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Cardiac transplantation after the Fontan or Glenn procedure
K Anitha Jayakumar1, Linda J Addonizio, Maryanne R Kichuk-Chrisant
1Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York, USA.
Insights
Cardiac transplantation after a failed Glenn or Fontan procedure is successful. Outcomes for these congenital heart disease patients are similar to those with other heart failure causes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Late complications of the Glenn or Fontan procedure, such as ventricular failure and cyanosis, can lead to significant morbidity and mortality.
- Cardiac transplantation is the only recourse when other therapies fail for these complex cases.
- Transplantation in patients with prior Glenn or Fontan procedures presents unique surgical and perioperative challenges.
Purpose of the Study:
- To review the clinical course and outcomes of cardiac transplantation in patients who previously underwent a Glenn or Fontan procedure.
- To assess the success rates and survival of this specific patient population.
Main Methods:
- Retrospective review of patients who underwent cardiac transplantation after a Glenn or Fontan procedure.
- Characterization of diagnoses, prior surgeries, clinical status, and transplant indications.
- Comparison of outcomes, including complications and mortality, between survivors and nonsurvivors.
Main Results:
- 35 patients (mean age 15.7 years) underwent primary orthotopic cardiac transplantation.
- Indications included ventricular dysfunction, failed Fontan physiology, and cyanosis.
- One-year survival was 71.5%, and five-year survival was 67.5%, with no significant difference compared to other etiologies.
Conclusions:
- Cardiac transplantation is a viable and successful option for end-stage congenital heart disease patients post-Glenn or Fontan procedure.
- Outcomes are comparable to those undergoing transplantation for other causes of end-stage heart failure.
- This approach offers a positive prognosis for carefully selected patients.
Objectives:
The purpose of this study was to review the clinical course and outcome of cardiac transplantation after a failed Glenn or Fontan procedure.
Background:
Late complications of the Glenn or Fontan procedure, including ventricular failure, cyanosis, protein-losing enteropathy, thromboembolism, and dysrhythmias often lead to significant morbidity and mortality. If other therapies are ineffective, cardiac transplantation is the only therapeutic recourse. Transplantation in this unique population presents significant challenges in the operative and perioperative periods.
Methods:
The anatomic diagnoses, previous operations, clinical status, and indications for transplantation were characterized in patients transplanted after a Glenn or Fontan procedure. Outcomes after transplantation, including postoperative complications and mortality, were reviewed. Comparisons were made between survivors and nonsurvivors.
Results:
Primary orthotopic cardiac transplantation was performed in 35 patients (mean age 15.7 +/- 8.5 years) with a mean follow-up of 54 +/- 46 months. A total of 11 patients had undergone a Glenn shunt and 24 patients a Fontan procedure. Indications for transplantation were a combination of causes including ventricular dysfunction, failed Fontan physiology, and/or cyanosis. Ten patients died
Conclusions:
Cardiac transplantation can be performed successfully in patients with end-stage congenital heart disease after a Glenn or Fontan procedure, with outcomes similar to transplantation for end-stage heart failure secondary to other etiologies.
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