Orthotopic cardiac transplantation for the failing fontan circulation

Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulat...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 1998-07, Vol.14 (1), p.7-14
Main Authors: Carey, John A., Hamilton, J.R. Leslie, Hilton, Colin J., Dark, John H., Forty, Jonathon, Parry, Gareth, Hasan, Asif
Format: Article
Language:English
Subjects:
Antilymphocyte Serum
Biological and medical sciences
Cardiac transplantation
Cardiomyopathies - surgery
Child, Preschool
Congenital heart disease
Fontan Procedure
Heart Defects, Congenital - physiopathology
Heart Defects, Congenital - surgery
Heart Transplantation - mortality
Hospital Mortality
Humans
Infant
Lymphocytotoxic antibodies
Medical sciences
Myocardial Ischemia - surgery
Pulmonary Artery - physiopathology
Pulmonary vascular disease
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Survival Analysis
Treatment Failure
Vascular Resistance
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Summary:Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulation and transplantation results. Methods: Retrospective review of patients referred to a single centre for cardiac transplant assessment. Results: Between 1985 and 1996, 46 of 448 cardiac transplants were performed for congenital heart disease. Nine of these were performed in patients with a failing Fontan circulation (four adults, five children). In six cases, the dominant ventricle had left ventricular (LV) morphology. Congenital anomalies included double outlet right ventricle (three cases), double inlet left ventricle (two cases), tricuspid atresia (two cases), and pulmonary atresia with intact ventricular septum (one case). Fontan procedures were performed in absence of sinus rhythm (four cases), atrio-ventricular (AV) valve regurgitation (two cases), aortic regurgitation and systolic LV dysfunction (one case), elevated mean pulmonary artery pressure (one case), and older age (>7 years, eight cases). Three patients required early re-operation and two needed permanent pacing. Subsequent deterioration associated with loss of sinus rhythm (four cases) and progressive AV valve regurgitation (seven cases) led to transplant assessment (at
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(98)00130-4