Previous studies have reported that children with a prior Fontan procedure have decreased
survival after heart transplantation. We examined 273 primary pediatric heart transplants.
Since 1988, 33 (12.1%) of 273 children <18 years old undergoing primary heart transplantation
had a Fontan procedure 3.7 ± 4.3 years before transplantation. Compared with 240 (87.9%)
non-Fontan primary transplants, the Fontan patients were older (8.8 ± 5.2 vs 6.6 ± 5.9 years; P = .023), but were similar in presensitization and pre-transplant clinical status.
More Fontan patients had prior operations (100% vs 51.7%; P < .0001) and needed pulmonary artery reconstruction (100% vs 21.7%; P < .0001). Thirteen (39%) had protein-losing enteropathy. Donor ischemic times (213
± 73 vs 177 ± 57 minutes; P = .0013) and cardiopulmonary bypass times (199 ± 86 vs 125 ± 53 minutes; P < .0001) were greater in the Fontan group, as were durations of ventilator support
(4.4 ± 6.0 vs 2.5 ± 4.3 days; P = .035) and hospital stay (18.6 ± 16.1 vs 14.7 ± 13.1 days; P = NS). The Fontan group had one 30-day mortality. One-year actuarial survival (84.8%
vs 86.9%, Fontan vs non-Fontan) and 5-year actuarial survival (70.8% vs 70.3%, Fontan vs non-Fontan) were similar, as was rejection incidence at 1 year (2.0 ± 2.0 vs 1.7 ± 1.9 episodes/patient; P = .3972). Five Fontan patients (18.5%) required retransplantation 4.9 ± 3.6 years
post-transplant, compared with 22 non-Fontan patients (9.2%) retransplanted 5.2 ±
3.4 years post-transplant. Contrary to prior reports, we did not identify any early
or mid-term disadvantage for children undergoing heart transplantation after a previous
Fontan procedure, despite more complex transplant operations. We contend that carefully
selected children with a failing Fontan circulation can do as well as other children
with heart transplantation.
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References
- Orthotopic cardiac transplantation for the failing Fontan circulation.Eur J Cardiothorac Surg. 1998; 14: 7-13
- Trends and outcomes in transplantation for complex congenital heart disease: 1984 to 2004.Ann Thorac Surg. 2004; 78: 1352-1361
- Heart transplantation in children with congenital heart disease.J Am Coll Cardiol. 1995; 26: 743-749
- Cardiac transplantation after the Fontan or Glenn procedure.J Am Coll Cardiol. 2004; 44: 2065-2072
- Outcome after orthotopic cardiac transplantation in adults with congenital heart disease.Circulation. 1999; 100: II200-II205
- Orthotopic heart transplantation for failing single ventricle physiology.Eur J Cardiothorac Surg. 2003; 24: 502-510
- Orthotopic heart transplantation for congenital heart disease: an alternative for high-risk Fontan candidates?.Circulation. 2003; 108: II140-II149
- Surgical reinterventions following the Fontan procedure.Eur J Cardiothorac Surg. 2003; 24: 255-259
- Transplantation in the Fontan patient.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2015; 18: 7-16
- Liver cirrhosis in Fontan patients does not affect 1-year post-heart transplant mortality or markers of liver function.J Heart Lung Transplant. 2014; 33: 170-177
- Heart transplantation for the failing Fontan.Ann Thorac Surg. 2013; 96: 1413-1419
- Heart transplantation for adults with congenital heart disease: results in the modern era.J Heart Lung Transplant. 2013; 32: 499-504
- Outcomes after transplantation for "failed" Fontan: a single-institution experience.J Thorac Cardiovasc Surg. 2012; 143: 1183-1192
- Transplantation for adults with congenital heart disease.Eur J Cardiothorac Surg. 2006; 30: 508-514
- Evidence of pulmonary vascular disease after heart transplantation for Fontan circulation failure.J Thorac Cardiovasc Surg. 2004; 128: 693-702
- Heart transplantation after congenital heart surgery: improving results and future goals.Eur J Cardiothorac Surg. 2008; 34: 313-317
- Importance of acquired systemic-to-pulmonary collaterals in the Fontan operation.Ann Thorac Surg. 1999; 68: 969-974
- Cardiac transplantation in situs inversus.J Thorac Cardiovasc Surg. 1990; 99: 493-499
- Pediatric heart transplantation: surgical considerations for congenital heart diseases.J Heart Transplant. 1990; 9: 608-616
- Orthotopic heart transplantation for complex congenital heart disease.J Thorac Cardiovasc Surg. 1990; 99: 484-491
- The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease.J Am Coll Cardiol. 2009; 54: 160-165
- Outcome of listing for cardiac transplantation for failed Fontan: a multi-institutional study.Circulation. 2006; 114: 273-280
- Heart transplantation for the failing Fontan circulation.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004; 7: 56-64
- Heart transplantation in patients with previous Fontan operations.J Thorac Cardiovasc Surg. 2004; 127: 555-562
- Protein-losing enteropathy after Fontan surgery: resolution after cardiac transplantation.J Heart Lung Transplant. 2003; 22: 484-486
- Reversal of protein-losing enteropathy in a child with Fontan circulation is correlated with central venous pressure after heart transplantation.Pediatr Transplant. 2001; 5: 135-137
- The outcome of heart transplantation for protein-losing enteropathy after the Fontan operation (abstract).Circulation. 1999; 100: I-602
Article info
Footnotes
Presented at the AATS/STS Congenital Heart Disease Symposium 95th Annual Meeting, American Association for Thoracic Surgery, Seattle, WA, April 25–29, 2015.
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
