Author + information
- Received June 12, 2019
- Revision received August 20, 2019
- Accepted September 3, 2019
- Published online October 28, 2019.
- Michael M. Givertz, MDa,∗ (, )@GivertzMichael@ersied727,
- Ersilia M. DeFilippis, MDb,
- Michael J. Landzberg, MDc,
- Sean P. Pinney, MDd,
- Ronald K. Woods, MDe and
- Anne Marie Valente, MDc
- aCardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bDivision of Cardiology, Columbia University Irving Medical Center, New York, New York
- cDepartment of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- dDivision of Cardiology, The Mount Sinai Hospital, New York, New York
- eDivision of Cardiothoracic Surgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
- ↵∗Address for correspondence:
Dr. Michael M. Givertz, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
• Many patients with adult CHD will experience a progressive decline in cardiopulmonary function leading to advanced HF.
• These high-risk patients present unique anatomic and physiological challenges that may not be amenable to repair.
• For highly selected patients, mechanical circulatory support and heart transplantation offer excellent short- and long-term outcomes.
• Prospective registries are needed to determine optimal timing of referral, risk factors for adverse outcomes, and strategies for preservation of end-organ function.
In the contemporary era, nearly 85% of children with congenital heart disease will reach adulthood. Despite optimal medical and surgical treatment, many will experience a progressive decline in cardiopulmonary function leading to advanced heart failure. These patients present unique anatomic and physiological challenges to the care team, and unlike adults with acquired heart disease who progress to severe heart failure, advanced treatment options such as mechanical circulatory support and cardiac transplant may be limited. Severe ventricular dysfunction and/or pulmonary hypertension may not be amenable to corrective repair. Heart transplantation with or without mechanical circulatory support may be the only option for highly selected patients. The aim of this review is to describe advanced heart failure therapies for adults with congenital heart disease, including the general approach to evaluation and management, pre- and post-operative care, anticipated short- and long-term outcomes, and future directions for clinical care and research.
Dr. Givertz has received institutional research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases and Abbott. Dr. Landzberg has served as Clinical Trials Principal Investigator for Actelion/Johnson & Johnson; and has served as Registry Principal Investigator for Canada Heart Research Institute. Dr. Pinney has received consulting fees from Abbott, CareDx, and Medtronic. Dr. Woods is cofounder of OperVu, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Jamil A. Aboulhosn, MD, served as Guest Associate Editor for this paper.
- Received June 12, 2019.
- Revision received August 20, 2019.
- Accepted September 3, 2019.
- 2019 American College of Cardiology Foundation
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