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Heart transplantation after Fontan: Results from a surgical Fontan cohort
Kavitha N Pundi1, Krishna Pundi2, David J Driscoll1
1Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.
Insights
Heart transplantation is a viable option for Fontan circulation failure patients. Despite challenges, survival rates at 1, 5, 10, and 15 years post-transplant were 80%, 72%, 69%, and 55%, respectively.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- The Fontan procedure is a palliative surgery for complex congenital heart disease.
- Long-term Fontan circulation can lead to failure, necessitating advanced treatment options.
- Heart transplantation is a potential solution for end-stage Fontan-associated circulatory dysfunction.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation in patients with a history of Fontan surgery.
- To assess the survival rates and complications associated with cardiac transplantation in this specific patient cohort.
Main Methods:
- Retrospective review of 1138 Fontan patients evaluated at the Mayo Clinic.
- Analysis of medical records and clinical questionnaires for 44 patients who underwent heart transplantation between 1988 and 2014.
- Comparison of outcomes between transplanted and non-transplanted Fontan patients.
Main Results:
- Forty-four Fontan patients underwent heart transplantation (mean age 23.2 years).
- Overall survival rates at 1, 5, 10, and 15 years post-transplant were 80%, 72%, 69%, and 55%.
- Sixteen patients (36%) died, with seven deaths within 30 days of transplantation.
Conclusions:
- Cardiac transplantation offers a reasonable option for patients with failed Fontan circulation.
- Despite being a high-risk group, intermediate-term results support heart transplantation.
- Further research may explore strategies to improve outcomes in this complex population.
Abstract:
We performed a retrospective review of outcomes after heart transplantation during long-term follow-up of a surgical cohort of 1138 Fontan patients who were followed at the Mayo Clinic. Follow-up information was obtained from medical records and a clinical questionnaire that was mailed to patients not known to be deceased at the initiation of the study. Forty-four of 1138 Fontan patients with initial or subsequent evaluation at Mayo had cardiac transplantation between 1988 and 2014 (mean age at transplantation was 23.2 ± 12 yr, median was 19.8 yr; mean interval between Fontan and transplantation was 13.0 ± 7.7 yr, median was 13.1 yr). Two patients had combined organ transplantation (one heart-lung, one heart-liver). Twelve of the 44 (27%) patients had PLE prior to transplantation. There was no difference in post-bypass Fontan pressures or incidence of late reoperations for AVV repair/replacement between transplanted and non-transplanted patients. There were 16 (36%) deaths in the transplantation cohort; seven occurred within 30 days of transplantation. Overall one, five, 10, and 15 yr post-transplantation survival was 80%, 72%, 69%, and 55%, respectively. Although this is a challenging group of patients, intermediate-term results suggest that cardiac transplantation remains a reasonable option for patients with a failed Fontan circulation.
