Surgical reinterventions following the Fontan procedure

Petko, Matus

doi:10.1016/s1010-7940(03)00257-4

Cited by 84 publications

(48 citation statements)

References 10 publications

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“…In previous eras, these patients with immediate compromise who are usually extremely sick (47), were not considered for transplant and therefore underwent Fontan take-down. Mortality of OHT in this scenario is reported to be as high as 44-66% (29,48). In our institution, OHT proved to be viable although technically challenging, in a limited cohort in this situation (49).…”

Section: Optimal Timing Of Heart Transplant In Sv Patientsmentioning

confidence: 59%

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: 59%

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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“…8,10,16 -19 Although the long-term course of these patients remains undefined, as many as 10% to 20% of CHD patients will eventually require cardiac transplantation. 17 Because of the small proportion of transplants performed for adults with CHD, accurate data with which to guide decisions regarding listing and transplantation have been lacking. Early publications were often single-institution studies with small sample sizes 10,18 ; more recent multiinstitutional studies have been published but have suffered from methodological problems: statistical issues (for example, handling of missing variables in large data sets), inclusion of a small group of adults within a larger group of children in the same analysis, and inclusion of noncontemporary transplants performed Ͼ22 years ago.…”

Section: Discussionmentioning

confidence: 99%

Listing and Transplanting Adults With Congenital Heart Disease

et al. 2011

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Background-An increasing number of patients with congenital heart disease (CHD) are reaching adulthood and may require heart transplantation. The survival of these patients after listing and transplantation has not been evaluated. Methods and Results-A total of 41 849 patients (aged Ͼ18 years) were listed for primary transplantation during [1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009]. Patients with a history of CHD (nϭ1035; 2.5%) were compared with those with other causes (non-CHD group) (nϭ40 814; 97.5%); 26 055 (62.3%) reached transplantation and were subdivided into those with (reoperation group; nϭ10 484; 40.2%) and without (nonreoperation group; nϭ15 571; 59.8%) a previous sternotomy. Survival on the waiting list was similar between groups, but mechanical ventricular assistance was not associated with superior survival to transplantation among CHD patients. CHD patients were more likely to have body mass index Ͻ18.5 at transplantation (PϽ0.0001), were younger, and had fewer comorbidities. Early mortality among patients with CHD was high (reoperation, 18.9% versus 9.6%; PϽ0.0001; nonreoperation, 16.6% versus 6.3%; PϽ0.0001), but by 10 years, overall survival was equivalent (53.8% versus 53.6%). Analysis was limited by the lack of specific information regarding the CHD diagnosis in most patients. Conclusions-Adults with CHD have high 30-day mortality but better late survival after heart transplantation. Mechanical circulatory assistance does not improve waiting list survival in these patients. This may be due to a combination of highly complex reoperative surgery and often poor preoperative systemic health. (Circulation. 2011;123:759-767.)

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“…[3][4][5][6] However, despite these efforts, a significant number of patients with single-ventricle physiology, particularly those with systemic right ventricles, have late hemodynamic complications, including ventricular failure, atrioventricular valve regurgitation, atrial arrhythmias, pleural and pericardial effusions, and protein-losing enteropathy. [7][8][9][10][11][12] For many of these patients, transplantation has become the next surgical "stage." As increasing numbers of patients with complex single-ventricle physiology are palliated, the number of children and young adults requiring late secondary heart transplantation will increase.…”

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confidence: 99%

Outcome of Listing for Cardiac Transplantation for Failed Fontan

Bernstein¹,

Naftel²,

Chin³

et al. 2006

Circulation

243

172

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Background-The Fontan procedure is a successful palliation for children with single-ventricle physiology; however, many will eventually require heart transplantation. The purpose of this study was to determine risk factors for death awaiting transplantation and to examine results after transplantation in Fontan patients. Methods and Results-A retrospective, multi-institutional review was performed of 97 Fontan patients Ͻ18 years of age listed at 17 Pediatric Heart Transplant Study centers from 1993 to 2001. Mean age at listing was 9.7 years (0.5 to 17.9 years); 25% were Ͻ4 years old; 53% were United Network for Organ Sharing status 1; 18% required ventilator support. Pretransplantation survival was 78% at 6 months and 74% at 12 months and was similar to 243 children with other congenital heart disease (CHD) and 747 children without congenital heart disease (No-CHD), who were also awaiting transplantation. Patients who were younger, status 1, had shorter interval since Fontan, or were on a ventilator were more likely to die while waiting. At 6 months, the probability of receiving a transplant was similar for status 1 and 2 (65% versus 68%); however, the probability of death was higher for status 1 (22% versus 5%). Seventy patients underwent transplantation. Survival was 76% at 1 year, 70% at 3 years, and 68% at 5 years, slightly less than CHD and No-CHD patients. Causes of death included infection (30%), graft failure (17%), rejection (13%), sudden death (13%), and graft coronary artery disease (9%). Protein-losing enteropathy (present in 34 patients) resolved in all who survived Ͼ30 days after transplantation. Conclusions-Heart transplantation is an effective therapy for pediatric patients with a failed Fontan. Although early posttransplantation survival is slightly lower than other patients with CHD, long-term results are encouraging, and protein-losing enteropathy can be expected to resolve. (Circulation. 2006;114:273-280.)

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Surgical reinterventions following the Fontan procedure

Cited by 84 publications

References 10 publications

Transplantation in the single ventricle population

Transplantation in the single ventricle population

Listing and Transplanting Adults With Congenital Heart Disease

Outcome of Listing for Cardiac Transplantation for Failed Fontan

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