Transplant Evaluation and Acute Posttransplant Care of the Adult with Congenital Heart Disease
As of 2010 there were approximately 2.4 million people in the United States living with congenital heart disease of which 1.4 million are adults (Gilboa SM, Devine OJ, Kucik JE, Oster ME, Riehle-Colarusso T, Nembhard WN, Xu P, Correa A, Jenkins K, Marelli AJ, Circulation. 134:101–9, 2016). With the advancement in prenatal detection, early surgical intervention, and improved medical management, more children with congenital heart disease are living into adulthood. While there has been significant advancement in palliative and corrective surgical repairs of congenital heart disease, congestive heart failure still remains a significant cause for morbidity and mortality in adults with congenital heart disease. As a result, 10–20% of adults with congenital heart disease may require heart transplantation, and they account for approximately 3% of all adult heart transplants (Goldberg SW, Fisher SA, Wehman B, Mehra MR, The Journal of Heart and Lung Transplantation. 33:873–7, 2014). Although congenital heart disease is a small percentage of causes for heart transplant, the percentage of heart transplants for adults with congenital heart disease has nearly doubled in the last 18 years and will likely continue to increase as more children with congenital heart disease survive into adulthood. Much of the transplant evaluation is similar in adults with congenital heart disease and those without; however, there are unique pathologic and physiologic characteristics of those with congenital heart disease that require special consideration in the evaluation process prior to listing for heart transplantation and the postoperative care after transplantation. In this chapter we will discuss the evaluation process for transplant and the immediate postoperative management of the adult congenital heart disease population who receive a heart transplantation.
KeywordsAdult congenital heart disease (ACHD) Heart transplant Transplant evaluation Postoperative care Graft failure Arrhythmias Immunosuppression
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