Background: The objectives of this study were to ascertain perioperative and post-heart transplant (HTx) outcomes for congenital vs acquired heart disease.

Methods: Review of HTx patients (1989-Dec 2007). Data collected included demographics, pre-HTx medical characteristics (surgical history, HLA senzitization, days wait-listed), and perioperative and post-HTx outcomes including ICU time, ECMO use and survival.

Results: 181 patients underwent HTx, of whom 118 had CHD (43 hypoplastic left heart syndrome; and 63 acquired heart disease (AHD)(30 male, 48%; 2 LV fibromas, and 61 CM: 11 restrictive CM, 48 dilated CM; 2 Anthracycline CM). Of the CHD patients, 64 (54%) had prior cardiac surgeries: failed univentricular palliation (n=35); failed biventricular repair (n=28). Mean follow-up time of the groups was similar: 3.8 yrs (CHD) vs 3.5 yrs (AHD). Kaplan Meier survival outcomes were better for AHD vs CHD at 1 yr post-Htx: 88% vs 80%; 3 yrs: 86% vs 74.5%; 5 yrs: 73% vs 68.5%.

CHD patients were more likely to be HLA sensitized (13% vs 6%, p<0.01), be younger at HTx (4.8 yrs vs 7.3 yrs, p<0.05), have longer mean days wait-listed (105 vs 64, p<0.01), use ECMO post-HTx (17 vs 5, p<0.01), and have greater mortality (37 vs 13, p<0.05) than AHD patients.

Conclusions: Patients with CHD have higher mortality after HTx, compared to those with AHD. The increased risk of allosensitization and prior cardiac surgeries likely contributes to the increased risk of death in patients with CHD.