203: Comparison of Risk Factors and Outcomes for Pediatric Patients Listed for Heart Transplantation after Bidirectional Glenn and after Fontan: A Multi-Institutional Study

Kovach, Joshua; Blume, Elizabeth D.; Naftel, David C.; Pearce, F. Bennett; Foushee, Margaret T.; Edens, Ernst; Shuhaiber, Jeffrey; Fynn-Thompson, F.; Kirklin, James K.; Zangwill, Steven

doi:10.1016/j.healun.2009.11.214

Cited by 2 publications

(3 citation statements)

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“…These authors concluded that for selected high-risk single-ventricle patients, transplant should be considered as an alternative to Fontan completion (393). However, a recent large multi-center study from the Pediatric Heart Transplant Study group found similar outcomes for patients listed after bidirectional Glenn (n = 189) versus those transplanted after Fontan (n = 194); in this series, patients transplanted with Fontan who became ventilator dependent had poor survival (395). …”

Section: Stage III (Fontan Operation; Total Cavopulmonary Connection)mentioning

confidence: 89%

Hypoplastic Left Heart Syndrome

Feinstein

Benson

Dubin

et al. 2012

Journal of the American College of Cardiology

445

176

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In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

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Section: Stage III (Fontan Operation; Total Cavopulmonary Connection)mentioning

confidence: 89%

Hypoplastic Left Heart Syndrome

Feinstein

Benson

Dubin

et al. 2012

Journal of the American College of Cardiology

445

176

View full text Add to dashboard Cite

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“…11 Kovach and colleagues performed another multiinstitutional analysis in the PHTS to examine risk factors and outcomes for heart transplantation after Fontan versus those listed following the bidirectional Glenn stage of palliation. 14 This study was undertaken to examine the possibility that outcomes may be superior with listing after bidirectional Glenn for ''high-risk'' Fontan candidates because of the more stable physiology following Glenn, the presence of fewer prior surgical interventions, and the known increased risk of transplantation with acutely decompensating patients with a failing Fontan. Despite these theoretical concerns, survival after listing was similar and posttransplant survival was nearly identical (Figure 16).…”

Section: Posttransplant Survivalmentioning

confidence: 99%

“…PHTS (2003-2008). Reproduced with permission from Kovach et al 14 PHTS indicates Pediatric Heart Transplant Study.…”

Section: Posttransplant Survivalmentioning

confidence: 99%

Cardiac Transplantation and Mechanical Support for Functional Single Ventricle

Kirklin

Pearce

Dabal

et al. 2012

World J Pediatr Congenit Heart Surg

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Cardiac transplantation has played a pivotal role in the therapeutic algorithm for anatomically uncorrectable congenital heart disease, particularly the failing single ventricle. The historical evolution from Kantrowitz to Bailey and beyond challenges the application of this scarce resource to complex cardiac malformations in the presence of physiologic and circulatory failure. While selection of cardiac transplantation as primary therapy for hypoplastic-left heart syndrome is currently rare, the failing single ventricle in various stages of the Fontan pathway is increasingly considered for this therapy. The results of transplantation in this complex situation have progressively improved and now approached the late outcomes for other conditions. Mechanical circulatory support for the failing single ventricle has recently carried infants and children to successful transplant. The development of miniaturized continuous flow pumps offers the hope of major new avenues of successful circulatory support for single ventricle patients.

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203: Comparison of Risk Factors and Outcomes for Pediatric Patients Listed for Heart Transplantation after Bidirectional Glenn and after Fontan: A Multi-Institutional Study

Cited by 2 publications

References 0 publications

Hypoplastic Left Heart Syndrome

Hypoplastic Left Heart Syndrome

Cardiac Transplantation and Mechanical Support for Functional Single Ventricle

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