Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements

被引:16
作者
Duong, Son Q. [1 ]
Godown, Justin [2 ]
Soslow, Jonathan H. [2 ]
Thurm, Cary [3 ]
Hall, Matt [3 ]
Sainathan, Sandeep [4 ]
Morell, Victor O. [4 ]
Dodd, Debra A. [2 ]
Feingold, Brian [1 ,5 ]
机构
[1] Univ Pittsburgh, Sch Med, Dept Pediat, 4401 Penn Ave,Fac Pavil Floor 5, Pittsburgh, PA 15224 USA
[2] Univ Pittsburgh, Sch Med, Dept Cardiothorac Surg, Pittsburgh, PA USA
[3] Univ Pittsburgh, Sch Med, Dept Clin & Translat Sci, Pittsburgh, PA USA
[4] Monroe Carell Jr Childrens Hosp Vanderbilt, Div Pediat Cardiol, Nashville, TN USA
[5] Childrens Hosp Assoc, Lenexa, KS USA
基金
美国国家卫生研究院;
关键词
heterotaxy; heart transplantation; congenital abnormalities; dextrocardia; situs inversus; registries; reoperation; CARDIAC TRANSPLANTATION; REQUIRING DIALYSIS; DISEASE; PREVALENCE; ANOMALIES; INVERSUS; CHILDREN; OUTCOMES; REGISTRY; SURGERY;
D O I
10.1016/j.jtcvs.2018.11.022
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly. Methods: Using linked registry data (2001-2016), we identified 186 HT recipients with heterotaxy/situs anomaly and 1254 with congenital heart disease without heterotaxy/situs anomaly. We compared post-HT outcomes in univariable and multivariable time-to-event analyses. LOS and cost from HT to discharge were compared using Wilcoxon rank-sum tests. Sensitivity analyses were performed using stricter heterotaxy/situs anomaly group inclusion criteria and through propensity matching. Results: HT recipients with heterotaxy/situs anomaly were older (median age, 5.1 vs 1.6 years; P < .001) and more often black, Asian, Hispanic, or "other'' nonwhite (54% vs 32%; P < .001). Heterotaxy/situs anomaly was independently associated with increased mortality (hazard ratio, 1.58; 95% confidence interval, 1.19-2.09; P = .002), even among 6-month survivors (hazard ratio, 1.86; 95% confidence interval, 1.09-3.16; P = .021). Heterotaxy/situs anomaly recipients more commonly required dialysis (odds ratio, 2.58; 95% confidence interval, 1.51-4.42; P = .001) and cardiac reoperation (odds ratio, 1.91; 95% confidence interval, 1.17-3.11; P = .010) before discharge. They had longer ischemic times (19.2 additional minutes [range, 10.9-27.5 minutes]; P < .001), post-HT intensive care unit LOS (16 vs 13 days; P = .012), and hospital LOS (26 vs 23 days; P = .005). Post-HT hospitalization costs were also greater ($447,604 vs $379,357; P = .001). Conclusions: Heterotaxy and other complex arrangements of cardiac situs are associated with increased mortality, postoperative complications, LOS, and costs after HT. Although increased surgical complexity can account for many of these differences, inferior late survival is not well explained and deserves further study.
引用
收藏
页码:730 / +
页数:22
相关论文
共 41 条
[1]  
[Anonymous], SRTR DAT OV
[2]  
[Anonymous], MAPIT AUT IN HOUS ST
[3]   Challenging venous reconstruction and heart transplantation in a patient with viscero-atrial situs inversus and complex congenital heart disease with Fontan circulation [J].
Beiras-Fernandez, A. ;
Daebritz, S. H. ;
Kaczmarek, I. ;
Kozlik-Feldmann, R. ;
Tiete, A. R. ;
Reichart, B. .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2007, 26 (03) :290-292
[4]   Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation [J].
Boyle, Janet M. ;
Moualla, Soundous ;
Arrigain, Susana ;
Worley, Sarah ;
Bakri, Mohamed H. ;
Starling, Randall C. ;
Heyka, Robert ;
Thakar, Charuhas V. .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2006, 48 (05) :787-796
[5]   Peritoneal dialysis after surgery for congenital heart disease in infants and young children [J].
Chan, KL ;
Ip, P ;
Chiu, CSW ;
Cheung, YF .
ANNALS OF THORACIC SURGERY, 2003, 76 (05) :1443-1449
[6]   Cardiac Transplantation in Situs Inversus: Two Cases Reports [J].
Chang, Y. L. ;
Wei, J. ;
Chang, C. -Y. ;
Chuang, Y. -C. ;
Sue, S. -H. .
TRANSPLANTATION PROCEEDINGS, 2008, 40 (08) :2848-2851
[7]   Heterotaxy syndrome with functional single ventricle: Does prenatal diagnosis improve survival? [J].
Cohen, Meryl S. ;
Schultz, Amy H. ;
Tian, Zhi-Yun ;
Donaghue, Denise D. ;
Weinberg, Paul M. ;
Gaynor, J. William ;
Rychik, Jack .
ANNALS OF THORACIC SURGERY, 2006, 82 (05) :1629-1636
[8]   Heart transplantation in situs inversus totalis [J].
Deuse, Tobias ;
Reitz, Bruce A. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2010, 139 (02) :501-503
[9]   Ten yr of pediatric heart transplantation: A report from the Pediatric Heart Transplant Study [J].
Dipchand, Anne I. ;
Kirk, Richard ;
Mahle, William T. ;
Tresler, Margaret A. ;
Naftel, David C. ;
Pahl, Elfriede ;
Miyamoto, Shelley D. ;
Blume, Elizabeth ;
Guleserian, Kristine J. ;
White-Williams, Connie ;
Kirklin, James K. .
PEDIATRIC TRANSPLANTATION, 2013, 17 (02) :99-111
[10]   Rejection with hemodynamic compromise in the current era of pediatric heart transplantation: A multi-institutional study [J].
Everitt, Melanie D. ;
Pahl, Elfriede ;
Schechtman, Kenneth B. ;
Zheng, Jie ;
Ringewald, Jeremy M. ;
Ecuyer, Thomas L' ;
Naftel, David C. ;
Kirklin, James K. ;
Blume, Elizabeth D. ;
Bullock, Emily A. ;
Canter, Charles E. .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2011, 30 (03) :282-288