The Waiting List Mortality of Pediatric Heart Transplantation Candidates in Korea before the Pediatric Ventricular Assist Device Era

Background@#Despite advancements in heart transplantation for pediatric patients in Korea, the waiting list mortality has not been reported. Therefore, we investigated the waiting list mortality rate and factors associated with patient mortality. @*Methods@#We reviewed the medical records of pediatric patients who were registered for heart transplantation at three major hospitals in Korea from January 2000 to January 2020.All patients who died while waiting for heart transplantation were investigated, and we identified the waiting list mortality rate, causes of mortality and the median survival periods depending on the variable risk factors. @*Results@#A total of 145 patients received heart transplantations at the three institutions we surveyed, and the waiting list mortality rate was 26%. The most common underlying diseases were cardiomyopathy (66.7%) and congenital heart disease (30.3%). The leading causes that contributed to death were heart failure (36.3%), multi-organ failure (27.2%), and complications associated with extracorporeal membrane oxygenation (ECMO) (25.7%). The median survival period was 63 days. ECMO was applied in 30 patients. The different waiting list mortality percentages according to age, cardiac diagnosis, use of ECMO, and initial Korean Network of Organ Sharing (KONOS) level were determined using univariate analysis, but age was the only significant factor associated with waiting list mortality based on a multivariate analysis. @*Conclusion@#The waiting list mortality of pediatric heart transplantation candidates was confirmed to be considerably high, and age, underlying disease, the application of ECMO, and the initial KONOS level were the factors that influenced the survival period.

Survival of the Infants with Bronchopulmonary Dysplasia and Congenital Heart Disease

PURPOSE: Pulmonary hypertension is a known risk factor for mortality in preterm infants with bronchopulmonary dysplasia. However, mortality in patients with bronchopulmonary dysplasia and congenital heart disease has been poorly investigated. Therefore, we conducted an investigation into the mortality and risk factors in these patients. METHODS: We reviewed the records of 45 preterm infants who were diagnosed with bronchopulmonary dysplasia and congenital heart disease from 2010 to 2013. Their survival was compared with that of a group of control individuals who did not have congenital heart disease. A variety of factors associated with survival were examined. RESULTS: Although initial pulmonary hypertension was more frequent in the patient group, no significant differences were found between the patients and the control subjects with respect to cumulative mortality. The log-rank test indicated that many factors, including follow-up pulmonary hypertension, the use of pulmonary vasodilators, and aggravated oxygen demand, but not the congenital heart disease type, impacted upon survival in the patient group. Aggravated oxygen demand was the only factor that was determined to be associated with mortality in the multivariate analysis. CONCLUSION: There was no significant difference between the patient and the control groups with respect to cumulative survival. Of the three factors that affected survival within the patient group, aggravated oxygen demand was the only risk factor that was associated with mortality.