Peter Moritz Becher1, Benedikt Schrage2, Jessica Weimann3, Jacqueline Smits4, Christina Magnussen2, Hermann Reichenspurner5, Alina Goßling3, Inez Rodrigus6, Julia Dumfarth7, Michel de Pauw8, Katrien François9, Olivier van Caenegem10, Arnaut Ancion11, Johan Van Cleemput12, Davor Milicic13, Ajay Moza14, Peter Schenker15, Luise Röhrich16, Felix Schönrath16, Josef Thul17, Michael Steinmetz18, Bastian Schmack19, Arjang Ruhparwar19, Gregor Warnecke20, Sebastian V Rojas20, Tim Sandhaus21, Assad Haneya22, Sandra Eifert23, Henryk Welp24, László Ablonczy25, Florian Wagner26, Dirk Westermann2, Alexander M Bernhardt26, Dorit Knappe3, Stefan Blankenberg2, Paulus Kirchhof27, Elvin Zengin3, Christoph Sinning2. 1. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany. Electronic address: m.becher@uke.de. 2. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany. 3. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany. 4. Eurotransplant, Leiden, The Netherlands. 5. Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany. 6. Department of Cardiovascular Surgery, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium. 7. Department of Cardiovascular Surgery, University of Innsbruck, Innsbruck, Austria. 8. Departments of Cardiology. 9. Cardiovascular Surgery, Universitair Ziekenhuis Gent, Gent, Belgium. 10. Department of Cardiac Research, Université Catholique de Louvain Clinique Saint-Luc, Brussels, Belgium. 11. Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium. 12. Department of Cardiology, Universitair Ziekenhuis Leuven, Leuven, Belgium. 13. Department of Cardiology, Medical Faculty University of Zagreb, Zagreb, Croatia. 14. Department of Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany. 15. Department of Surgery, University Hospital Bochum, Bochum, Germany. 16. Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. 17. Department of Pediatric Cardiology, University Hospital Giessen/Marburg, Giessen, Germany. 18. Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany; Partner Site Göttingen, German Centre of Cardiovascular Research (DZHK), Berlin, Germany. 19. Department of Cardiovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany. 20. Department of Cardiovascular Surgery, University Hospital Hannover, Hannover, Germany. 21. Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany. 22. Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany. 23. Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany. 24. Department of Cardiovascular Surgery, University Hospital Münster, Münster, Germany. 25. Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 26. Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany. 27. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany; University Hospital Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom; SWBH and UHB NHS Trusts, Birmingham, United Kingdom.
Abstract
BACKGROUND: The therapeutic success in patients with congenital heart disease (CHD) leads to a growing number of adults with CHD (adult CHD [ACHD]) who develop end-stage heart failure. We aimed to determine patient characteristics and outcomes of ACHD listed for heart transplantation. METHODS: Using data from all the patients with ACHD in 20 transplant centers in the Eurotransplant region from 1999 to 2015, we analyzed patient characteristics, waiting list, and post-transplantation outcomes. RESULTS: A total of 204 patients with ACHD were listed during the study period. The median age was 38 years, and 62.3% of the patients were listed in high urgency (HU), and 37.7% of the patients were in transplantable (T)-listing status. A total of 23.5% of the patients died or were delisted owing to clinical worsening, and 75% of the patients underwent transplantation. Median waiting time for patients with HU-listing status was 4.18 months and with T-listing status 9.07 months. There was no difference in crude mortality or delisting between patients who were HU status listed and T status listed (p = 0.65). In multivariable regression analysis, markers for respiratory failure (mechanical ventilation, hazard ratio [HR]: 1.41, 95% CI: 1.11-1.81, p = 0.006) and arrhythmias (anti-arrhythmic medication, HR: 1.42, 95% CI: 1.01-2.01, p = 0.044) were associated with a higher risk of death or delisting. In the overall cohort, post-transplantation mortality was 26.8% after 1 year and 33.4% after 5 years. CONCLUSIONS: Listed patients are at high risk of death without differences in the urgency of listing. Respiratory failure requiring invasive ventilation and possibly arrhythmias requiring anti-arrhythmic medication indicate worse outcomes on waiting list.
BACKGROUND: The therapeutic success in patients with congenital heart disease (CHD) leads to a growing number of adults with CHD (adult CHD [ACHD]) who develop end-stage heart failure. We aimed to determine patient characteristics and outcomes of ACHD listed for heart transplantation. METHODS: Using data from all the patients with ACHD in 20 transplant centers in the Eurotransplant region from 1999 to 2015, we analyzed patient characteristics, waiting list, and post-transplantation outcomes. RESULTS: A total of 204 patients with ACHD were listed during the study period. The median age was 38 years, and 62.3% of the patients were listed in high urgency (HU), and 37.7% of the patients were in transplantable (T)-listing status. A total of 23.5% of the patients died or were delisted owing to clinical worsening, and 75% of the patients underwent transplantation. Median waiting time for patients with HU-listing status was 4.18 months and with T-listing status 9.07 months. There was no difference in crude mortality or delisting between patients who were HU status listed and T status listed (p = 0.65). In multivariable regression analysis, markers for respiratory failure (mechanical ventilation, hazard ratio [HR]: 1.41, 95% CI: 1.11-1.81, p = 0.006) and arrhythmias (anti-arrhythmic medication, HR: 1.42, 95% CI: 1.01-2.01, p = 0.044) were associated with a higher risk of death or delisting. In the overall cohort, post-transplantation mortality was 26.8% after 1 year and 33.4% after 5 years. CONCLUSIONS: Listed patients are at high risk of death without differences in the urgency of listing. Respiratory failure requiring invasive ventilation and possibly arrhythmias requiring anti-arrhythmic medication indicate worse outcomes on waiting list.
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