Orthotopic heart transplantation for failing single ventricle physiology

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• 作者：Michielon ; Guido ; Parisi ; Francesco ; Di Carlo ; Duccio ; Squitieri ; Cosimo ; Carotti ; Adriano ; et. al.
• 关键词：Transplantation ; Heart disease ; Congenital
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2003
• 出版时间：October, 2003
• 年：2003
• 卷：24
• 期：4
• 页码：502-510
• 全文大小：207 K

文摘

Objective: Evaluation of incremental risk factors for early mortality in children undergoing orthotopic heart transplantation (OHT) for failing single ventricle physiology. Methods: Between 1988 and 2002, 25 patients (mean age 9.3±7.1 years) underwent OHT for complex congenital heart disease (CHD) with a functional right (15 patients) or left (10 patients) single ventricle. Palliative staging towards Fontan completion had been previously accomplished in 22 patients (88 % ). Transition to OHT occurred from a shunt stage in 10, a bi-directional cavopulmonary anastomosis (BDG) stage in nine, and after Fontan failure in six patients. Results: Thirty-day survival was 68.0±9.3 % with no additional mortality up to 14.1 years. OHT following BDG staging exhibited 100 % long-term survival, as opposed to 66.7±15.7 % for OHT after systemic-to-pulmonary shunt, and 33.3±19.2 % for OHT following failing Fontan (p=0.032). Regression logistic modelling indicated failing Fontan circulation as predictor of higher mortality after OHT (p=0.041). Reintervention was necessary in four patients 40±11 months after OHT to address residual superior vena cava (two) and isthmic (two) stenosis. Overall freedom from reintervention was 88.3±8.1 % at 5 years. Conclusions: OHT for structural CHD with single ventricle physiology entails substantial early mortality while BDG 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.