Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: A multi-institutional study

Everitt, Melanie D.; Boyle, Gerard J.; Schechtman, Kenneth B.; Zheng, Jie; Bullock, Emily A.; Kaza, Aditya K.; Dipchand, Anne I.; Naftel, David C.; Kirklin, James K.; Canter, Charles E.

doi:10.1016/j.healun.2011.12.013

Cited by 69 publications

(77 citation statements)

References 22 publications

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“…In a recent review, HLHS infants with previous palliation were shown to have poorer outcomes compared to those with unoperated HLHS (21). Infants undergoing OHT for failed first stage 1 at less than 1 month of age were at highest risk.…”

Section: Optimal Timing Of Heart Transplant In Sv Patientsmentioning

confidence: 99%

“…But poor organ availability and combined high waiting list and early post OHT mortality continues to drive palliation as the primary management approach in most centres, except in those with severe ventricular dysfunction or valve regurgitation (20). Despite this, HLHS is still reported as the most common diagnosis for infants undergoing OHT for CHD in the current era (21). With predicted expansion of this cohort, it is important to recognize that these patients present younger and with a shortened interval since palliation, reflecting the poor durability of the systemic right ventricle.…”

Section: Hlhsmentioning

confidence: 99%

“…SV physiology in adults has been shown to carry a 3-fold higher risk of in-hospital mortality following OHT compared with biventricular pathologies (16), prompting discussion of appropriate allocation of limited donor resources (21,29,37). Early complications, relating to transplant complexity, contribute substantially to the mortality of both adults and children and have been reported across the literature (24,28,38).…”

Section: Mortality In Sv Heart Transplantationmentioning

confidence: 99%

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Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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The single ventricle patient population comprises the most complex cohort presenting to the cardiac transplant team, in terms of demographics, anatomic substrate, and unique physiology. It is also the most rapidly growing diagnostic group presenting for heart transplantation. In this manuscript, we aim to describe the changing landscape of transplantation in single ventricle conditions through reflection on our own institution's practice and experience, alongside contemporary literature review. Single ventricle patients are heterogeneous in terms of age, anatomic diagnosis and physiology according to surgical stage of repair.Progress in surgical palliative strategies has impacted upon the present composition of the population, with growing numbers of hypoplastic left heart syndrome patients and those with late physiology failure following Fontan completion. Multiple prior surgeries, immunological sensitivity and multi-organ involvement impart high peri-operative risk but can be mitigated in part by careful pre-operative planning by a dedicated multidisciplinary team addressing issues such as planning of concurrent reconstructive surgery, minimizing the post-operative effect of collaterals, timely harvesting, oversizing of donor organs to minimize graft failure, and strategies to address anticipated post-operative elevation in pulmonary vascular resistance. Determining optimal timing for transplant in these patients remains unclear, but understanding the risk of alternative surgical options can help guide decision making with regards to listing.

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Section: Optimal Timing Of Heart Transplant In Sv Patientsmentioning

confidence: 99%

Section: Hlhsmentioning

confidence: 99%

Section: Mortality In Sv Heart Transplantationmentioning

confidence: 99%

See 1 more Smart Citation

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…17,18,90 Although results in infants transplanted for unrepaired complex congenital heart disease are similar to those for transplanted infants with dilated cardiomyopathy, 18,91 outcomes of transplantation in young infants as a rescue therapy for failed hypoplastic left heart syndrome are worse compared with those for patients with cardiomyopathy (1-year survival, 70% versus 89%, respectively). 81,91 Older children and young adults with congenital heart disease have additional risk factors affecting their outcome after listing and transplantation compared with children with cardiomyopathy. Patients who were listed for transplantation within 6 months of the Fontan procedure were more likely to die while waiting for a heart than patients who were listed >6 months after the procedure (33% versus 11%, respectively).…”

Section: Risk Factors For Mortality Unique To Patients With Congenitamentioning

confidence: 99%

Changing Indications for Pediatric Heart Transplantation

Hsu

Lamour

2015

Circulation

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“…In addition, HLHS infants with previous surgery are associated with the worst outcomes post-heart transplant (Carlo et al 2016). In reality, the combined waiting list and transplant mortality far exceed the current interstage mortality (Everitt et al 2012) and, therefore, is not a favored option.…”

Section: Heart Transplantmentioning

confidence: 99%

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

Jean‐St‐Michel

Meza

Coles

et al. 2017

The Journal of Heart and Lung Transplantation

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We investigated patient and procedural factors associated with failure of staged palliation after the Norwood procedure in patients with right ventricular dysfunction (RVDfx).Patients from the Pediatric Heart Network Single Ventricle Reconstruction (SVR) Trial dataset were selected if RVDfx was present, defined as an ejection fraction of less than 44% and a fractional area of change of less than 35% on the post-Norwood echocardiogram. Transplantfree survival after the Norwood procedure was analyzed using multiphase parametric hazard analysis and factors associated with death or transplant were identified.In the SVR cohort, 123 (34%) infants had RVDfx. The six-month transplant-free survival was 87% (70%CI 82-91%). The independent factors associated with increased risk of death or transplant were BT shunt, increased RV size, infectious disease complications and low surgeon volume.Patient factors can help identify which patient with RVDfx is at higher risk of death and help decision making around early transplant listing.iii

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Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: A multi-institutional study

Cited by 69 publications

References 22 publications

Transplantation in the single ventricle population

Transplantation in the single ventricle population

Changing Indications for Pediatric Heart Transplantation

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

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