Orthotopic heart transplantation for failing single ventricle physiology

Guido Michielon, Francesco Parisi, Duccio Di Carlo, Cosimo Squitieri, Adriano Carotti, Michaela Buratta, Roberto M. Di Donato

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)502-510
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume24
Issue number4
DOIs
Publication statusPublished - Oct 1 2003

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Heart Transplantation
Mortality
Heart Diseases
Right Heart Bypass
Child Mortality
Superior Vena Cava
Survival
Patient Rights
Decision Making
Pathologic Constriction
Logistic Models
Transplants
Lung

Keywords

  • Congenital
  • Heart disease
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Orthotopic heart transplantation for failing single ventricle physiology. / Michielon, Guido; Parisi, Francesco; Di Carlo, Duccio; Squitieri, Cosimo; Carotti, Adriano; Buratta, Michaela; Di Donato, Roberto M.

In: European Journal of Cardio-thoracic Surgery, Vol. 24, No. 4, 01.10.2003, p. 502-510.

Research output: Contribution to journalArticle

Michielon, Guido ; Parisi, Francesco ; Di Carlo, Duccio ; Squitieri, Cosimo ; Carotti, Adriano ; Buratta, Michaela ; Di Donato, Roberto M. / Orthotopic heart transplantation for failing single ventricle physiology. In: European Journal of Cardio-thoracic Surgery. 2003 ; Vol. 24, No. 4. pp. 502-510.
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abstract = "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.",
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N2 - 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.

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