Single-ventricle palliation starting with a Norwood procedure which culminates in
a failed Fontan palliation poses certain unique operative challenges for cardiac transplantation.
In this manuscript, we describe some of these challenges and our particular approach
in management.
Keywords
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References
- Heart transplantation in children after a fontan procedure: Better than people think.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2016; 19: 44-49
- Transplantation in the fontan patient.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2015; 18: 7-16
- Outcomes after transplantation for “failed” fontan: A single-institution experience.J Thorac Cardiovasc Surg. 2012; 143: 1183-1192
- Transplantation in fontan failure: The final stage.JTCVS Open. 2020; 3: 154-159
- Transplantation and arch repair in fontan 3 years after heartmate 3: Technical considerations.Ann Thorac Surg. 2022; 114: e5-e7
- Improving outcomes for transplantation in failing fontan – what is the next target?.JTCVS Open. 2021; 8: 565-573
- Hepatorenal dysfunction assessment with the model for end-stage liver disease excluding INR score predicts worse survival after heart transplant in pediatric fontan patients.J Thorac Cardiovasc Surg. 2022; 163: 1462-1473
- Heart transplantation after fontan operation.JTCVS Techniques. 2022; 13: 182-191
- Evolving understanding of total artificial heart support of infants and children.J Thorac Cardiovasc Surg. 2020; 159: 1075-1082
- Commentary: The fontan cardiac transplant – time to embrace change.J Thorac Cardiovasc Surg. 2022; 163: 1473-1475
- We need better pediatric cardiac transplant risk modeling.J Thorac Cardiovasc Surg. 2022; (in press)
Article info
Publication history
Published online: August 01, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Ronald K Woods, MD, PhD: Co-founder OperVu, Inc – no relationship to content of this work. Michael E Mitchell, MD: Co-Founder of Ariosa Diagnostics and TAI Diagnostics – no relationship to content of this work.
This work received no funding.
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Copyright
© 2022 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Commentary: Transplantation After Norwood Palliation: Proper Preparation Minimizes the RiskOperative Techniques in Thoracic and Cardiovascular Surgery
- PreviewAs the population with a Fontan circulation continues to grow, there is an increasing rate of patients with Fontan failure being referred for heart transplantation.1 Importantly, there has been an increase in the proportion of patients with hypoplastic left heart syndrome surviving to achieve Fontan completion, and these patients represent the highest complexity for heart transplantation due to their aortic arch and pulmonary artery anatomy. The mortality rate for transplantation in patients with single ventricle palliation has been reported to be as high as 20-30%,2-4 and it is likely that many have been denied transplantation due to the perceived extremely high risk.
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