transplant outcomes. OBJECTIVES: This study aimed to evaluate the effect of center CHD transplant volume and expertise on transplant outcomes in CHD patients. METHODS: The authors studied heart transplantations in CHD patients age ≥18 years using the United Network of Organ Sharing (UNOS) database for the primary outcomes of waitlist mortality and post-transplant outcomes at 30 days and 1 year. Transplant centers were assessed by status as the highest CHD transplant volume center in a UNOS region versus all others, presence of Adult Congenital Heart Association accreditation, and adult versus pediatric hospital designation. RESULTS: Between January of 2000 and June of 2018, 1,746 adult CHD patients were listed for transplant; 1,006 (57.6%) of these underwent heart transplantation. After adjusting for age, sex, listing status, and inotrope requirement, waitlist mortality risk was lower at Adult Congenital Heart Association accredited centers (hazard ratio: 0.730; p = 0.020). Post-transplant 30-day mortality was lower at the highest volume CHD transplant center in each UNOS region (hazard ratio: 0.706; p = 0.014). CONCLUSIONS: Designated expertise in CHD care is associated with improved waitlist outcomes for CHD patients listed for transplantation. Post-transplant survival was improved at the highest volume regional center. These findings suggest a possible advantage of regionalization of CHD transplantation.
BACKGROUND: The number of adult congenital heart disease (CHD) patients undergoing heart transplantation is increasing rapidly. CHDpatients have higher surgical risk at transplantation. High-volume adult CHD transplant centers may have better transplant outcomes. OBJECTIVES: This study aimed to evaluate the effect of center CHD transplant volume and expertise on transplant outcomes in CHDpatients. METHODS: The authors studied heart transplantations in CHDpatients age ≥18 years using the United Network of Organ Sharing (UNOS) database for the primary outcomes of waitlist mortality and post-transplant outcomes at 30 days and 1 year. Transplant centers were assessed by status as the highest CHD transplant volume center in a UNOS region versus all others, presence of Adult Congenital Heart Association accreditation, and adult versus pediatric hospital designation. RESULTS: Between January of 2000 and June of 2018, 1,746 adult CHDpatients were listed for transplant; 1,006 (57.6%) of these underwent heart transplantation. After adjusting for age, sex, listing status, and inotrope requirement, waitlist mortality risk was lower at Adult Congenital Heart Association accredited centers (hazard ratio: 0.730; p = 0.020). Post-transplant 30-day mortality was lower at the highest volume CHD transplant center in each UNOS region (hazard ratio: 0.706; p = 0.014). CONCLUSIONS: Designated expertise in CHD care is associated with improved waitlist outcomes for CHDpatients listed for transplantation. Post-transplant survival was improved at the highest volume regional center. These findings suggest a possible advantage of regionalization of CHD transplantation.
Authors: Christoph Sinning; Elvin Zengin; Gerhard-Paul Diller; Francesco Onorati; María-Angeles Castel; Thibault Petit; Yih-Sharng Chen; Mauro Lo Rito; Carmelina Chiarello; Romain Guillemain; Karine Nubret-Le Coniat; Christina Magnussen; Dorit Knappe; Peter Moritz Becher; Benedikt Schrage; Jacqueline M Smits; Andreas Metzner; Christoph Knosalla; Felix Schoenrath; Oliver Miera; Mi-Young Cho; Alexander Bernhardt; Jessica Weimann; Alina Goßling; Amedeo Terzi; Antonio Amodeo; Sara Alfieri; Emanuela Angeli; Luca Ragni; Carlo Pace Napoleone; Gino Gerosa; Nicola Pradegan; Inez Rodrigus; Julia Dumfarth; Michel de Pauw; Katrien François; Olivier Van Caenegem; Arnaut Ancion; Johan Van Cleemput; Davor Miličić; Ajay Moza; Peter Schenker; Josef Thul; Michael Steinmetz; Gregor Warnecke; Fabio Ius; Susanne Freyt; Murat Avsar; Tim Sandhaus; Assad Haneya; Sandra Eifert; Diyar Saeed; Michael Borger; Henryk Welp; László Ablonczy; Bastian Schmack; Arjang Ruhparwar; Shiho Naito; Xiaoqin Hua; Nina Fluschnik; Moritz Nies; Laura Keil; Juliana Senftinger; Djemail Ismaili; Shinwan Kany; Dora Csengeri; Massimo Cardillo; Alessandra Oliveti; Giuseppe Faggian; Richard Dorent; Carine Jasseron; Alicia Pérez Blanco; José Manuel Sobrino Márquez; Raquel López-Vilella; Ana García-Álvarez; María Luz Polo López; Alvaro Gonzalez Rocafort; Óscar González Fernández; Raquel Prieto-Arevalo; Eduardo Zatarain-Nicolás; Katrien Blanchart; Aude Boignard; Pascal Battistella; Soulef Guendouz; Lucile Houyel; Marylou Para; Erwan Flecher; Arnaud Gay; Éric Épailly; Camille Dambrin; Kaitlyn Lam; Cally Ho Ka-Lai; Yang Hyun Cho; Jin-Oh Choi; Jae-Joong Kim; Louise Coats; David Steven Crossland; Lisa Mumford; Samer Hakmi; Cumaraswamy Sivathasan; Larissa Fabritz; Stephan Schubert; Jan Gummert; Michael Hübler; Peter Jacksch; Andreas Zuckermann; Günther Laufer; Helmut Baumgartner; Alessandro Giamberti; Hermann Reichenspurner; Paulus Kirchhof Journal: ESC Heart Fail Date: 2021-09-12