Outcomes after transplantation for "failed" Fontan

A single-institution experience

Ryan R Davies, Robert A. Sorabella, Jonathan Yang, Ralph S. Mosca, Jonathan M. Chen, Jan M. Quaegebeur

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objective: Despite the excellent outcomes in the current era after the Fontan procedure, it continues to have an inherent risk of failure. Cardiac transplantation provides 1 option for treating these patients; however, the indications for, timing of, and outcomes after, transplantation remain undefined. We examined our own institutional experience with transplantation for failed Fontan. Methods: The records of 155 patients transplanted for congenital heart disease at a single institution from June 1984 to September 2007 were reviewed. Of these patients, 43 had undergone a previous Fontan procedure (25 male, 15 female; median age, 14.5 years; range, 1-47; 23 classic Fontan, 13 lateral tunnel, 4 extracardiac conduit, and 3 revised to shunt). The predictors of short- and long-term survival were evaluated, and the Fontan patients were compared with all other patients with congenital heart disease (n = 129, 78 male, 51 female). Results: The most common indications for transplantation included protein-losing enteropathy (PLE) (39.5%), chronic heart failure (41.8%), and acute post-Fontan failure (9.3%). The transplants performed in Fontan patients were more likely to require pulmonary artery reconstruction (85.4% vs 42.9%; P < .0001) and had longer cardiopulmonary bypass times (278 vs 179 minutes; P < .0001). The 90-day mortality rate was greater in the Fontan group (35.0% vs 20.0%; P = .055). No correlation was observed between the interval from Fontan to transplantation and morality; however, renal failure was a strong predictor of early mortality (odds ratio, 10.8; 95% confidence interval, 1.5-75.7). Conclusions: Transplantation is an acceptable treatment for patients with a failed Fontan. Clinical factors (instead of the indication for transplantation) appear to have the greatest correlation with early mortality.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number5
DOIs
StatePublished - May 1 2012

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Transplantation
Fontan Procedure
Mortality
Heart Diseases
Protein-Losing Enteropathies
Heart Transplantation
Cardiopulmonary Bypass
Pulmonary Artery
Renal Insufficiency
Heart Failure
Odds Ratio
Confidence Intervals
Transplants
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes after transplantation for "failed" Fontan : A single-institution experience. / Davies, Ryan R; Sorabella, Robert A.; Yang, Jonathan; Mosca, Ralph S.; Chen, Jonathan M.; Quaegebeur, Jan M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 5, 01.05.2012.

Research output: Contribution to journalArticle

Davies, Ryan R ; Sorabella, Robert A. ; Yang, Jonathan ; Mosca, Ralph S. ; Chen, Jonathan M. ; Quaegebeur, Jan M. / Outcomes after transplantation for "failed" Fontan : A single-institution experience. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 5.
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