title: Listing and transplanting adults with congenital heart disease.
abstract: BACKGROUND
  An increasing number of patients with congenital heart disease (CHD) are reaching adulthood and may require heart transplantation. The survival of these patients after listing and transplantation has not been evaluated.
  
  
  RESULTS
  A total of 41 849 patients (aged >18 years) were listed for primary transplantation during 1995-2009. Patients with a history of CHD (n=1035; 2.5%) were compared with those with other causes (non-CHD group) (n=40 814; 97.5%); 26 055 (62.3%) reached transplantation and were subdivided into those with (reoperation group; n=10 484; 40.2%) and without (nonreoperation group; n=15 571; 59.8%) a previous sternotomy. Survival on the waiting list was similar between groups, but mechanical ventricular assistance was not associated with superior survival to transplantation among CHD patients. CHD patients were more likely to have body mass index <18.5 at transplantation (P<0.0001), were younger, and had fewer comorbidities. Early mortality among patients with CHD was high (reoperation, 18.9% versus 9.6%; P<0.0001; nonreoperation, 16.6% versus 6.3%; P<0.0001), but by 10 years, overall survival was equivalent (53.8% versus 53.6%). Analysis was limited by the lack of specific information regarding the CHD diagnosis in most patients.
  
  
  CONCLUSIONS
  Adults with CHD have high 30-day mortality but better late survival after heart transplantation. Mechanical circulatory assistance does not improve waiting list survival in these patients. This may be due to a combination of highly complex reoperative surgery and often poor preoperative systemic health.
authors.affiliation: Falk Cardiovascular Research Building, 300 Pasteur Drive, Palo Alto, CA 94305-5407, USA. rdavies2@stanford.edu
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Davies
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult