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J Thorac Cardiovasc Surg 2007;133:637-639
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Vaughn A. Starnes (Los Angeles, Calif). Dr Morales and associates are to be congratulated on an excellent paper retrospectively reviewing 21 years of experience at the TCH. During that time, they performed 165 transplants on 155 recipients. As noted in the paper, children with cardiomyopathy made up more than 50% of the patients, another approximately 40% were children with CHD, and 7.9% were children with graft failure.

As noted by the author, this series compares favorably with the International Registry of Heart and Lung Transplant survival statistics and the causes for transplant.

As we see in this report, as also true of the registry, our improvement in survival over time has been primarily related to our early graft survival, particularly in the first year after the transplant event. As noted by these authors, an increase of 20% over this decade between 1995 and after 1995, it increased from 71% to 91% during that period of time; that survival statistic paralleled the course over the next 5 to 10 years.

The authors bring up some interesting findings that are also true in the registry, that ethnicity does affect survival, with the pediatric white population faring better than the African American or Hispanic transplant recipients.

The other interesting factor was that the mismatch between genders was very compelling. The mismatch of a male recipient receiving a female donor heart had a significant importance over time and, in fact, at 10 years the survival difference was 49% versus 70%. I thought that was a very compelling argument about trying to match gender.

I have three questions.

The ISHLT reported a significant negative impact with an odds ratio of 2.1 on the influence of CHD as a pretransplant diagnosis on the outcome of the recipient. You found no statistical difference between . . . [Full Text of this Article]