Long-Term Risk of Heart Failure-Related Death and Heart Transplant After Congenital Heart Surgery in Childhood (from the Pediatric Cardiac Care Consortium)

• Type of Material: Article
• Authors: Lydia A Wright, The Ohio State University; Rachel Zmora, Boston University; Yijian Huang, Emory University; Matthew Oster, Emory University; Courtney McCracken, Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta; William Mahle, Emory University; Lazaros Kochilas, Emory University; Andreas Kalogeropoulos, Emory University
• Language: English
• Date: 2022-02-24
• Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2021.11.052
• Title of Journal or Parent Work: AMERICAN JOURNAL OF CARDIOLOGY
• Volume: 167
• Start Page: 111
• End Page: 117
• Keywords: Science & Technology; TRENDS; POPULATION; Cardiac & Cardiovascular Systems; MORTALITY; DISEASE; ADULTS; Cardiovascular System & Cardiology; Life Sciences & Biomedicine

Abstract

We aimed to describe the longitudinal risk of advanced heart failure (HF) leading to death, heart transplantation, or ventricular assist device (VAD) placement after congenital heart surgery (CHS) and how it varies across the spectrum of congenital heart disease. We linked the records of patients who underwent first CHS in the Pediatric Cardiac Care Consortium between 1982 and 2003 with the United States National Death Index and Organ Procurement and Transplantation Network databases. Primary outcome was time from CHS discharge to HF-related death, heart transplant, or VAD placement, analyzed with proportional hazards models accounting for competing mortality. In 35,610 patients who survived a first CHS, there were 799 HF deaths, transplants, or VADs over a median of 23 years (interquartile range, 19 to 27). Cumulative incidence at 25 years was 2.3% (95% confidence interval [CI] 2.1% to 2.4%). Compared to mild 2-ventricle defects, the adjusted subhazard ratio for moderate and severe 2-ventricle defects was 3.21 (95% CI 2.28 to 4.52) and 9.46 (95% CI 6.71 to 13.3), respectively, and for single-ventricle defects 31.8 (95% CI 22.2 to 45.6). Systemic right ventricle carried the highest risk 2 years after CHS (subhazard ratio 2.76 [95% CI 2.08 to 3.68]). All groups had higher rates of HF-related death compared with the general population (cause-specific standardized mortality ratio 56.1 [95% CI 51.0 to 61.2]). In conclusion, the risk of advanced HF leading to death, transplantation, or VAD was high across the spectrum of congenital heart disease. While severe defects carry the highest risk, those with mild disease are still at greater risk than the general population.