AHA
Scientific Sessions

ORLANDO — Listing unborn babies with severe prenatal heart problems
results in earlier heart transplants and comparable outcomes when compared with
babies added to a transplant list after birth, researchers reported here.

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A prospective, multicenter, events-driven data registry was used to
determine outcomes of babies listed for heart transplantation before birth. The
researchers’ search identified 4,365 children added to a heart transplant
list for the study period of 1993 to 2009. Unborn babies comprised 1% and
newborns (aged 0 to 30 days) comprised 19.8% of those listed.

The most common indication for fetal listing for
heart transplant was congenital heart disease, with left-side
obstructive lesions predominating.

Unborn babies were listed for an average 18 days before delivery. About
half of the babies listed before birth waited 1 month to receive a transplant
while newborn babies waited 3 months, on average. The median wait-list time to
heart transplant after birth was 25 days for babies listed before birth vs. 39
days for newborns.

Survival did not differ for babies listed before or after birth
(P=.2). Multisystem failure was the most common cause of wait-list death
among babies listed before birth and cardiac failure was the most common cause
among babies listed after birth.

Of those who survived the heart transplant, mean age at transplant (50
days vs. 66 days), sex (78% vs. 62% male) and race (89% vs. 79% white) were not
different between the unborn and newborn listed groups.

“Babies continue to have the highest chance of dying while waiting
for a heart transplant due to the shortage of donor organs. Listing a fetus
with severe heart disease is one way to try to deal with this shortage,
although only a few patients were actually delivered early after receiving a
donor offer while in utero. This strategy does not apply to most fetuses but
can be considered in specific types of cases because the outcomes after
transplant are good,” Jennifer Conway, MD, from the Hospital for
Sick Children, Toronto, told Cardiology Today.

“Our hope would be that studies such as this can contribute to
increasing community awareness about the difficult outcomes for babies in need
of heart transplants and underscore the importance of organ donation,”
Conway said. Future research may focus on which fetuses would benefit most from
early transplant listing and how to determine whether a fetus should undergo
surgery after birth, she added. – by Katie Kalvaitis

For more information:

• Conway J. Abstract #11335. Presented at:
  American Heart Association Scientific Sessions 2011; Nov. 12-16,
  2011; Orlando.

Disclosure: Dr. Conway reports no relevant financial disclosures.

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