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Systemic Venous Reconstructions During Pediatric Heart Transplantation
Firat Altin1, Bahaaldin Alsoufi2, Kirk Kanter3
1Department of Pediatric Cardiac Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey.
World Journal for Pediatric & Congenital Heart Surgery
|October 1, 2021
Summary
Systemic venous reconstruction is common in pediatric heart transplantation (HT) for congenital heart disease. Post-transplant stenosis and interventions are frequent, especially in patients with prior Glenn anastomosis, suggesting a need to refine surgical techniques.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Congenital heart disease (CHD) is a primary reason for pediatric heart transplantation (HT).
- Systemic venous anomalies frequently complicate CHD, necessitating complex surgical reconstruction during HT.
- Limited documentation exists on the techniques and outcomes of venous reconstruction in pediatric HT.
Purpose of the Study:
- To evaluate the incidence and outcomes of systemic venous reconstruction in pediatric heart transplantation.
- To identify risk factors for post-transplant venous complications.
- To assess the need for interventions following venous reconstruction in this population.
Main Methods:
- Retrospective descriptive study of pediatric heart transplant recipients at Emory University (2006-2017).
- Analysis of surgical data, follow-up records, and interventions for patients requiring systemic venous reconstruction.
- Comparison of outcomes based on prior surgical history, including Glenn anastomosis and Fontan procedure.
Main Results:
- 41% of 179 pediatric heart transplants required systemic venous reconstruction.
- Systemic venous stenosis occurred in 18.9% of these patients, with 10.8% needing interventions.
- Prior bilateral Glenn anastomosis was associated with a high risk of stenosis and interventions.
- Patients without prior Glenn or Fontan procedures had fewer systemic venous complications.
Conclusions:
- Systemic venous reconstruction is frequently required in pediatric heart transplantation for CHD.
- Post-transplant stenosis and the need for interventions are relatively common complications.
- Current surgical techniques for venous reconstruction in complex CHD patients may require optimization to improve outcomes.
