Jeffrey Phillip Jacobs, MD, Alfred Asante-Korang, MD, Sean M

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Presentation transcript:

Lessons Learned From 119 Consecutive Cardiac Transplants for Pediatric and Congenital Heart Disease Jeffrey Phillip Jacobs, MD, Alfred Asante-Korang, MD, Sean M. O'Brien, PhD, Paul Jubeong Chai, MD, Gul H. Dadlani, MD, Gerson L. Rodriguez-Fazzi, MD, Dien Vu, MD, Jorge McCormack, MD, Daniel E. McKenna, MD, Robert Joseph Boucek, MD, David S. Cooper, MD, Albert Saltiel, MD, Jennifer Carapellucci, RN, Hugh M. van Gelder, MD, George R. Daicoff, MD, James Anthony Quintessenza, MD The Annals of Thoracic Surgery Volume 91, Issue 4, Pages 1248-1255 (April 2011) DOI: 10.1016/j.athoracsur.2010.10.083 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Overall survival of all 116 patients with a Kaplan-Meier analysis of patient survival from the time of first orthotopic heart transplantation at The Congenital Heart Institute of Florida (CHIF) and All Children's Hospital. Overall Kaplan-Meier 5-year survival is 72.7%. (Dark line is the estimated survival probability. Light lines are pointwise 95% confidence limits; see methods.) The Annals of Thoracic Surgery 2011 91, 1248-1255DOI: (10.1016/j.athoracsur.2010.10.083) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Kaplan-Meier analysis of patient survival by diagnostic category for the most common diagnoses: cardiomyopathy (n = 37), primary transplantation for hypoplastic left heart syndrome (HLHS) or hypoplastic left heart syndrome–related malformation (n = 29), and non–hypoplastic left heart syndrome congenital heart disease (n = 39). This figure demonstrates that survival is not statistically different in these three diagnostic groups (p = 0.54). The Annals of Thoracic Surgery 2011 91, 1248-1255DOI: (10.1016/j.athoracsur.2010.10.083) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier analysis of patient survival by diagnostic category for patients with the diagnosis of hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 38). This figure compares primary transplantation for HLHS or HLHS-related malformation (n = 29) with transplantation after prior cardiac surgery (S/P Prior) for HLHS or HLHS-related malformation (n = 9). This figure documents that survival after transplantation after prior cardiac surgery for HLHS or HLHS-related malformation appears to be worse than survival after primary transplantation for HLHS or HLHS-related malformation, although the probability value is not quite significant (p = 0.05). The Annals of Thoracic Surgery 2011 91, 1248-1255DOI: (10.1016/j.athoracsur.2010.10.083) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier analysis of patient survival for all patients comparing patients with high panel reactive antibody (PRA; n = 13) with patients without high panel reactive antibody (n = 103). This figure demonstrates no significant increase in risk for patients with high panel reactive antibody (p = 0.20). (Patients who underwent retransplantation are only shown in this figure for their initial transplant. Two patients with high panel reactive antibody at the time of retransplantation are still alive today.) The Annals of Thoracic Surgery 2011 91, 1248-1255DOI: (10.1016/j.athoracsur.2010.10.083) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier analysis of patient survival for all patients comparing survival in patients undergoing primary transplantation (n = 114) with those undergoing retransplantation (n = 5). This figure documents no increase in risk for those undergoing retransplantation (p = 0.87). (It should be noted that these results were identical when only one operation per patient was analyzed.) The Annals of Thoracic Surgery 2011 91, 1248-1255DOI: (10.1016/j.athoracsur.2010.10.083) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions