Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements

Son Q. Duong, Justin Godown, Jonathan H. Soslow, Cary Thurm, Matt Hall, Sandeep Sainathan, Victor O. Morell, Debra A. Dodd, Brian Feingold

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Abstract

Objectives: Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly. Methods: Using linked registry data (2001-2016), we identified 186 HT recipients with heterotaxy/situs anomaly and 1254 with congenital heart disease without heterotaxy/situs anomaly. We compared post-HT outcomes in univariable and multivariable time-to-event analyses. LOS and cost from HT to discharge were compared using Wilcoxon rank-sum tests. Sensitivity analyses were performed using stricter heterotaxy/situs anomaly group inclusion criteria and through propensity matching. Results: HT recipients with heterotaxy/situs anomaly were older (median age, 5.1 vs 1.6 years; P <.001) and more often black, Asian, Hispanic, or “other” nonwhite (54% vs 32%; P <.001). Heterotaxy/situs anomaly was independently associated with increased mortality (hazard ratio, 1.58; 95% confidence interval, 1.19-2.09; P =.002), even among 6-month survivors (hazard ratio, 1.86; 95% confidence interval, 1.09-3.16; P =.021). Heterotaxy/situs anomaly recipients more commonly required dialysis (odds ratio, 2.58; 95% confidence interval, 1.51-4.42; P =.001) and cardiac reoperation (odds ratio, 1.91; 95% confidence interval, 1.17-3.11; P =.010) before discharge. They had longer ischemic times (19.2 additional minutes [range, 10.9-27.5 minutes]; P <.001), post-HT intensive care unit LOS (16 vs 13 days; P =.012), and hospital LOS (26 vs 23 days; P =.005). Post-HT hospitalization costs were also greater ($447,604 vs $379,357; P =.001). Conclusions: Heterotaxy and other complex arrangements of cardiac situs are associated with increased mortality, postoperative complications, LOS, and costs after HT. Although increased surgical complexity can account for many of these differences, inferior late survival is not well explained and deserves further study.

Original languageEnglish (US)
Pages (from-to)730-740.e11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number2
DOIs
StatePublished - Feb 1 2019

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Heterotaxy Syndrome
Heart Transplantation
Morbidity
Costs and Cost Analysis
Length of Stay
Mortality
Transplants
Confidence Intervals
Nonparametric Statistics
Heart Diseases
Odds Ratio
Reoperation
Hispanic Americans
Intensive Care Units
Survivors
Registries
Dialysis
Hospitalization
Pediatrics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements. / Duong, Son Q.; Godown, Justin; Soslow, Jonathan H.; Thurm, Cary; Hall, Matt; Sainathan, Sandeep; Morell, Victor O.; Dodd, Debra A.; Feingold, Brian.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 2, 01.02.2019, p. 730-740.e11.

Research output: Contribution to journalArticle

Duong, Son Q. ; Godown, Justin ; Soslow, Jonathan H. ; Thurm, Cary ; Hall, Matt ; Sainathan, Sandeep ; Morell, Victor O. ; Dodd, Debra A. ; Feingold, Brian. / Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 2. pp. 730-740.e11.
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abstract = "Objectives: Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly. Methods: Using linked registry data (2001-2016), we identified 186 HT recipients with heterotaxy/situs anomaly and 1254 with congenital heart disease without heterotaxy/situs anomaly. We compared post-HT outcomes in univariable and multivariable time-to-event analyses. LOS and cost from HT to discharge were compared using Wilcoxon rank-sum tests. Sensitivity analyses were performed using stricter heterotaxy/situs anomaly group inclusion criteria and through propensity matching. Results: HT recipients with heterotaxy/situs anomaly were older (median age, 5.1 vs 1.6 years; P <.001) and more often black, Asian, Hispanic, or “other” nonwhite (54{\%} vs 32{\%}; P <.001). Heterotaxy/situs anomaly was independently associated with increased mortality (hazard ratio, 1.58; 95{\%} confidence interval, 1.19-2.09; P =.002), even among 6-month survivors (hazard ratio, 1.86; 95{\%} confidence interval, 1.09-3.16; P =.021). Heterotaxy/situs anomaly recipients more commonly required dialysis (odds ratio, 2.58; 95{\%} confidence interval, 1.51-4.42; P =.001) and cardiac reoperation (odds ratio, 1.91; 95{\%} confidence interval, 1.17-3.11; P =.010) before discharge. They had longer ischemic times (19.2 additional minutes [range, 10.9-27.5 minutes]; P <.001), post-HT intensive care unit LOS (16 vs 13 days; P =.012), and hospital LOS (26 vs 23 days; P =.005). Post-HT hospitalization costs were also greater ($447,604 vs $379,357; P =.001). Conclusions: Heterotaxy and other complex arrangements of cardiac situs are associated with increased mortality, postoperative complications, LOS, and costs after HT. Although increased surgical complexity can account for many of these differences, inferior late survival is not well explained and deserves further study.",
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T1 - Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements

AU - Duong, Son Q.

AU - Godown, Justin

AU - Soslow, Jonathan H.

AU - Thurm, Cary

AU - Hall, Matt

AU - Sainathan, Sandeep

AU - Morell, Victor O.

AU - Dodd, Debra A.

AU - Feingold, Brian

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N2 - Objectives: Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly. Methods: Using linked registry data (2001-2016), we identified 186 HT recipients with heterotaxy/situs anomaly and 1254 with congenital heart disease without heterotaxy/situs anomaly. We compared post-HT outcomes in univariable and multivariable time-to-event analyses. LOS and cost from HT to discharge were compared using Wilcoxon rank-sum tests. Sensitivity analyses were performed using stricter heterotaxy/situs anomaly group inclusion criteria and through propensity matching. Results: HT recipients with heterotaxy/situs anomaly were older (median age, 5.1 vs 1.6 years; P <.001) and more often black, Asian, Hispanic, or “other” nonwhite (54% vs 32%; P <.001). Heterotaxy/situs anomaly was independently associated with increased mortality (hazard ratio, 1.58; 95% confidence interval, 1.19-2.09; P =.002), even among 6-month survivors (hazard ratio, 1.86; 95% confidence interval, 1.09-3.16; P =.021). Heterotaxy/situs anomaly recipients more commonly required dialysis (odds ratio, 2.58; 95% confidence interval, 1.51-4.42; P =.001) and cardiac reoperation (odds ratio, 1.91; 95% confidence interval, 1.17-3.11; P =.010) before discharge. They had longer ischemic times (19.2 additional minutes [range, 10.9-27.5 minutes]; P <.001), post-HT intensive care unit LOS (16 vs 13 days; P =.012), and hospital LOS (26 vs 23 days; P =.005). Post-HT hospitalization costs were also greater ($447,604 vs $379,357; P =.001). Conclusions: Heterotaxy and other complex arrangements of cardiac situs are associated with increased mortality, postoperative complications, LOS, and costs after HT. Although increased surgical complexity can account for many of these differences, inferior late survival is not well explained and deserves further study.

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