HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Guido Michielon Francesco Parisi Duccio Di Carlo Cosimo Squitieri Adriano Carotti Roberto M. Di Donato Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Michielon, G. Articles by Di Donato, R. M. Search for Related Content PubMed PubMed Citation Articles by Michielon, G. Articles by Di Donato, R. M. Related Collections Congenital - cyanotic Congestive Heart Failure Extracorporeal circulation Transplantation - heart

Eur J Cardiothorac Surg 2003;24:502-510
© 2003 Elsevier Science NL

Orthotopic heart transplantation for failing single ventricle physiology

^a Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
^b Department of Pediatric Cardiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy

Received 5 November 2002; received in revised form 23 April 2003; accepted 26 April 2003.

^* Corresponding author. Tel.: +39-06-6859-2333; fax: +39-06-6859-2257
e-mail: guido.michielon{at}tin.it

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.

Key Words: Transplantation • Heart disease • Congenital

This article has been cited by other articles:

				E. R. Griffiths, A. K. Kaza, M. C. Wyler von Ballmoos, H. Loyola, A. M. Valente, E. D. Blume, and P. del Nido Evaluating failing Fontans for heart transplantation: predictors of death. Ann. Thorac. Surg., August 1, 2009; 88(2): 558 - 563. [Abstract] [Full Text] [PDF]

				R.-B. Hsu, F.-Y. Lin, N.-K. Chou, W.-J. Ko, N.-H. Chi, and S.-S. Wang Heart transplantation in patients with extreme right ventricular failure Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 457 - 461. [Abstract] [Full Text] [PDF]

				A.-R. Hosseinpour, S. Cullen, and V. T. Tsang Transplantation for adults with congenital heart disease. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 508 - 514. [Abstract] [Full Text] [PDF]

				D. Bernstein, D. Naftel, C. Chin, L.J. Addonizio, P. Gamberg, E.D. Blume, D. Hsu, C.E. Canter, J.K. Kirklin, W.R. Morrow, et al. Outcome of Listing for Cardiac Transplantation for Failed Fontan: A Multi-Institutional Study Circulation, July 25, 2006; 114(4): 273 - 280. [Abstract] [Full Text] [PDF]

				M. B. Mitchell, D. N. Campbell, D. Ivy, M. M. Boucek, H. M. Sondheimer, B. Pietra, B. B. Das, and J. R. Coll Evidence of pulmonary vascular disease after heart transplantation for Fontan circulation failure J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 693 - 702. [Abstract] [Full Text] [PDF]

				J. M. Chen, R. R. Davies, S. R. Mital, M. L. Mercando, L. J. Addonizio, S. P. Pinney, D. T. Hsu, J. M. Lamour, J. M. Quaegebeur, and R. S. Mosca Trends and Outcomes in Transplantation for Complex Congenital Heart Disease: 1984 to 2004 Ann. Thorac. Surg., October 1, 2004; 78(4): 1352 - 1361. [Abstract] [Full Text] [PDF]