Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease

Tara Karamlou, Brian S. Diggs, Karl Welke, Frederick (Fred) Tibayan, Jill Gelow, Steven W. Guyton, Matthew Slater, Craig Broberg, Howard Song

    Research output: Contribution to journalArticle

    27 Citations (Scopus)

    Abstract

    Background: Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients. Methods: The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007). In-hospital death was compared among recipients with 1V and 2V anatomy. Multivariable determinants associated with an increased risk of in-hospital death were sought with logistic regression models. Results: From a national estimate of 509 ACHD recipients, 143 were 1V and 366 were 2V. Overall, 1V in-hospital mortality (23%) was higher than for 2V (8%; p <0.001) and remained associated with in-hospital death after adjustment for other factors (odds ratio, 3.9; 95% confidence interval, 1.29 to 11.74; p = 0.02). All 1V diagnoses had higher mortality than all 2V diagnoses. Despite minor fluctuations, the proportion of 1V patients did not increase over time (era 1, 36%; era 2, 30%; p = 0.46). Conclusions: Overall case-mix of ACHD recipients (1V vs 2V) has not changed over time. Initial 1V anatomy increases post-HTx death among ACHD recipients, whereas 2V patients have mortality rates similar to non-CHD recipients. National and international transplant registries should include specific CHD diagnoses because this factor plays such a large role in determining early outcomes.

    Original languageEnglish (US)
    Pages (from-to)1281-1288
    Number of pages8
    JournalAnnals of Thoracic Surgery
    Volume94
    Issue number4
    DOIs
    StatePublished - Oct 2012

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    Heart Transplantation
    Heart Diseases
    Anatomy
    Diagnosis-Related Groups
    Logistic Models
    Transplants
    Mortality
    Hospital Mortality
    Registries
    Inpatients
    Odds Ratio
    Confidence Intervals

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery
    • Pulmonary and Respiratory Medicine

    Cite this

    Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease. / Karamlou, Tara; Diggs, Brian S.; Welke, Karl; Tibayan, Frederick (Fred); Gelow, Jill; Guyton, Steven W.; Slater, Matthew; Broberg, Craig; Song, Howard.

    In: Annals of Thoracic Surgery, Vol. 94, No. 4, 10.2012, p. 1281-1288.

    Research output: Contribution to journalArticle

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    title = "Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease",
    abstract = "Background: Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients. Methods: The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007). In-hospital death was compared among recipients with 1V and 2V anatomy. Multivariable determinants associated with an increased risk of in-hospital death were sought with logistic regression models. Results: From a national estimate of 509 ACHD recipients, 143 were 1V and 366 were 2V. Overall, 1V in-hospital mortality (23{\%}) was higher than for 2V (8{\%}; p <0.001) and remained associated with in-hospital death after adjustment for other factors (odds ratio, 3.9; 95{\%} confidence interval, 1.29 to 11.74; p = 0.02). All 1V diagnoses had higher mortality than all 2V diagnoses. Despite minor fluctuations, the proportion of 1V patients did not increase over time (era 1, 36{\%}; era 2, 30{\%}; p = 0.46). Conclusions: Overall case-mix of ACHD recipients (1V vs 2V) has not changed over time. Initial 1V anatomy increases post-HTx death among ACHD recipients, whereas 2V patients have mortality rates similar to non-CHD recipients. National and international transplant registries should include specific CHD diagnoses because this factor plays such a large role in determining early outcomes.",
    author = "Tara Karamlou and Diggs, {Brian S.} and Karl Welke and Tibayan, {Frederick (Fred)} and Jill Gelow and Guyton, {Steven W.} and Matthew Slater and Craig Broberg and Howard Song",
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    T1 - Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease

    AU - Karamlou, Tara

    AU - Diggs, Brian S.

    AU - Welke, Karl

    AU - Tibayan, Frederick (Fred)

    AU - Gelow, Jill

    AU - Guyton, Steven W.

    AU - Slater, Matthew

    AU - Broberg, Craig

    AU - Song, Howard

    PY - 2012/10

    Y1 - 2012/10

    N2 - Background: Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients. Methods: The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007). In-hospital death was compared among recipients with 1V and 2V anatomy. Multivariable determinants associated with an increased risk of in-hospital death were sought with logistic regression models. Results: From a national estimate of 509 ACHD recipients, 143 were 1V and 366 were 2V. Overall, 1V in-hospital mortality (23%) was higher than for 2V (8%; p <0.001) and remained associated with in-hospital death after adjustment for other factors (odds ratio, 3.9; 95% confidence interval, 1.29 to 11.74; p = 0.02). All 1V diagnoses had higher mortality than all 2V diagnoses. Despite minor fluctuations, the proportion of 1V patients did not increase over time (era 1, 36%; era 2, 30%; p = 0.46). Conclusions: Overall case-mix of ACHD recipients (1V vs 2V) has not changed over time. Initial 1V anatomy increases post-HTx death among ACHD recipients, whereas 2V patients have mortality rates similar to non-CHD recipients. National and international transplant registries should include specific CHD diagnoses because this factor plays such a large role in determining early outcomes.

    AB - Background: Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients. Methods: The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007). In-hospital death was compared among recipients with 1V and 2V anatomy. Multivariable determinants associated with an increased risk of in-hospital death were sought with logistic regression models. Results: From a national estimate of 509 ACHD recipients, 143 were 1V and 366 were 2V. Overall, 1V in-hospital mortality (23%) was higher than for 2V (8%; p <0.001) and remained associated with in-hospital death after adjustment for other factors (odds ratio, 3.9; 95% confidence interval, 1.29 to 11.74; p = 0.02). All 1V diagnoses had higher mortality than all 2V diagnoses. Despite minor fluctuations, the proportion of 1V patients did not increase over time (era 1, 36%; era 2, 30%; p = 0.46). Conclusions: Overall case-mix of ACHD recipients (1V vs 2V) has not changed over time. Initial 1V anatomy increases post-HTx death among ACHD recipients, whereas 2V patients have mortality rates similar to non-CHD recipients. National and international transplant registries should include specific CHD diagnoses because this factor plays such a large role in determining early outcomes.

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    U2 - 10.1016/j.athoracsur.2012.05.075

    DO - 10.1016/j.athoracsur.2012.05.075

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