When Should Adult Congenital Heart Disease Patients be Considered for Transplant and Deciding Which Organs to Transplant

Progress in Cardiovascular Diseases
Matthew Lewis, Marlon Rosenbaum

Abstract

The number of adult congenital heart disease (ACHD) patients continues to increase. Because of multiple related factors such as aging, residual cardiac lesions and prior palliative procedures, advanced heart failure (HF) is increasingly prevalent in this population. Consequently, there is an emerging need to determine which patients are best suited for advanced cardiac therapies, including heart transplantation (HT) and mechanical circulatory support. Unfortunately, optimizing patient selection for these therapies is complicated by patient heterogeneity, variable HF presentation across lesion-type, and a paucity of outcome data. The lack of patient specific data and the increasing number of ACHD patients with end-stage HF identifies a need to more precisely stratify risk and determine appropriate timing for referral. As such, this article will discuss the clinical recognition and classification of advanced HF in the ACHD patient populations and review current data regarding HT outcomes. Following, key considerations regarding the timing of HT in specific forms of ACHD, the role of device therapy, and when dual organ transplantation should be considered will be reviewed. Finally, existing knowledge gaps and key research needs wi...Continue Reading

Citations

Dec 4, 2019·Heart Failure Reviews·Rose Tompkins, Anitra Romfh
May 10, 2021·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Stephen J DolgnerTodd F Dardas
Apr 13, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Sébastien HascoëtElie Fadel
Aug 9, 2021·Clinical Transplantation·Angelo L de la RosaMichelle M Kittleson
Dec 4, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Katia Bravo-JaimesAri Cedars

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