Orthotopic heart transplantation for congenital heart disease: An alternative for high-risk Fontan candidates?

Article; Proceedings Paper

关键词: CARDIAC TRANSPLANTATION;    ATRIAL ISOMERISM;    OPERATION;    CHILDREN;    INSTITUTION;    PALLIATION;    OUTCOMES;    SHUNT;   

DOI  :  10.1161/01.cir.0000087442.82569.51

来源: SCIE

【 摘 要 】

Objective - Evaluation of incremental risk factors for early mortality in children undergoing orthotopic heart transplantation (OHT) for congenital heart disease. Methods - Between 1988 and 2002, 43 patients ( mean age 9.1 +/- 7.2 years) underwent 44 OHT for complex TGA ( 6), DORV ( 4), single ventricle ( 21), and other end-stage structural heart disease ( 11). Two discernible ventricular chambers were present in 18 pts (41.8%). Previous reconstructive or palliative procedures had been previously accomplished in 35 pts (83.3%), including atrial switch ( 5), systemic-to-pulmonary shunts ( 10), cavopulmonary anastomosis ( 9), Fontan completion ( 6), and others ( 5). Results - 30-day survival for the 2-ventricle subgroup was 94.4 +/- 5.4% compared with 67.2 +/- 9.5% for the single ventricle subgroup ( P = 0.04) ( overall 78.6% +/- 3.3%). OHT following single ventricle staging to bi-directional cavopulmonary anastomosis exhibited 100% early survival, as opposed to 62.5 +/- 17.1% for OHT after systemic-to-pulmonary shunts, and 33.3 +/- 19.2% for OHT following failing Fontan ( P = 0.010). HLHS diagnosis ( 0.0085) and failing Fontan ( P = 0.003) were identified as independent predictors of early mortality by regression logistic modeling, while Fontan stage represented the only predictor of overall mortality by Cox proportional hazard. Overall 10-year survival was 54.3 +/- 11%. Conclusions - OHT for structural congenital heart disease with single ventricle physiology entails substantial early mortality and bi-directional cavopulmonary anastomosis enables the best transition to heart transplant. OHT should be considered in the decision making process as an alternative to Fontan completion in high-risk candidates, since rescue-OHT after failing Fontan seems unwarranted.

【 授权许可】

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