Heart transplantation for adult CHD: Overview and special considerations

June 11, 2018, Cardiovascular Innovations and Applications

In the current issue of Cardiovascular Innovations and Applications , Dipankar Gupta, Jana Reid, Diego Moguillansky, Renata Shih, Mark S. Bleiweis, Frederick J. Fricker and Biagio A. Pietra from the Congenital Heart Center, Department of Pediatrics, UF Health Shands Children's Hospital, University of Florida, Gainesville, FL, USA consider how with improvements in surgical and medical management, the number of patients with congenital heart disease (CHD) reaching adulthood has increased over the last decade.

Success in the management of (CHD) in the young is leading to an increasing number of heart transplants in adults with CHD. CHD has an incidence of 0.8-1%, translating to approximately 40,000 newborns per year. With improving surgical and interventional techniques and medical management, approximately 90% of children with CHD survive to adulthood. On the basis of a recent study, there are approximately 2.4 million people in the United States with CHD. On the basis of this study, the estimated number of adults with CHD in the United States is approximately 1.4 million. The population of adults with CHD in 2010 demonstrated a 63% increase when compared with the estimates from 2000, making it the fastest growing population in congenital cardiology. In addition, approximately 300,000 patients of the 1.4 million adults with CHD have evidence of severe CHDs. Adult CHD (ACHD) is associated with multiple morbidities secondary to the original anatomic substrate, multiple palliative procedures, and associated complications. Unfortunately, despite improved surgical and , approximately 10-20% patients with CHD progress to end-stage heart failure as adults, and it is the most common cause of late death in patients with ACHD.

The cohort of ACHD patients is increasing significantly. There is a high likelihood for the need for heart transplantation as these patients develop chronic failure and other chronic sequelae of palliated CHD. It is important to recognize advanced and other associated complications early in this cohort of complex patients for early referral to an ACHD specialist. Because of the presence of multiple factors that can affect the long-term outcomes, there needs to be a careful selection process for transplantation to optimize the utilization of donor organs. Our experience with transplantation in ACHD demonstrates excellent short-term outcomes; however, the timing of transplantation is a huge challenge, mostly related to other end-organ dysfunction. Further studies are needed to continue to improve the outcomes after transplantation.

Explore further: Left ventricular systolic function after pulmonary valve replacement

More information: Dipankar Gupta et al, Heart Transplantation for Adult Congenital Heart Disease: Overview and Special Considerations, Cardiovascular Innovations and Applications (2018). DOI: 10.15212/CVIA.2017.0043

Related Stories

Left ventricular systolic function after pulmonary valve replacement

June 11, 2018
In the current issue of Cardiovascular Innovations and Applications , Ali N. Zaidi and W. Aaron Kay from Columbus Ohio Adult Congenital Heart Disease Program, The Heart Center, Nationwide Children's Hospital and Division ...

Researchers report successful cardiac transplant outcomes in adult patients with congenital heart disease

April 4, 2016
Congenital heart disease, which includes various conditions involving defects in the structure of the heart or blood vessels that develop before birth, affects nearly 1 percent of children - about 40,000 babies each year. ...

The Fontan circulation—Contemporary review of ongoing challenges and management strategies

June 11, 2018
In the current issue of Cardiovascular Innovations and Applications , researchers Ahmed Kheiwa, Anushree Agarwal and Anitha John from the Division of Cardiology, Department of Medicine, University of California San Francisco, ...

Congenital heart defects linked to increased risk of dementia

February 13, 2018
Being born with a heart defect may raise the odds of later developing dementia, especially early-onset dementia, a new study finds.

Atrial arrhythmias including atrial fibrillation in congenital heart disease

June 11, 2018
In the current issue of Cardiovascular Innovations and Applications , Jerold S. Shinbane and Philip M. Chang from the Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, ...

Mortality still high after surgery for congenital heart defects

May 25, 2018
(HealthDay)—Long-term mortality after congenital heart surgery is higher than that of the general population for all forms of congenital heart defects (CHDs), according to a study published in the May 29 issue of the Journal ...

Recommended for you

Rethinking the stroke rule 'time is brain'

August 13, 2018
In 1993, neurologist Camilo R. Gomez, MD, coined a phrase that for a quarter century has been a fundamental rule of stroke care: "Time is brain!"

High oxidative stress hampers males' production of powerful blood vessel dilator

August 13, 2018
Higher levels of oxidative stress in males results in lower levels of a cofactor needed to make the powerful blood vessel dilator nitric oxide, researchers report.

Epigenetic reprogramming of human hearts found in congestive heart failure

August 9, 2018
Congestive heart failure is a terminal disease that affects nearly 6 million Americans. Yet its management is limited to symptomatic treatments because the causal mechanisms of congestive heart failure—including its most ...

Older adults who get physical can lower their heart disease risk

August 8, 2018
Adults in their early 60s, who spend less time sitting and more time engaged in light to vigorous physical activity, benefit with healthier levels of heart and vessel disease markers, according to new research in Journal ...

Cardiac progenitor cells undergo a cell fate switch to build coronary arteries

August 7, 2018
Cells switch fates and acquire new identities during organogenesis and regeneration as a critical trait, although the mechanisms underlying such conversions are poorly understood. The vasculature provides a biological model ...

Taking a pill can effectively treat brutal lung disease

August 7, 2018
Researchers report in Nature Communications they figured out why air sacs in the lungs clog up with a thick substance called surfactant in a brutal disease called Pulmonary Alveolar Proteinosis (PAP), and they show taking ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.