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[Cardiac transplantation for old congenital heart diseases after multiple surgery]
1Service de chirurgie cardiovasculaire et cardiaque pédiatrique, centre chirurgical Marie-Lannelongue et université Paris XI.
Insights
Cardiac transplantation is a viable option for patients with end-stage congenital heart disease, even after complex prior surgeries. This study shows successful outcomes without prosthetic material, overcoming anatomical challenges.
Area of Science:
- Cardiology
- Transplantation Surgery
- Congenital Heart Disease
Context:
- Cardiac transplantation is a life-saving procedure.
- Congenital heart disease (CHD) can lead to end-stage cardiac failure.
- Prior palliative surgeries in CHD patients can complicate transplantation.
Purpose:
- To evaluate the feasibility and outcomes of cardiac transplantation in patients with end-stage CHD.
- To assess the effectiveness of a "subtotal" transplantation technique in complex CHD cases.
- To determine if prior surgeries for CHD contraindicate cardiac transplantation.
Summary:
- Four patients with end-stage CHD, who had undergone an average of 3.75 prior palliative procedures, received cardiac transplants.
- A "subtotal" transplantation technique utilizing donor tissue for anatomical reconstruction was employed, avoiding prosthetic materials.
- No hospital mortality or specific postoperative complications occurred; long-term results were comparable to other transplant recipients.
Impact:
- Cardiac transplantation is a suitable option for select patients with end-stage CHD.
- Complex anatomical abnormalities from prior surgeries can be managed successfully during transplantation.
- Pulmonary arterial resistance is a critical factor to consider for successful CHD cardiac transplantation.
Abstract:
Of the 100 consecutive patients undergoing cardiac transplantation between January 1988 and October 1993, 4 patients had terminal cardiac failure related to congenital heart disease after multiple prior palliative procedures (transposition of the great arteries, N = 1, tricuspid atresia, N = 1, single ventricle, N = 2). The prior palliative or curative operations (average 3.75 procedures per patient) modified essentially the systemic venous return and the pulmonary arteries. The technique of "subtotal" cardiac transplantation enabled anatomical reconstruction without prosthetic material in all cases by extensive usage of the donor tissue. There was no hospital mortality. There were no specific postoperative complications. The long-term results were comparable to those of the rest of the transplanted population. Patients with congenital heart disease in a terminal condition should be considered as candidates for cardiac transplantation. The difficulties related to anatomical abnormalities caused by prior surgery may be overcome and should not be considered a contra-indication to transplantation, providing pulmonary arterial resistances are taken into consideration.