AI Chat Paper
Discover the SciOpen Platform and Achieve Your Research Goals with Ease.
Search articles, authors, keywords, DOl and etc.
{{expandStatus?'Exit ':''}}Advanced Search
The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood (FFN) to those without a prior Norwood (FF).
A single-institution retrospective review of all patients with Fontan failure who underwent cardiac transplantation from 2003–2021 was completed—22 underwent prior Norwood (FFN) and 11 did not (FF). Descriptive and inferential statistics were calculated for operative course and patient outcomes.
The operative course of the FFN cohort appeared to be more complex (not statistically significant, but clinically relevant)—this group exclusively experienced sternal re-entry events (3 of 22 patients) and concomitant neo-aortic reconstruction (6 patients), had a longer duration of surgery (median of 682 min vs. 575.5 min), more time on circulatory arrest (median of 25.5 min vs. 12.5 min), and more frequent use of open sternal management [50% of patients (11/22) vs. 27.3% of patients (3/11)]. Postoperatively, these patients underwent more mediastinal explorations [other than sternal closure; 40.9% of patients (9/22) vs. 18.2% of patients (2/11)], spent more time on mechanical ventilation (median of 5 days vs. 2 days), had a longer length of stay (median of 30 days vs. 19 days), and required more catheter-based re-interventions [22.7% of patients (5/22) vs. 9.1% of patients (1/11)].
Although underpowered, our results suggest that the operative course of FFN patients is more challenging, based mostly on neo-aortic arch issues. In turn, this likely leads to a more complex postoperative course. We are currently collaborating with other institutions to increase the cohort size and power of the study.
Mauchley DC, Mitchell MB. Transplantation in the Fontan patient. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2015;18:7–16. doi:10.1053/j.pcsu.2015.01.001.
McCormick AD, Schumacher KR. Transplantation of the failing Fontan. Transl Pediatr. 2019;8:290–301. doi:10.21037/tp.2019.06.03.
Kirklin JK, Pearce FB, Dabal RJ, Carlo WF Jr, Mauchley DC. Challenges of cardiac transplantation following the Fontan procedure. World J Pediatr Congenit Heart Surg. 2017;8:480–6. doi:10.1177/2150135117714.
Gil-Jaurena JM, Pardo C, Pita A, Pérez-Caballero R, Zamorano J, Camino M, et al. Technical modifications for transplant in the failing Fontan. Cardiol Young. 2021;31(3):400–5. doi:10.1017/S104795112000414X.
Kutty S, Jacobs ML, Thompson WR, Danford DA. Fontan circulation of the next generation: why it’s necessary, what it might look like. J Am Heart Assoc. 2020;9(1):e013691. doi:10.1161/JAHA.119.013691.
Poh CL, d’Udekem Y. Life after surviving Fontan surgery: a meta-analysis of the incidence and predictors of late death. Heart Lung Circ. 2018;27(5):552–9. doi:10.1016/j.hlc.2017.11.007.
Mazza GA, Gribaudo E, Agnoletti G. The pathophysiology and complications of Fontan circulation. Acta Biomed. 2021;92(5):e2021260
Kverneland LS, Kramer P, Ovroutski S. Five decades of the Fontan operation: a systematic review of international reports on outcomes after univentricular palliation. Congenit Heart Dis. 2018;13(2):181–93. doi:10.1111/chd.2018.13.issue-2.
Serfas JD, Thibault D, Andersen ND, Chiswell K, Jacobs JP, Jacobs ML, et al. The evolving surgical burden of Fontan failure: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg. 2021;112(1):179–87. doi:10.1016/j.athoracsur.2020.05.174.
Simpson KE, Pruitt E, Kirklin JK, Naftel DC, Singh RK, Edens RE, et al. Fontan patient survival after pediatric heart transplantation has improved in the current era. Ann Thorac Surg. 2017;103(4):1315–20. doi:10.1016/j.athoracsur.2016.08.110.
Richmond ME, Conway J, Kirklin JK, Cantor RS, Koehl DA, Lal AK, et al. Three decades of collaboration through the pediatric heart transplant society registry: a journey through registry data with a highlight on children with single ventricle anatomy. Pediatr Transplant. 2024;28(1):e14615. doi:10.1111/petr.v28.1.
Bearl DW. Can the pediatric heart transplant waitlist please get more granular? Pediatr Transplant. 2023;27(6):e14568. doi:10.1111/petr.v27.6.
Chowdhury UK, George N, Sankhyan LK, Pradeep D, Chittimuri C, Chauhan A, et al. Fontan failure: phenotypes, evaluation, management, and future directions. Cardiol Young. 2022;32(10):1554–63. doi:10.1017/S1047951122001433.
Woods RK, Kirklin JK, Maeda K, Adachi I. We need better pediatric cardiac transplantation risk modeling. J Thorac Cardiovasc Surg. 2022;164:2036–9. doi:10.1016/j.jtcvs.2021.12.046.
Woods RK, Mitchell ME. Cardiac transplantation of the Fontan patient with a prior Norwood procedure. Oper Tech Thorac Cardiovasc Surg. 2023;28:35–46. doi:10.1053/j.optechstcvs.2022.07.004.
This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
京公网安备11010802044758号