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Heart or heart-lung transplantation for patients with congenital heart disease in England

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Title: Heart or heart-lung transplantation for patients with congenital heart disease in England
Authors: Dimopoulos, K
Muthiah, K
Alonso-Gonzalez, R
Banner, NR
Wort, SJ
Swan, L
Constantine, AH
Gatzoulis, MA
Diller, GP
Kempny, A
Item Type: Journal Article
Abstract: BACKGROUND: Increased longevity in patients with congenital heart disease (CHD) is associated with late complications, mainly heart failure, which may not be amenable to redo surgery and become refractory to medical therapy and so, trigger referral for transplantation. We assessed the current role and future prospects of heart and heart-lung transplantation for patients with CHD in England. METHODS: We performed a retrospective analysis of hospital episodes for England for 1997-2015, identifying patients with a CHD code (ICD-10 'Q2xx.x'), who underwent heart or heart-lung transplantation. RESULTS: In total, 469 transplants (82.2% heart and 17.8% heart-lung) were performed in 444 patients. Half of patients transplanted had mild or moderate CHD complexity, this percentage increased with time (p=0.001). While overall, more transplantations were performed over the years, the proportion of heart-lung transplants declined (p<0.0001), whereas the proportion of transplants performed in adults remained static. Mortality was high during the first year, especially after heart-lung transplantation, but remained relatively low thereafter. Older age and heart-lung transplantation were strong predictors of death. While an increase in CHD transplants is anticipated, actual numbers in England seem to lag behind the increase in CHD patients with advanced heart failure. CONCLUSIONS: The current and future predicted increase in the numbers of CHD transplants does not appear to parallel the expansion of the CHD population, especially in adults. Further investment and changes in policy should be made to enhance the number of donors and increase CHD transplant capacity to address the increasing numbers of potential CHD recipients and optimise transplantation outcomes in this growing population.
Issue Date: 27-Mar-2019
Date of Acceptance: 6-Dec-2018
URI: http://hdl.handle.net/10044/1/67381
DOI: http://dx.doi.org/10.1136/heartjnl-2018-314262
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: 596
End Page: 602
Journal / Book Title: Heart
Volume: 105
Issue: 8
Copyright Statement: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
MECHANICAL CIRCULATORY SUPPORT
INTERNATIONAL SOCIETY
SCIENTIFIC STATEMENT
UNITED NETWORK
ADULTS
POPULATION
OUTCOMES
REGISTRY
AGE
GUIDELINES
congenital heart disease
survival
transplantation
Adult
Child
Databases, Factual
Disease Progression
England
Female
Heart Defects, Congenital
Heart Failure
Heart Transplantation
Heart-Lung Transplantation
Humans
Infant, Newborn
Male
Middle Aged
Mortality
Needs Assessment
Outcome and Process Assessment (Health Care)
Postoperative Complications
Reoperation
Retrospective Studies
Risk Factors
Humans
Heart Defects, Congenital
Disease Progression
Postoperative Complications
Heart Transplantation
Heart-Lung Transplantation
Reoperation
Mortality
Risk Factors
Retrospective Studies
Needs Assessment
Databases, Factual
Adult
Middle Aged
Child
Infant, Newborn
Outcome and Process Assessment (Health Care)
England
Female
Male
Heart Failure
congenital heart disease
survival
transplantation
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: England
Online Publication Date: 2019-01-12
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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