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Trends in the Indications and Survival in Pediatric Heart Transplants: A 24-year Single- Center Experience in 307 Patients  Rochus K. Voeller, MD, Deirdre.

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Presentation on theme: "Trends in the Indications and Survival in Pediatric Heart Transplants: A 24-year Single- Center Experience in 307 Patients  Rochus K. Voeller, MD, Deirdre."— Presentation transcript:

1 Trends in the Indications and Survival in Pediatric Heart Transplants: A 24-year Single- Center Experience in 307 Patients  Rochus K. Voeller, MD, Deirdre J. Epstein, RN, Tracey J. Guthrie, RN, Sanjiv K. Gandhi, MD, Charles E. Canter, MD, Charles B. Huddleston, MD  The Annals of Thoracic Surgery  Volume 94, Issue 3, Pages (September 2012) DOI: /j.athoracsur Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Indications for transplant annually are broken down into the percentage of cardiomyopathy (CM, black bar), congenital heart disease (CHD, vertical line), and retransplants (RETX, slanted line). In recent years, the percentage of CM as an indication has become more prevalent at our center. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 An analysis of age groups at transplant annually shows recipients aged > 10 years (hashed bars) have become more prevalent in recent years in our series than those aged <1 year (slanted bars) and those aged 1 to 10 years (black bars). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 The overall breakdown for indications by percentage for transplantation is shown by (left) cardiomyopathy (CM, black), congenital heart disease (CHD, grey), and retransplantation (white) in all patients and (right) in patients with CHD by subgroups of single-ventricle and no palliation (black), single-ventricle after (s/p) a palliation procedure (gray), and in patients with other (white) types of CHD. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 The data were divided into three consecutive intervals by 8-year increments: (A) 1986 to 1993; (B) 1994 to 2001; and (C) 2002 to This revealed an overall decline in congenital heart disease (gray) as an indication for transplant, an increase in cardiomyopathy (black) as an indication for transplant, and retransplant rates (white) have remained relatively stable. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 In our series, there was a significant increase in the percentage of patients who received allografts for single-ventricle (SV) with failed palliative operations (gray), particularly Fontan procedures, compared with SV with no palliation (black) and patients with other congenital heart disease (white) over the years. (A) 1984 to 1993; (B) 1994 to 2001; (C) 2002 to 2009. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 (A) This Kaplan-Meier survival curve is for all patients (black), the cardiomyopathy group (dark gray), the congenital heart disease group (light gray), and those who received pretransplant support with extracorporeal membrane oxygenation or a ventricular assist device (dotted line). Patients who received mechanical support are a subgroup of the cardiomyopathy group; none of the congenital group had mechanical support pretransplant. (B) The survival curves for the single-ventricle (SV) groups (dark dotted line for SV without palliation; light dotted line for SV with palliation, dash-dot line for failed Fontan) are shown with the main diagnostic groups (cardiomyopathy, dark gray line; congenital, light gray line) for contrast. In particular, SV patients without palliation had a comparable survival to the cardiomyopathy group. (C) Survival curves for the SV patients (without palliation, dash-dot line; with palliation, black line) only, based on the pretransplant interventions (failed Fontan, dashed line) as well as the basic anatomy (double-ventricle, gray line), show the SV patients had the best overall survival. (VAD = ventricular assist device.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 6 (A) This Kaplan-Meier survival curve is for all patients (black), the cardiomyopathy group (dark gray), the congenital heart disease group (light gray), and those who received pretransplant support with extracorporeal membrane oxygenation or a ventricular assist device (dotted line). Patients who received mechanical support are a subgroup of the cardiomyopathy group; none of the congenital group had mechanical support pretransplant. (B) The survival curves for the single-ventricle (SV) groups (dark dotted line for SV without palliation; light dotted line for SV with palliation, dash-dot line for failed Fontan) are shown with the main diagnostic groups (cardiomyopathy, dark gray line; congenital, light gray line) for contrast. In particular, SV patients without palliation had a comparable survival to the cardiomyopathy group. (C) Survival curves for the SV patients (without palliation, dash-dot line; with palliation, black line) only, based on the pretransplant interventions (failed Fontan, dashed line) as well as the basic anatomy (double-ventricle, gray line), show the SV patients had the best overall survival. (VAD = ventricular assist device.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

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