Congenital heart disease, how should we have to be prepared for transplantation?: Surgical tips and tricks

Introduction and objectives: Congestive heart failure develops in congenital heart disease (CHD) after failure of conventional medical-surgical treatments. In suitable candidates, heart transplantation improves their quality and quantity of life. We present our heart transplants in CHD performed in the last 20 years, focusing on technical modifications required, and transplant short-medium-term results. Material and methods: Retrospective analysis of 44 patients with CHD transplanted during 2001-2021 in our specialized CHD hospital. Statistical study: SPSS-15.0. Results: Median age 17.5 years (IQR: 3.2-40.6), 22 children and 22 adults. Previous surgeries: 93% and mechanical circulatory support: 25%. Most frequent initial diagnoses: single ventricle-45%, and transposition of the great vessels-20%. Transplant was bicaval: 43 (98%), biatrial: 1(2%). Additional surgical techniques needed more frequently: removal of prosthetic material (pacemakers-defibrillators-ventricular assist-stents) and reconstruction of pulmonary arteries. Median cardiopulmonary bypass time: 208 min (IQR: 160-245), and heart ischemia 271 min (IQR: 220-302). Inhospital mortality: 9 (20%). Previous surgeries (p = 0.01), postoperative ECMO (p = 0.007) and hemofiltration for acute renal failure (p = 0.003) are statistically associated with inhospital mortality. Median follow-up: 21 months (IQR: 9-72), 4 late deaths. Survival after hospital discharge is 93% at 1 year, 87% at 3 years, and 80% after 5 years. Conclusions: Transplantation of patients with CHD with our multidisciplinary approach in a specialized setting has good results. Reoperations that prolong surgical times and transplant with technical modifications are frequent. Previous surgeries, postoperative need of ECMO or hemofiltration are significantly associated with higher inhospital mortality in these patients. Survival after hospital discharge is favourable. (C) 2021 Sociedad Espafiola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espafia, S.L.U.