Cardiac transplantation for the treatment of adults with congenital heart disease: a single center experience

The Journal of Heart and Lung Transplantation Volume 22, Number 1S beneficial. This report describes outcome for six heart transplant patients who had an ICD placed for ventricular tachycardia or syncope with known left ventricular dysfunction and/or severe transplant coronary artery disease (TCAD). Methods: Six heart transplant patients with symptoms of left ventricular dysfunction and/or severe TCAD by angiography presented with syncope or non-sustained ventricular tachycardia on cardiac monitoring. Due to the implied risk of sudden death, these patients underwent percutaneous ICD placement [Medtronic (2), Guidant, Atlas, Ventak, CPI]. Results: The average age of the six patients was 58 years and the average time to ICD after heart transplant was 82 months (range 53 to 155 months). 4/5 patients had reduced echo left ventricular ejection fraction between 18 and 45% and 5/6 patients had severe 2 to 3 vessel TCAD. 2/6 patients died suddenly within four months of having the ICD placed. The two patients had progression of TCAD at absaopsy. The four remaining patients have had no firing of the ICD and have had routine ICD follow-up. The longest patient has had the ICD for 65 months with progression of his TCAD. Conclusion: ICD placement does not necessarily protect heart transplant patients from sudden death especially if they have progression of underlying TCAD. Further experience with ICD in heart transplant patients is needed prior to establishing a policy regarding the use of this life saving device. 324 CARDIAC TRANSPLANTATION FOR THE TREATMENT OF ADULTS WITH CONGENITAL HEART DISEASE: A SINGLE CENTER EXPERIENCE S.P. Pinney,1 D.T. Hsu,2 L.J. Addonizio,2 M.S. Rosenbaum,1 J.M. Chen,3 J.M. Quaegebeur,3 R.S. Mosca,3 N.M. Edwards,3 D.M. Mancini,1 J.M. Lamour,2 1Cardiology, Columbia University; 2 Pediatric Cardiology, Columbia University; 3Cardiothoracic Surgery, Columbia University, New York, NY Background: Despite advances in surgical and medical care, some adult patients with congenital heart disease (CHD) develop myocardial failure requiring cardiac transplantation. Adults with CHD are considered to be at increased risk for transplant becuase of their complex anatomy and previous operations. To determine whether this negatively impacts survival, we conducted a retrospective review of the outcome of adult transplants with CHD. Methods: We reviewed recipient charts for patients ⱖ18 years transplanted between 1/1/1985 and 1/1/2002 for the primary indication of CHD. Results: Of 1,101 orthotopic transplants, 33 (3.0%) were for the treatment of adults with CHD. Three additional patients transplanted for dilated cardiomyopathy had congenital anomalies: HoltOram syndrome (n ⫽ 2) and anomalous origin of the left coronary artery (n ⫽ 1). The anatomic diagnoses were: single ventricle (SV)-13 (39%), tetralogy of Fallot-6 (18%), d-TGA-5 (15%), lTGA-4 (12%), Ebstein’s anomaly-2 (6%), VSD-2 (6%), pulmonary stenosis-1 (3%). The one, five and ten year Kaplan-Meir survival rates were 78, 67 and 60%, respectively. This compares with survival rates of 82, 67 and 47% for all adults transplanted at our center during this period (p ⫽ NS). There were 6 early deaths occurring within 45 days post-transplant. Five were in patients with SV; one had l-TGA. The cause of death was bleeding-2, sepsis-2, RV failure-1 and intracranial bleed-1. In spite of this early mortality, overall survival of patients with SV vs. those with other CHD was not significantly different. By multivariate analysis, no single anatomic or surgical risk factor was predictive of death.

Abstracts

S179

Conclusion: Cardiac transplantation for the treatment of adults with CHD is not associated with decreased survival although the presence of SV may increase the early mortality risk. Careful patient selection and meticulous peri-operative management in experienced centers are necessary to ensure successful outcomes.

325 EARLY INITIATION OF AEROBIC AND RESISTANCE TRAINING IMPROVES PEAK AEROBIC POWER, LEG-PRESS MAXIMAL STRENGTH AND DISTANCE WALKED IN SIX MINUTES IN RECENT CARDIAC TRANSPLANT RECIPIENTS M. Haykowsky,1 N. Eves,1 L. Figgures,1 M. Koller,1 J. Burton,2 W. Tymchak,2 1Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; 2Division of Cardiology, University of Alberta, Edmonton, AB, Canada Purpose: Currently, there has not been a prospective study that has examined the effects of aerobic and resistance training on peak aerobic power (VO2peak), leg-press maximal strength and distance walked in 6 minutes (6MW) in recent cardiac transplant recipients (CTR). The aim of this study was to examine the effects of 12 weeks of aerobic and resistance training, initiated within one month after orthotopic cardiac transplantation, on VO2peak, leg-press maximal strength and 6MW. Methods: Seven clinically stable CTR (mean ⫾ SD, age: 55⫾7 years) were recruited for this study. Each subject performed the following baseline tests: 1) An incremental cycle exercise test to determine their VO2peak and O2pulsepeak; 2) A maximal leg-press test and 3) A 6MW test. Subjects then completed 12 weeks of aerobic exercise (30-40 minutes/day of treadmill and/or cycling exercise at an intensity between 12 to 14 on the Borg scale) and lower extremity resistance training (3-5 sets of 10 repetitions at 50% of their maximal strength) 5 days/week. All baseline tests were repeated after 12 weeks of training. Results: The results are shown in the table below. Selected variables demonstrating the effects of 12-weeks of aerobic and resistance training

Pre Training Post Training

VO2peak (ml/kg/min)

HRpeak (bt/min)

O2pulsepeak (ml/bt)

RER

LPmax (kg)

6MW (m)

13.4 ⫾ 2.4 19.0 ⫾ 4.1*

108 ⫾ 19 135 ⫾ 14*

10.5 ⫾ 2.4 12.1 ⫾ 3.3*

1.14 ⫾ 0.09 1.12 ⫾ 0.06

75 ⫾ 32 129 ⫾ 47*

331 ⫾ 120 589 ⫾ 76*

(* ⫽ p ⬍ 0.05 vs. pre training; RER ⫽ respiratory exchange ratio; LPmax ⫽ maximal leg press).

Conclusions: Initiation of aerobic and resistance training within one month after cardiac transplantation resulted in a 41% increase in VO2peak secondary to increases in heart ratepeak and O2pulsepeak. Training was also associated with a 1.7 fold increase in maximal leg press strength and 6MW. In addition, the improvement in 6MW was significantly correlated to the increases in VO2peak and leg-press maximal strength (r2 ⫽ 0.83). In summary, aerobic and resistance training initiated within the first month after cardiac transplantation is an effective intervention to improve overall fitness and function.

326 THE RIGHT VENTRICULAR RESPONSE TO PULMONARY HYPERTENSION IS RELATED TO LEFT VENTRICULAR MASS T. Saba,1 J. Foster,2 M. Cockburn,2 M. Cowan,2 A. Peacock,1 1Scottish Pulmonary Vascular Unit, Western Infirmary, Glasgow, Lanarkshire, United Kingdom; 2Department of Radiology, Western Infirmary, Glasgow, Lanarkshire, United Kingdom