Cardiopulmonary transplantation for congenital heart disease in the adult

Background: Patients surviving into adulthood with congenital heart disease (CHD) often succumb to progressive cardiopulmonary dysfunction. For these patients transplantation is often considered. Methods: We performed a retrospective review of 69 adults (age >18 years) w ith CHD transplanted between 1984 and 1999. Results: We evaluated 31 heart-lung (HLTxp), 30 lung (LTxp), and 8 heart (H Txp) transplants performed in 22 men and 47 women with CHD. Mean age was 37 +/- 10 years with a mean follow-up of 3.1 +/- 3.5 years. A concomitant car diovascular procedure was performed in 1 HLTxp, 23 LTxp, and 2 HTxp. Early mortality (>30 days) was 26% (8/31) fur HLTxp, mostly due to bleeding. Earl y LTxp mortality was 23% (7/30), largely due to graft failure. One and 3-ye ar survival was similar in adults transplanted for CHD and adults transplan ted for other disease. Early mortality among HTxp recipients was 50% (4/8) from rejection or technical complications. Survival for patients undergoing HLTxp versus LTxp with cardiac repair was similar. When examined by era, t he survival of patients transplanted for CHD between 1992 and 1999 was grea ter than that of patients transplanted between 1984 and 1991. Conclusions: Adults undergoing HLTxp and LTxp fur CHD can expect survival c omparable to that of non-CHD adults. In the presence of a reparable cardiac lesion, LTxp with cardiovascular repair for CHD is an attractive option, o ptimizing organ allocation. Specific technical concerns are discussed. Surv ival of adults undergoing cardiopulmonary transplantation for CHD has impro ved over time.