title: Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease.
abstract: BACKGROUND
  Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007). In-hospital death was compared among recipients with 1V and 2V anatomy. Multivariable determinants associated with an increased risk of in-hospital death were sought with logistic regression models.
  
  
  RESULTS
  From a national estimate of 509 ACHD recipients, 143 were 1V and 366 were 2V. Overall, 1V in-hospital mortality (23%) was higher than for 2V (8%; p<0.001) and remained associated with in-hospital death after adjustment for other factors (odds ratio, 3.9; 95% confidence interval, 1.29 to 11.74; p=0.02). All 1V diagnoses had higher mortality than all 2V diagnoses. Despite minor fluctuations, the proportion of 1V patients did not increase over time (era 1, 36%; era 2, 30%; p=0.46).
  
  
  CONCLUSIONS
  Overall case-mix of ACHD recipients (1V vs 2V) has not changed over time. Initial 1V anatomy increases post-HTx death among ACHD recipients, whereas 2V patients have mortality rates similar to non-CHD recipients. National and international transplant registries should include specific CHD diagnoses because this factor plays such a large role in determining early outcomes.
authors.affiliation: Congenital Cardiac Center, Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, USA. tara.karamlou@ucsfmedctr.org
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Karl
authors.initials: K
authors.lastname: Welke
authors.forename: Fred
authors.initials: F
authors.lastname: Tibayan
authors.forename: Jill
authors.initials: J
authors.lastname: Gelow
authors.forename: Steven W
authors.initials: SW
authors.lastname: Guyton
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Slater
authors.forename: Craig
authors.initials: C
authors.lastname: Broberg
authors.forename: Howard K
authors.initials: HK
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death / Q000639:trends; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult