Single-ventricle CHD tied to poorer survival after heart transplant

Single-ventricle physiology appears to predict higher short-term mortality among adult transplant recipients with coronary heart disease (CHD), suggests a study.

“However, 10-year conditional survival was similar for biventricular and most single-ventricle CHD patients, and notably better for biventricular CHD patients compared to non-CHD heart transplant recipients,” the investigators said.

This retrospective analysis was conducted from 2005 to 2020. The outcome-blinded investigators used probability-linkage to combine the National Inpatient Sample and Organ Procurement and Transplantation Network data sets. They identified a total of 382 adult heart transplant recipients with CHD, of whom 185 (48 percent) had single-ventricle physiology.

Single-ventricle patients had significantly lower survival than biventricular CHD counterparts at 1 year (80 percent vs 91 percent; hazard ratio [HR], 2.50, 95 percent confidence interval [CI], 1.40‒4.49; p=0.002) and 10 years (54 percent vs 71 percent; HR, 2.10, 95 percent CI, 1.38‒3.18; p<0.001).

Among patients who survived the first post-transplantation year, those with biventricular CHD showed similar 10-year survival as patients with single ventricle physiology, except for those with hypoplastic left heart syndrome (79 percent vs 71 percent; HR, 1.58, 95 percent CI, 0.85‒2.92; p=0.15).

Of note, transplant recipients with biventricular CHD also had significantly better 10-year conditional survival than their non-CHD counterparts (79 percent vs 68 percent; HR, 0.73, 95 percent CI, 0.59‒0.90; p=0.003).

“These findings have significant implications towards patient selection and listing strategies, easing concerns related to heart transplantation in adults with CHD and destigmatizing most subtypes of single-ventricle CHD,” the investigators said.