Abstract
Characteristics And In-hospital Outcomes Of Patients With Fontan Circulation Undergoing Heart Transplants
Journal of cardiac failure, v 31(1), pp 204-204
Jan 2025
Abstract
Advancements in medical and surgical care have led to a growing population of patients with congenital heart disease (CHD) including complex CHD with Fontan circulation. There are more patients with Fontan circulation experiencing heart failure each year. These patients eventually require advanced therapies including heart transplant (HTx). There is limited data on outcomes of heart transplant among Fontan patients in the United States.
This is a retrospective cohort analysis using 2016 to 2020 National Inpatient Sample, the largest publicly available all-payer inpatient care database in the United States. Our study population included all patients who underwent HTx using ICD-10 diagnostic codes. HTx patients were divided into two groups: with and without Fontan. Those with diagnosis of hypoplastic left heart syndrome (HLHS), tricuspid atresia and common ventricle were considered as Fontan patients. We used Chi-square and t-test for data analysis. Univariate and multivariate logistic regression were used to analyze the clinical outcomes between the two groups.
A total of 257 Fontan patients underwent HTx during the study period (1.2% of all heart transplants). There was a higher percentage of HLHS (0.9%) followed by common ventricle (0.32%) and tricuspid atresia (0.3%). Among Fontan HTx, mean age was 10 years ± 11, and 37% were female. Racial distributions were: 63% Whites, 23% Hispanics, 10% Blacks and 2.6% Asians. Of 257 Fontan HTx, 41%, 31%, 19% and 9% were admitted to the United States census regions of the South, Midwest, West and Northeast, respectively. Fontan patients were more likely to undergo HTx in urban teaching hospitals. Compared to non- Fontan HTx, Fontan HTx recipients were younger in age (mean age 10 years vs 54 years, p<0.001), more females (37% vs 30%, p=0.008), and had lower prevalence of coronary artery disease (0.4% vs 14%, p<0.001), diabetes mellitus (0.8% vs 14%, p<0.001), chronic kidney disease (12% vs 59%, p<0.001) and high Charlson comorbidity index (CCI) of ≥3 (18% vs 59%, p<0.001). These patients had higher prevalence of supraventricular tachycardia (14% vs 4%, p<0.001), ventricular tachycardia (17% vs 7%, p<0.001), heart failure (66% vs 43%, p<0.001), and liver disease (15% vs 5%, p<0.001). Univariate regression followed by multivariate regression showed that Fontan HTx recipients had higher in-hospital mortality (aOR:7.89, 95% CI: 4.37,14.25, p<0.001), longer length of stay (beta coefficient: 1.42, 95% CI: 1.22, 1.62, p<0.001), higher odds of post operative bleeding (aOR: 2.72, 95% CI: 1.53, 4.82, p<0.001) and intracerebral hemorrhage (aOR: 4.38, 95% CI: 1.78-10.79, p<0.001) after controlling for age, race, CCI, supraventricular tachycardia and ventricular tachycardia.
Our study showed that there were higher rates of in-hospital mortality and hemorrhagic complications in Fontan HTx recipients compared to non-Fontan HTx cohorts. Higher prevalence of liver disease and heart failure were seen in Fontan patients undergoing HTx.
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Details
- Title
- Characteristics And In-hospital Outcomes Of Patients With Fontan Circulation Undergoing Heart Transplants
- Creators
- Khaing Khaing Htwe - McLaren Flint/Michigan State University, Grand Blanc, MINischit Baral - Mount Sinai Medical CenterHtay Aung - St. Christopher's Hospital for ChildrenWilliam Lim - McLaren Flint/Michigan State University, Flint, MIAhmad Munir - McLaren Flint/Michigan State University, Flint, MI
- Publication Details
- Journal of cardiac failure, v 31(1), pp 204-204
- Publisher
- Elsevier Inc
- Number of pages
- 1
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Pediatrics
- Other Identifier
- 991022047141904721