Heart transplantation in adults with congenital heart diseases: A comprehensive meta-analysis on waiting times, operative, and survival outcomes

Abstract

The rising prevalence of congenital heart disease (CHD) among adults has led to increased heart transplantation (HT) procedures in this population. However, CHD patients face significant challenges including longer waiting times, higher early mortality rates, and increased risks of complications such as renal dysfunction. This systematic review and meta-analysis examined 50 studies to assess waiting times, postoperative outcomes, and survival rates in CHD patients undergoing HT compared to non-CHD patients. Results revealed that CHD patients experience longer HT waiting times (mean difference [MD]: 53.86 days, 95 % CI: [22.00, 85.72], P = 0.0009) and increased ischemic times (MD: 20.01 min, 95 % CI: [10.51, 29.51], P < 0.0001), which may increase waitlist and early postoperative mortality. Regarding complications, renal dysfunction is more prevalent in CHD patients than in non-CHD patients (RR: 2.05, 95 % CI: [1.61, 2.61], P < 0.00001). Despite these challenges, long-term survival rates for CHD patients are comparable to those of non-CHD recipients, with significant improvements noted in recent allocation systems. Our findings emphasize the need for ongoing refinements in HT allocation systems to improve outcomes for CHD patients, particularly in reducing waiting times and managing post-transplant complications.