Heart transplantation after congenital heart surgery: improving results and future goals.

With growing numbers of children with complex congenital heart disease surviving initial surgical procedures, more patients are presenting in later childhood or early adulthood in cardiac failure. This presents an obvious increased burden on transplant centres, and a further strain on a limited donor pool. Historically, results for heart transplant following congenital heart disease (CHD) have been worse than those following cardiomyopathy. With increased surgical experience and intensive care expertise, the gap between the two aetiologies in our practice is decreasing. This article reviews the current protocols for transplantation in this setting, presenting a large single-centre experience over 20 years, and speculates on possible future advancements in this very challenging field.