Adults with congenital heart disease (CHD) represent an increasing proportion of heart transplant candidates. A retrospective cohort study published in the Canadian Journal of Cardiology evaluated post-transplant outcomes in 89 adults with CHD treated at a high-volume center between 2003 and 2024.

The median age was 40 years (interquartile range 9–66 years), and 52% were male. Seventy-five percent had biventricular physiology and 25% had Fontan physiology. Single-organ transplantation was performed in 56%, while 44% required multi-organ transplantation. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late era (after December 31, 2013) compared with the early era (on or before December 31, 2013), 31% (21/67) versus 5% (1/22), respectively (P = 0.005).

Survival rates were 97% at 30 days (95% CI 97%–99%), 91% at 1 year (95% CI 87%–95%), and 87% at 5 years (95% CI 82%–92%). Although these rates were higher than national registry estimates, direct statistical comparisons were not reported. Fontan physiology was not independently associated with mortality. Predictors of death included longer cardiopulmonary bypass time, prolonged ventilation, and postoperative mechanical circulatory support.

As a single-center retrospective analysis, findings may reflect institutional expertise and may not be generalizable.

Patients with Fontan physiology had lower post-transplantation survival compared with those with biventricular physiology; however, Fontan physiology was not an independent predictor of mortality.