Andre Thien Vu

All Publications

• Outcomes of Adults with Congenital Heart Disease Undergoing Heart and Heart-Liver Transplantation: A Single-Center Experience. The Journal of thoracic and cardiovascular surgery Mullis, D. M., Krishnan, A., Vargas, N. M., Hu, S., Heng, E., Alnasir, D., Berg, A. R., Vu, A., Lui, G. K., Haeffele, C. L., Teuteberg, J. J., Daugherty, T., Gallo, A., Esquivel, C. O., Bonham, C. A., Woo, Y. J., MacArthur, J. W. 2026

  Abstract

  The number of adults with congenital heart disease (ACHD) continues to rise, often presenting with multiorgan dysfunction. This is the largest single-center series reporting outcomes of ACHD who underwent either heart transplantation (HT) or combined heart-liver transplantation (CHLT).Adults (age ≥ 18) with congenital heart disease were identified in retrospective review. All-cause mortality was compared in a Cox-proportional hazards model. Mann-Whitney and Chi-squared tests were used to analyze differences between groups.Between 1987 and 2024, 81 ACHD underwent HT (N=67, 83%) or CHLT (N=14, 17.3%) at our institution. There has been an increasing number of HTs and CHLTs performed for ACHD at our institution, especially over the past decade. Patients who underwent CHLT were more likely to have single-ventricle physiology (57% vs 20% for CHLT vs HT, respectively, p=.007). Amongst patients palliated with prior Fontan, the median time between Fontan and transplant was 19 years for HT and 26 years for CHLT. The en bloc technique was used for 13 of 14 patients who underwent CHLT (92.9%). Median cross-clamp time and total heart ischemic time were similar between HT and CHLT (p=.20, p=.19, respectively). Short- and mid-term survival were comparable for patients who underwent CHLT and HT (Figure 2). CHLT recipients exhibited a higher degree of freedom from acute cellular rejection, antibody-mediated rejection, and chronic rejection, though this did not reach statistical significance when compared to HT recipients (Figure 3).Our experience demonstrates that both HR and CHLT can be performed safely with excellent outcomes.

  View details for DOI 10.1016/j.jtcvs.2026.03.614

  View details for PubMedID 42092508

• Expanding access and rising complexity: Contemporary early outcomes in heart-liver transplantation for adult congenital heart disease. The Journal of thoracic and cardiovascular surgery Berg, A. R., Krishnan, A., Heng, E. E., Hu, S., Mullis, D. M., Vargas, N. M., Vu, A., Garrison, A. C., Alnasir, D. I., Clark, D., Haeffele, C., Lui, G., Teuteberg, J., Woo, Y. J., MacArthur, J. W. 2026; 171 (5): 1090-1100.e3

  Abstract

  Adoption of the 6-tier US heart allocation policy in October 2018 coincided with increasing use of combined heart-liver transplantation (CHLT) and more adults with congenital heart disease (ACHD) candidates. The impact of early outcomes is uncertain, however.We retrospectively analyzed adult CHLTs recorded in the United Network for Organ Sharing (UNOS) database between January 1, 2000, and July 1, 2025, excluding retransplantation and multiorgan cases. Two eras were defined: premodern (2000-2018) and modern (2019-2025). Cox models for 1-year mortality included era, ACHD status, and an era × ACHD interaction, adjusted for primary analysis covariates. Era-stratified survival also compared CHLT with orthotopic heart transplantation (OHT) for ACHD.Among 602 recipients (premodern era, 247; modern era, 355), annual CHLT volume tripled and the ACHD share rose from 20.6% to 50.7% from the premodern era to the modern era. Modern recipients were younger and of greater acuity; procurement distance and cold ischemic time increased (192 nautical miles vs 47 nautical miles and 3.7 hours vs 2.9 hours), and the use of donation after circulatory death hearts began. Unadjusted 30-day and 1-year mortality were higher post-2019, while conditional survival beyond 30 days was similar in the 2 eras. Adjusted analyses showed an era × ACHD association with higher 1-year mortality (hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.08-9.50); longer cardiac cold ischemic time was associated with increased risk (per hour HR, 1.32; 95% CI, 1.14-1.54). In ACHD patients, survival after OHT improved in the modern era but survival after CHLT declined, yielding a ∼20-point 1-year gap.Post-2018 expansion broadened CHLT access for ACHD. The early perioperative signal aligns with ACHD OHT complexity and may be amplified in dual-organ CHLT, particularly as longer travel and ischemia accompany expanded accessibility, supporting earlier referral and physiologically aligned exception pathways.

