The study analyzes cardiothoracic transplantation in adults with congenital heart disease (ACHD) at a single center over nearly three decades (1987–2024). A total of 196 ACHD patients underwent first-time transplantation.
The annual ACHD transplant rate doubled after 2018, marking a shift from an early era dominated by heart–lung transplantation for isolated septal defects to a contemporary period involving sicker, more complex patients. Two eras are contrasted: 1987–2018, characterized by heart–lung procedures and less complex anatomy, and 2018 onwards, characterized by increased patient complexity, prior surgeries, and greater utilization of single-ventricle circulations with Glenn/Fontan palliation.
Post–UNOS heart allocation policy changes, recipients tended to be older, with more prior cardiac surgeries, more hospitalization events, and greater prevalence of single-ventricle anatomy. 1-year survival for all ACHD transplant recipients remained comparable between eras (about 81% in both).
Among heart-only transplants, survival appeared higher in the contemporary era (approximately 90.7% vs 72.5%), though the difference did not reach conventional statistical significance (P=0.066). The authors conclude that ACHD transplantation has grown in volume and complexity, with excellent long-term survival achievable with medical and surgical adjuncts.