Observations and Single-Center Outcomes in Orthotopic Heart Transplant for Patients With Adult Congenital Heart Disease: A Call for Equity and Parity

Background. For persons with adult congenital heart disease (ACHD), optimum patient selection and eligibility for orthotopic heart transplant ( OHT) is not well defined. There is difficulty quantifying risk in patients with ACHD, leading to variability in OHT listing time and status. They are often disadvantaged due to a lack of mechanical support options, a shortage of congenital surgeons, and encounters with risk adverse health care programs. We examined patient characteristics and outcomes of a contemporary cohort of patients with ACHD undergoing OHT at a single high-volume Adult Congenital Heart Association accredited transplant center. Methods. Retrospective analysis of 49 consecutive patients with ACHD who underwent OHT from November 2010 through March 2020 was performed. Survival analysis was performed using Kaplan-Meier analysis. Results. Survival at 1 month, 1 year, 3 years, and 10 years was 94%, 92%, 92%, and 83%, respectively. Conclusions. This study highlights the diversity and complexity of the population with ACHD proceeding to OHT as well as the multispecialty care needed to overcome disadvantages and optimize survival. Continued national discussions and policy adjustments will be necessary to bring parity and equity to this unique population.