  View details for DOI 10.1016/j.jtcvs.2025.12.035

  View details for PubMedID 41967883

• Expanding Access and Rising Complexity: Contemporary Early Outcomes in Heart-Liver Transplantation for Adult Congenital Heart Disease Berg, A., Krishnan, A., Heng, E. E., Hu, S., Mullis, D., Vu, A., Garrison, A., Alnasir, D., Clark, D., Haeffele, C., Teuteberg, J., Woo, Y., MacArthur, J. MOSBY-ELSEVIER. 2026: S215-S216

  View details for DOI 10.1016/j.jtcvs.2026.03.271

  View details for Web of Science ID 001763347800029

• Long-Term Outcomes for Patients Undergoing Hybrid Ablation for Atrial Fibrillation. The Journal of thoracic and cardiovascular surgery Weininger, G., Aparicio-Valenzuela, J., Yau, T., Vu, A., Pong, T., Lee, A. M. 2025

  Abstract

  Hybrid ablation (HA) for atrial fibrillation (AF) consists of a thoracoscopic epicardial ablation followed by an endocardial, catheter ablation. Several small randomized controlled trials have recently demonstrated the efficacy of this approach; however the data is limited by modest sample sizes with limited follow up. In this study we evaluate the long-term efficacy of HA in a large single-institution series over a ten-year period.Patients with refractory AF underwent HA between the years of 2015 and 2025 at a single institution with a single surgeon. Epicardial ablation consisted of pulmonary vein isolation, isolation of the posterior left atrium, and left atrial appendage clip application. Patient medical records were reviewed for demographics, comorbidities, medications, recurrence of AF, operative reports, pathology reports, length of hospital stay, stroke, and death. Recurrence was defined as AF > 30 seconds in duration beyond a 90-day blanking period on 24 hour or longer continuous monitoring. Patients were followed for up to nine years.304 patients were identified who underwent the first stage epicardial ablation, 239 of whom also completed the second stage endocardial ablation between the years of 2015 and 2025. At one year, 81% of patients were in normal sinus rhythm (NSR) and 64% were also off all class I and class III anti-arrhythmic drugs (AADs). At five years these rates were 66% and 47% respectively. 8 patients (2.6%) required conversion to open Maze and 30-day mortality occurred in 1 patient (0.3%). In 199 patients (65% of cases) the epicardial ablation was performed through a left sided only thoracoscopic approach, which was associated with a mildly shorter hospital length of stay compared to bilateral thoracoscopic approach (3 days vs 4 days, p=0.0038), lower rate of ICU admission (9% vs 18% p=.038), and equivalent rates conversion to open Maze and AF recurrence at 1 year. 14 patients were incidentally found to have amyloid deposits in left atrial appendage specimens sent for pathology, 3 of these patients had transthyretin (ATTR) subtype.In this large single-institution study of hybrid ablation outcomes over a 10-year period, we demonstrate excellent short and long-term freedom from AF with low rates of complication and conversion to open surgery. Left sided, unilateral thoracoscopic access was safe and benefitted patients' length of stay and rate of ICU admission. It may be beneficial to routinely send left atrial appendage specimens at the time of epicardial ablation.

  View details for DOI 10.1016/j.jtcvs.2025.11.017

  View details for PubMedID 41314536

• Growing Use, Evolving Risk: A Contemporary Profile of Heart-Liver Transplantation Berg, A., Krishnan, A., Heng, E., Hu, S., Mullis, D., Vargas, N., Vu, A., Garrison, A., Alnasir, D., Clark, D., Haeffele, C., Lui, G., Teuteberg, J., Woo, Y., Macarthur, J. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1161/circ.152.suppl_3.4367893

  View details for Web of Science ID 001613950900034

• Donor Renal Function Should Inform Evaluation of Circulatory Death Heart Offers Berg, A., Krishnan, A., Heng, E., Mullis, D., Garrison, A., Vu, A., Alnasir, D., Teuteberg, J., Woo, Y., Macarthur, J. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1161/circ.152.suppl_3.4366285

  View details for Web of Science ID 001613917100040