Study Supports Regionalizing Heart Transplants to Improve Survival

Heart surgery should be performed in high-volume hospitals to improve outcomes, based on a recent study of adults undergoing heart transplants for congenital heart disease. Findings were published in the Journal of the American College of Cardiology and highlight the need for dedicated transplant centers across the United States, particularly for patients with congenital heart disease.

Conducted at the University of Washington, this study analyzed 2000–2018 data from a U.S. organ sharing registry. The goal was to see how the number of surgeries each hospital performed impacted outcomes among patients with congenital heart disease.

According to authors, previous studies have found that high-volume centers have better surgical outcomes among children with congenital heart disease. However, this is one of the first studies to compare outcomes among adults with this condition.

In total, the study included 1,746 adults with congenital heart disease who were listed for a heart transplant. About half of participants underwent the procedure during the study period. When comparing survival rates among participants, researchers found that patients had lower risk of death while waiting for an organ when treated at large centers accredited by the Adult Congenital Heart Association. Risk of death was also significantly lower among patients who underwent surgery in high-volume centers in the month after surgery.

As authors note, accredited hospitals have a dedicated team for treating patients with congenital heart disease, including heart failure cardiologists and congenital heart disease surgeons. These centers tend to have a higher volume of patients and, importantly, have the expertise to treat this high-risk group of patients.

Findings support the "regionalization" of heart transplants, which could help improve outcomes for patients with congenital heart disease.

According to the United Network for Organ Sharing, the country is divided into eleven regions when it comes to organ transplants. This study found that patients going to the highest-volume hospital in each region had significantly lower risk of death before and after surgery than those in smaller hospitals. Previous evidence also suggests that sending patients to hospitals performing at least 300 heart transplants a year would reduce death by up to 17%.

The biggest downside is that having fewer, more specialized centers would mean extra travel time for many patients. However, the boost in survival rates would likely outweigh the extra time and money required to send patients to high-volume centers in each region.