Cardiac transplantation and mechanical support for functional single ventricle

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Background:

• Cardiac transplantation is a critical treatment for anatomically uncorrectable congenital heart disease, particularly failing single ventricle.
• The use of this scarce resource for complex cardiac malformations with physiologic and circulatory failure presents challenges.
• While primary cardiac transplantation for hypoplastic-left heart syndrome is uncommon, failing single ventricle patients in the Fontan pathway are increasingly considered.

Purpose of the Study:

• To review the role and outcomes of cardiac transplantation in patients with failing single ventricle.
• To discuss the evolution of surgical techniques and the impact of mechanical circulatory support in this population.

Main Methods:

• Review of historical and current literature on cardiac transplantation for single ventricle physiology.
• Analysis of outcomes data for transplantation in Fontan pathway patients.
• Discussion of advancements in mechanical circulatory support devices.

Main Results:

• Outcomes for cardiac transplantation in failing single ventricle patients have progressively improved.
• Transplantation outcomes in this complex group now approach those seen in other conditions.
• Mechanical circulatory support has successfully bridged infants and children to transplantation.

Conclusions:

• Cardiac transplantation is an increasingly viable option for failing single ventricle, especially in the Fontan pathway.
• Mechanical circulatory support offers promising new avenues for managing single ventricle patients awaiting transplant.
• Continued advancements in surgical and support technologies are crucial for improving long-term outcomes.