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Heart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience
The Korean Journal of Thoracic and Cardiovascular Surgery ; : 167-171, 2018.
Article in English | WPRIM | ID: wpr-715415
ABSTRACT

BACKGROUND:

Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half (1½) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx.

METHODS:

From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or 1½ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3–24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS.

RESULTS:

No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54–68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62–128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP.

CONCLUSION:

Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or 1½ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Physiology / Pulmonary Artery / Surgical Procedures, Operative / Vena Cava, Superior / Central Venous Pressure / Survival Rate / Mortality / Heart Transplantation / Angioplasty / Fontan Procedure Type of study: Prognostic study Limits: Humans Language: English Journal: The Korean Journal of Thoracic and Cardiovascular Surgery Year: 2018 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Physiology / Pulmonary Artery / Surgical Procedures, Operative / Vena Cava, Superior / Central Venous Pressure / Survival Rate / Mortality / Heart Transplantation / Angioplasty / Fontan Procedure Type of study: Prognostic study Limits: Humans Language: English Journal: The Korean Journal of Thoracic and Cardiovascular Surgery Year: 2018 Type: Article