Abstract 18971: Heart Transplantation for Adult Patients With Congenital Heart Disease: Are the Outcomes Still Worse Than in the General Population in 2015?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Diego Moguillansky ◽  
Biagio A Pietra ◽  
Frederick J Fricker ◽  
Mark S Bleiweis
Keyword(s):  
Congenital Heart Disease ◽  
Survival Analysis ◽  
Heart Disease ◽  
General Population ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Congenital Heart ◽  
Medium Term ◽  
General Group

Introduction: Short and medium term outcome after heart transplantation has steadily improved over the last few decades. Outcomes for adult patients with congenital heart disease (ACHD) who undergo transplantation are generally considered to be less favorable. Hypothesis: We hypothesized that the development of heart teams that specialize in ACHD would lead to improved outcomes after transplantation in this population. Methods: We reviewed the records of all patients undergoing first heart transplant at a university center with a dedicated ACHD team over the last 10 years. Patients undergoing re-transplantation were excluded. We looked at short (30 days) and medium term (1 year) survival after heart transplantation in ACHD patients. Results: Between 1/1/05 and 6/10/15, 258 patients underwent heart transplantation. Of the 258 patients, 17 were re-transplants and were excluded. Of the remaining 241 patients, 12 were ACHD patients and 229 were transplanted for other diagnosis (general group). In the general group 184 of 212 (86.8%) patients were alive at 1 year (the remaining 17 did not have sufficient follow up to be included in the 1-year survival analysis). In the ACHD group 9 of 9 patients (100%) were alive at 1 year. The remaining 3 ACHD patients with insufficient follow up to be included in the 1-year survival analysis were still alive 2.5-9.5 months after transplant, such that all 12 ACHD patients survived at least 30 days and were discharged home after heart transplant. At the end of the study period 160 of 229 (70%) patients were still alive in the general group, compared to 8 of 12 (66.7%) in the ACHD group. Conclusions: Short and medium term survival after heart transplantation appears to be no worse for selected ACHD patients compared to the general population. Larger studies with longer follow up are needed to confirm our findings and clarify the intermediate and long-term outcomes of ACHD patients undergoing heart transplantation in the modern era.

Risk of ischemic stroke in adult patients with congenital heart disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.W Giang ◽  
M Fedchenko ◽  
M Dellborg ◽  
P Eriksson ◽  
A Rosengren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Congenital Heart ◽  
Funding Source

Abstract Introduction With an increasing proportion of adults with congenital heart disease (CHD) surviving into middle age and beyond, CHD patients will be at increased risk of acquired cardiovascular conditions, such as ischemic stroke. Compared to controls, patients with CHD have a higher prevalence of arrhythmias, persistent shunts enabling paradoxical embolization, heart failure, mechanical valves as well as potentially hypercoagulable states, all of which can further increase the risk of stroke. Purpose The aim of our study was to investigate the risk of developing ischemic stroke in adults with CHD in Sweden compared to controls from the general population. Methods We used data from the Swedish National Patient and Cause of Death registries to identify all CHD patients ≥18 years of age, born during the period 1930–1998, with a first time diagnosis of ischemic stroke. Follow-up started in January 1970 and went on until December 2017. Approximately ten controls matched for age and sex were randomly selected from the general population for each patient with CHD. CHD diagnoses were classified into six lesion groups according to a previously published hierarchical classification system. Results In total, 43,110 patients with CHD and 474,267 controls were included in the study (51.4% men) and mean follow up time was 25.4±18.4 years. Patients with CHD had a 6 times higher risk of developing an ischemic stroke compared with controls (hazard ratio 6.0, 95% confidence interval 5.8–6.2, p≤0.001), with altogether 8.8% (n=3785) of CHD patients developing ischemic stroke compared with 1.6% (n=7516) of controls. Ischemic stroke was more common in all CHD lesion groups; however, patients with atrial septal defects/patent foramen ovale had the highest incidence rate of ischemic stroke with an incidence rate of 76.1 events/10,000 patient years compared with 8.7 in controls. Patients with CHD and ischemic stroke had markedly less hypertension, diabetes mellitus and hypercholesterolemia, compared with controls (7.1%, 2.0%, 2.9% respectively in CHD patients, compared with 19.6%, 6.6%, 5.3%, in controls, p≤0.001 for all). In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients with ischemic stroke compared to controls (atrial fibrillation: 12.0% in CHD vs 10.4% in controls, p=0.01; heart failure: 8.7% in CHD vs 7.3% in controls, p=0.009). Conclusion In this large nationwide study, we found that the risk of ischemic stroke in adult patients with CHD was six times higher than in controls, despite a lower prevalence of common risk factors for stroke such as hypertension, diabetes mellitus and hypercholesterolemia. In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients compared with controls. This implies that the etiology of ischemic stroke might be different in CHD patients compared with controls. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was funded by the Swedish state under an agreement between the Swedish government and county councils, the ALF agreement (Grant number: 236611) and the Swedish Heart-Lung Foundation (Grant Number: 20090724).

scholarly journals Congenital Heart Disease has no Negative Impact on Educational Achievements and Employment among Maltese Adult Patients under Clinical Follow-Up

2016 ◽  
Vol 8 ◽  
Author(s):  
Maryanne Caruana ◽  
Victor Grech
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Population ◽  
Congenital Heart ◽  
Negative Impact ◽  
Severe Disease ◽  
Adult Patients ◽  
Educational Achievements ◽  
Education And Employment

<p><strong>Background:</strong> Most children born with congenital heart disease (CHD) nowadays survive into adulthood.  The aim of this study was to investigate the potential impact of CHD on educational achievements and employment in Maltese adult patients.</p><p><strong>Methods:</strong> A bespoke self-reporting questionnaire based on the 2008 European Health Interview Survey (EHIS 2008) was distributed to 162 consecutive Maltese adult congenital heart disease (ACHD) patients at time of hospital follow-up for the 1-year period May 2013-May 2014.  Education and employment in the ACHD cohort were compared with those from 372 randomly-selected age- and sex-matched EHIS 2008 responders (general population cohort).  Chi-squared and Fisher Exact tests were used for categorical variables, and Mann-Whitney <em>U</em> test was applied to numerical variables.</p><p><strong>Results:</strong>  There were 125 ACHD responders (65 males, mean age 30.64±12.80 years).  Nineteen patients had mild CHD, 85 had moderate lesions and 21 had severe disease.  Patients with moderate/severe CHD had undergone significantly more cardiac procedures (mean 1.79; 95% CI 1.56,2.02) compared to patients with mild disease (mean 0.68; 95% CI 0.40,0.96) (p&lt;0.001).  There were no significant differences in educational achievements, employment rate or working patterns between the 2 cohorts, but significantly more ACHD patients had higher-skilled occupations (82.1%) compared to the general population (67.5%; p=0.01), with this difference being restricted to male subjects.  There were no significant differences in education and employment upon comparison of patients with mild and moderate/severe disease.</p><p><strong>Conclusions:</strong>  This study suggests that, in Malta, ACHD has no negative impact on educational achievements and employment.</p>

scholarly journals Epidemiology of adult congenital heart disease among the general population in Kuwait

2021 ◽  
Vol 44 (4) ◽  
pp. 526-530
Author(s):  
Hasan Ashkanani ◽  
Idrees Mohiyaldeen ◽  
Hazem ElShenawy ◽  
Muath Alanbaei
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Population ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Adult Congenital
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