Advanced Heart Failure in Adults With Congenital Heart Disease

Differential myocardial fibrosis of the systemic right ventricle and subpulmonary left ventricle after atrial switch operation for complete transposition of the great arteries

“…The prevalence of repaired congenital heart disease in adults is increasing as survival into adulthood exceeds 85% after cardiac surgery in the present era [1] . Heart failure has emerged as one of the most important issues in patients with repaired complex congenital heart lesions [2] , [3] . In particular, dysfunction of the systemic right ventricle in adults after atrial switch operation for complete transposition of the great arteries (TGA) has been a focus of attention [4] , [5] .…”

Cardiac transplantation in adult congenital heart disease with prior sternotomy

“…The main cause of high operative mortality is surgical difficulty, which results from anatomical complexity and adhesions from previous sternotomy. Dense adhesions from previous sternotomies and anatomical complexities lead to longer ischemic times 18 . Heart transplantation in these patients often requires extensive reconstruction of the aortic arch, vena cava, or pulmonary arteries, leading to longer ischemic times and an increased risk of bleeding 13 .…”

“…Further data are required to determine the candidacy for isolated OHT or heart‐liver transplant if advanced liver disease is present. Appropriate patient selection and multidisciplinary perioperative care is essential in all cases 18 …”

“…Appropriate patient selection and multidisciplinary perioperative care is essential in all cases. 18 In our cohort, only 15% received left ventricular assist devices (LVAD) as a bridge to transplant. In contrast, nearly 30%-50% of overall adult recipients received MCS therapy at time of OHT in the recent era.…”

“…Dense adhesions from previous sternotomies and anatomical complexities lead to longer ischemic times. 18 Heart transplantation in these patients often requires extensive reconstruction of the aortic arch, vena cava, or pulmonary arteries, leading to longer ischemic times and an increased risk of bleeding. 13 In our cohort, more than 80% of patients had multiple prior palliative or corrective surgeries.…”