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Technical modifications for transplant in the failing Fontan
Juan-Miguel Gil-Jaurena1,2, Carlos Pardo1,2, Ana Pita1,2
1Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain.
Cardiology in the Young
|November 19, 2020
Summary
Heart transplant after Fontan completion is challenging. Surgical techniques for the five anastomoses, including stent removal and donor tissue use, are crucial for successful outcomes in these complex Fontan patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Heart transplantation following Fontan completion presents significant surgical complexities.
- This study examines technical considerations in 20 Fontan patients undergoing heart transplant.
Purpose of the Study:
- To detail surgical strategies and technical hints for the five key anastomoses in heart transplant recipients with prior Fontan procedure.
- To evaluate outcomes and challenges associated with heart transplantation in Fontan survivors.
Main Methods:
- Retrospective analysis of 20 Fontan patients who underwent heart transplant between 2013 and 2019.
- Data collection included patient demographics, Fontan type, pre-existing conditions (e.g., protein-losing enteropathy, prior stenting), and surgical modifications at each anastomosis.
Main Results:
- Modifications were frequently required at the superior vena cava (7 times), aorta (9 times), and pulmonary branches (15 times).
- Protein-losing enteropathy resolved in 5/6 patients post-transplant. Extracorporeal membrane oxygenation (ECMO) was necessary for pulmonary hypertension in 6 patients.
- Median follow-up was 42 months, with 2 deaths. Stent placement was required post-transplant in 2 patients.
Conclusions:
- Heart transplantation in Fontan patients is technically demanding, requiring anticipation of challenges at all five anastomoses, including stent removal.
- The use of extra donor tissue (innominate vein, aortic arch, pericardium) is recommended.
- ECMO support for right ventricular dysfunction was needed in approximately one-third of cases, with overall results comparable to other transplant cohorts.
