Heart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience.
10.5090/kjtcs.2018.51.3.167
- Author:
Bo Bae JEON
1
;
Chun Soo PARK
;
Tae Jin YUN
Author Information
1. Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. tjyun@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Heart transplantation;
Fontan procedure;
One and a half ventricle repair
- MeSH:
Angioplasty;
Central Venous Pressure;
Chungcheongnam-do;
Fontan Procedure;
Heart Defects, Congenital;
Heart Transplantation*;
Heart*;
Humans;
Mortality;
Physiology;
Pulmonary Artery*;
Surgical Procedures, Operative;
Survival Rate;
Vena Cava, Superior*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2018;51(3):167-171
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half (1½) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx. METHODS: From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or 1½ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3–24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS. RESULTS: No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54–68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62–128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP. CONCLUSION: Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or 1½ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.
