title: Patient genotypes impact survival after surgery for isolated congenital heart disease.
abstract: BACKGROUND
  Survival after cardiac surgery in infancy requires adaptive responses from oxidative stress management and vascular regulation pathways. We tested the hypothesis that genetic variation in these pathways influences postoperative survival in nonsyndromic congenital heart disease children.
  
  
  METHODS
  This is an analysis of a cohort of nonsyndromic congenital heart disease patients who underwent cardiac surgery with cardiopulmonary bypass before 6 months of age (n=422). Six single nucleotide polymorphisms (SNPs) in six genes involved in oxidative stress and vascular response pathways, identified through a priori literature search, were tested for effects on transplant-free survival. Survival curves, adjusting for confounding covariates, were calculated using the Cox proportional hazard models.
  
  
  RESULTS
  Long-term survival was strongly associated with vascular endothelial growth factor A gene SNP rs833069 (p=7.03×10(-4)) and superoxide dismutase 2 gene SNP rs2758331 (p=0.019). To test for joint effects of the two SNPs on transplant-free survival, the genotypes were grouped to form a risk score reflecting the cumulative number of risk alleles (0 to 4 alleles per patient). A higher risk score based on the VEGFA and SOD2 SNP genotypes was associated with worse transplant-free survival (p=3.02×10(-4)) after confounder adjustment. The total burden of risk alleles was additive; subjects with the highest risk score of 4 (n=59 subjects, 14.2% of the cohort) had a total covariate-adjusted hazard ratio of 15.64 for worse transplant-free survival.
  
  
  CONCLUSIONS
  After cardiac surgery, infants who are homozygous for the high-risk alleles for both the VEGFA and SOD2 SNPs have an approximately 16-fold increased risk of death or heart transplant, suggesting that genetic variants are important modifiers of survival after surgery for congenital heart disease.
authors.affiliation: Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, Washington; Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Daniel Seung
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Amber A
authors.initials: AA
authors.lastname: Burt
authors.affiliation: Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, Washington; Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Crosslin
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Nancy
authors.initials: N
authors.lastname: Burnham
authors.affiliation: Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Donna M
authors.initials: DM
authors.lastname: McDonald-McGinn
authors.affiliation: Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Elaine H
authors.initials: EH
authors.lastname: Zackai
authors.affiliation: Division of Cardiothoracic Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Stanaway
authors.affiliation: Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Nickerson
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russell
authors.affiliation: Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Hakon
authors.initials: H
authors.lastname: Hakonarson
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, Washington; Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington. Electronic address: pair@u.washington.edu.
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
mesh_terms: D000483:Alleles; D006348:Cardiac Surgical Procedures; D004247:DNA / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006330:Heart Defects, Congenital / Q000235:genetics* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018384:Oxidative Stress / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide; D016016:Proportional Hazards Models; D013482:Superoxide Dismutase / Q000235:genetics* / Q000378:metabolism; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics* / Q000378:metabolism; D000099156:Superoxide Dismutase 2
chemical_list: D004247:DNA; D013482:Superoxide Dismutase; D042461:Vascular Endothelial Growth Factor A; D000099156:Superoxide Dismutase 2; C467484:VEGFA protein, human