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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.
Insights
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.
Background:
Congenital heart disease continues to be an important indication for pediatric heart transplantation (HT) and is often complicated by systemic venous anomalies. The need for reconstruction, surgical technique used, as well as the outcomes of these have limited documentation.
Methods:
Descriptive, retrospective study of patients transplanted at Emory University between 2006 and 2017. We reviewed surgical data, follow-up, and interventions for patients necessitating venous reconstruction during transplantation.
Results:
A total of 179 transplants were performed during the time period of which 74 (41%) required systemic venous reconstruction. Mean age at transplant was 6.3 (±6.16) years, and 74.3% of these patients carried a diagnosis of single ventricle; 51 (68.9%) of 74 patients required pulmonary artery reconstruction at the time of HT. Forty patients required superior vena caval reconstruction, while 22 patients required inferior vena caval reconstruction due to prior palliation or anomaly. Venous anomalies along with other anatomic features necessitated biatrial transplantation in four patients. Posttransplant evaluation revealed systemic venous stenosis in 14 (18.9%) of 74 patients. Eight (10.8%) patients required 12 interventions for the systemic veins. Patients with bilateral Glenn anastomosis prior to transplant were at high risk for the development of stenosis and needing interventions. Systemic venous complications were uncommon in those with native systemic veins without Glenn or Fontan procedure.
Conclusion:
Systemic venous reconstruction needs are high in pediatric HT. Posttransplant stenosis and the need for interventions are relatively common. Current techniques for systemic venous reconstruction for complex congenital heart disease patients may deserve further review to optimize these outcomes.
