Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS)

Everitt, Melanie D.; Donaldson, Amy; Stehlik, Josef; Kaza, Aditya K.; Budge, D.; Alharethi, Rami; Bullock, Emily A.; Kfoury, Abdallah G.; Yetman, Anji T.

doi:10.1016/j.healun.2010.09.008

Cited by 108 publications

(74 citation statements)

References 40 publications

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“…This, combined with limited high-risk mechanical support options to bridge to OHT and unrelenting progression of physiological failure, should prompt early consideration of transplantation in apparently stable patients (17). Markers used to assess progression of ventricular failure in acquired heart failure are not predictive in SV physiology, nor do they indicate the degree of pulmonary vasculature abnormalities, cyanosis, collaterals, liver and kidney impairment, protein losing enteropathy (PLE), plastic bronchitis (PB) or other systemic consequences.…”

Section: Listingmentioning

confidence: 99%

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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The single ventricle patient population comprises the most complex cohort presenting to the cardiac transplant team, in terms of demographics, anatomic substrate, and unique physiology. It is also the most rapidly growing diagnostic group presenting for heart transplantation. In this manuscript, we aim to describe the changing landscape of transplantation in single ventricle conditions through reflection on our own institution's practice and experience, alongside contemporary literature review. Single ventricle patients are heterogeneous in terms of age, anatomic diagnosis and physiology according to surgical stage of repair.Progress in surgical palliative strategies has impacted upon the present composition of the population, with growing numbers of hypoplastic left heart syndrome patients and those with late physiology failure following Fontan completion. Multiple prior surgeries, immunological sensitivity and multi-organ involvement impart high peri-operative risk but can be mitigated in part by careful pre-operative planning by a dedicated multidisciplinary team addressing issues such as planning of concurrent reconstructive surgery, minimizing the post-operative effect of collaterals, timely harvesting, oversizing of donor organs to minimize graft failure, and strategies to address anticipated post-operative elevation in pulmonary vascular resistance. Determining optimal timing for transplant in these patients remains unclear, but understanding the risk of alternative surgical options can help guide decision making with regards to listing.

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Section: Listingmentioning

confidence: 99%

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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“…6 Despite this, adults with CHD are less likely to receive implantable cardioverterdefibrillator therapy, more likely to be listed at lower urgency status, less likely to have a status upgrade, and less likely to receive a transplant at any given time after listing than patients without CHD. 7,8 Although there are limited outcome data, ACHD patients are also less likely to receive a ventricular assist device (VAD) as a bridge to transplantation. Moreover, listed ACHD patients are more likely to experience cardiovascular death (including sudden death and death caused by HF) than adults with acquired HF.…”

Section: Overviewmentioning

confidence: 99%

“…Moreover, listed ACHD patients are more likely to experience cardiovascular death (including sudden death and death caused by HF) than adults with acquired HF. 7 There has been a significant increase in MCS use in patients with acquired HF as a bridge to transplantation (17%) 8 ; however, there has been little change in MCS use in ACHD patients, with only 3% receiving a VAD at the time of transplantation 8 and a higher mortality in patients receiving MCS independent of the type of support. 9 …”

Section: Overviewmentioning

confidence: 99%

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Ross¹,

Law²,

Book³

et al. 2016

Circulation

Self Cite

123

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“…(78,90) As discussed above, univentricular hearts account for the greatest number of CHD referrals for transplant. Thus, there has been much interest in the benefit of VADs in this growing population.…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

Management of advanced adult congenital heart disease

Bowater

2017

SAHJ

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As surgical techniques continue to develop, for example as seen with the Norwood procedure for hypoplastic left heart syndrome, the number of patients with the most complex forms of CHD will continue to increase along with their associated long term complications. Our ability to manage these patients appropriately, therefore, must also develop alongside. The purpose of this review is to examine the management of these patients once they have developed advanced disease, including drug therapy, devices, transplant and end of life care. In particular, the unique problems posed by patients with a systemic right ventricle (RV) and univentricular circulations are discussed. DRUG THERAPY IN HEART FAILUREIn patients with complex congenital heart disease, either palliated or unoperated, the development of ventricular dysfunction and clinical heart failure are common and as discussed above, is a common cause of morbidity and mortality in this population.

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Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS)

Cited by 108 publications

References 40 publications

Transplantation in the single ventricle population

Transplantation in the single ventricle population

Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

Management of advanced adult congenital heart disease

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