Document Detail

Orthotopic heart transplantation for congenital heart disease: an alternative for high-risk fontan candidates?
MedLine Citation:
PMID:  12970223     Owner:  NLM     Status:  MEDLINE    
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.
Guido Michielon; Francesco Parisi; Cosimo Squitieri; Adriano Carotti; Giulia Gagliardi; Luciano Pasquini; Roberto M Di Donato
Related Documents :
15614843 - The influence of prenatal diagnosis on postnatal outcome in patients with structural co...
19031393 - Can recent insights into cardiac development improve our understanding of congenitally ...
21624903 - Long-term treatment with nifedipine suppresses coronary hyperconstricting responses and...
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  108 Suppl 1     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-12     Completed Date:  2003-09-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  II140-9     Citation Subset:  AIM; IM    
Dipartimento Medico-Chirurgico di Cardiochirurgia e Cardiologia Pediatrica, DMCCP, Ospedale Pediatrico Bambino Gesù, Roma, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Fontan Procedure
Heart Defects, Congenital / diagnosis,  surgery*
Heart Transplantation / adverse effects,  mortality*
Infant, Newborn
Palliative Care
Risk Factors
Survival Analysis
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Introduction of a flexible polymeric heart valve prosthesis with special design for mitral position.
Next Document:  Topical VEGF enhances healing of thoracic aortic anastomosis for coarctation in a rabbit model.