title: Cardiac transplantation for end-stage congenital heart defects: the Mayo Clinic experience. Mayo Cardiothoracic Transplant Team.
abstract: OBJECTIVE
  To review the outcome of cardiac transplantation undertaken in patients with congenital heart defects.
  
  
  METHODS
  Between November 1991 and March 1998 at our institution, cardiac transplantation was performed in 16 patients with congenital heart disease (age range, 3 to 57 years; mean, 26.1). Preoperative diagnoses included univentricular heart (N = 4); complete transposition of the great arteries (N = 3); Ebstein's anomaly (N = 2); tetralogy of Fallot (N = 2); levotransposition (N = 2); dextrocardia, corrected transposition, ventricular and atrial septal defects, and pulmonary stenosis (N = 1); double-outlet right ventricle (N = 1); and hypertrophic obstructive cardiomyopathy (N = 1). All patients had undergone from one to five previous palliative operations.
  
  
  RESULTS
  Four patients required permanent pacemaker implantation during the first month postoperatively because of bradycardia; more than 2 years later, another patient required a permanent pacemaker because of sick sinus syndrome. In addition, one patient had an automatic implantable cardioverter-defibrillator. Three patients required reconstruction of cardiovascular structures with use of prosthetic material (Teflon patches or donor tissue) at the time of cardiac transplantation. Actuarial 1-, 2-, and 5-year survival was 86.2 +/- 9.1%. During the first year after transplantation, two deaths occurred--one at 41 days of putative vascular rejection and the second at 60 days of severe cellular rejection. All other patients are alive and functionally rehabilitated; the mean follow-up period has been 26.1 months (range, 2 to 89.6).
  
  
  CONCLUSIONS
  Cardiac transplantation for patients with congenital heart disease can be accomplished with a low perioperative mortality and an excellent medium-term survival despite the challenges presented by the technical difficulties during invasive diagnostic procedures and at operation and the need for adherence to long-term multiple-drug therapy in this patient population.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: G
authors.initials: G
authors.lastname: Speziali
authors.forename: D J
authors.initials: DJ
authors.lastname: Driscoll
authors.forename: G K
authors.initials: GK
authors.lastname: Danielson
authors.forename: P R
authors.initials: PR
authors.lastname: Julsrud
authors.forename: C J
authors.initials: CJ
authors.lastname: Porter
authors.forename: J A
authors.initials: JA
authors.lastname: Dearani
authors.forename: R C
authors.initials: RC
authors.lastname: Daly
authors.forename: C G
authors.initials: CG
authors.lastname: McGregor
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents