Outcomes of heart transplantation in children with hypoplastic left heart syndrome previously palliated with the Norwood procedure Bahaaldin Alsoufi,

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Presentation transcript:

Outcomes of heart transplantation in children with hypoplastic left heart syndrome previously palliated with the Norwood procedure Bahaaldin Alsoufi, MD, William T. Mahle, MD, Cedric Manlhiot, BSc, Shriprasad Deshpande, MD, Brian Kogon, MD, Brian W. McCrindle, MD, MPh, Kirk Kanter, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 1, Pages 167-175.e2 (January 2016) DOI: 10.1016/j.jtcvs.2015.09.081 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Time-dependent survival (A) and risk hazard of death (B) following listing for heart transplantation in 253 children who had prior first stage Norwood palliation. The solid lines in the parametric model represent parametric point estimates and the dashed lines enclose the 95% confidence interval. Circles represent nonparametric estimates. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Competing risks depiction of events (death without transplantation, heart transplantation, with the remaining being alive on the waiting list) following listing for heart transplantation in 253 children who had prior first stage Norwood palliation. Competing risks analysis showed that the hazard for death before heart transplantation was characterized by the presence of an early hazard phase during the initial 2 months following listing and a persistent hazard of death that continued during the constant and late phases over the following 10 months. The hazard for heart transplantation was characterized by the presence of a high early phase during the initial 2 months following listing, followed by lower constant and late phases over the following 10 months. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Parametric model for overall survival following listing for heart transplantation in children who had prior first stage Norwood palliation that is stratified by (A) requirement for mechanical circulatory support at time of listing, (B) United Network for Organ Sharing (UNOS) listing status. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Competing risks depiction of events (death without retransplantation, heart retransplantation, with the remaining being alive without retransplantation) following heart transplantation in 188 children who had prior first stage Norwood palliation. Competing risks analysis showed that the hazard for death following heart transplantation was biphasic with the presence of both early and late phases of risk. This was characterized by the presence of a risk of mortality during the initial 1 year following surgery, a persistent low mortality with sustained and increasing attrition with time in later years after transplantation. The hazard for retransplantation was characterized by the presence of constant and late hazard phases of risk. Hazard of retransplantation was low for the first 1 to 2 years following heart transplantation and increased with time since transplantation. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Parametric model for survival following heart transplantation in children who had prior first stage Norwood palliation that is stratified by (A) physiologic stage at time of transplantation (Norwood, Glenn, or Fontan); (B) United Network for Organ Sharing (UNOS) status at time of transplantation; (C) panel reactive antibodies (PRAs): 0%, 1%-10%, 11%-80%, 80%-100%; (D) era at time of transplantation (1993-2002, 2003-2012). The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Parametric model for freedom from first rejection following heart transplantation in 188 children who had prior first stage Norwood palliation. The solid lines in the parametric model represent parametric point estimates and the dashed lines enclose the 95% confidence interval. Circles represent nonparametric estimates. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Prevalence of events (death, retransplantation) following heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 167-175.e2DOI: (10.1016/j.jtcvs.2015.09.081) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions