Orthotopic cardiac transplantation for the failing fontan circulation
Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulat...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 1998-07, Vol.14 (1), p.7-14 |
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| container_title | European journal of cardio-thoracic surgery |
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| creator | Carey, John A. Hamilton, J.R. Leslie Hilton, Colin J. Dark, John H. Forty, Jonathon Parry, Gareth Hasan, Asif |
| description | Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulation and transplantation results. Methods: Retrospective review of patients referred to a single centre for cardiac transplant assessment. Results: Between 1985 and 1996, 46 of 448 cardiac transplants were performed for congenital heart disease. Nine of these were performed in patients with a failing Fontan circulation (four adults, five children). In six cases, the dominant ventricle had left ventricular (LV) morphology. Congenital anomalies included double outlet right ventricle (three cases), double inlet left ventricle (two cases), tricuspid atresia (two cases), and pulmonary atresia with intact ventricular septum (one case). Fontan procedures were performed in absence of sinus rhythm (four cases), atrio-ventricular (AV) valve regurgitation (two cases), aortic regurgitation and systolic LV dysfunction (one case), elevated mean pulmonary artery pressure (one case), and older age (>7 years, eight cases). Three patients required early re-operation and two needed permanent pacing. Subsequent deterioration associated with loss of sinus rhythm (four cases) and progressive AV valve regurgitation (seven cases) led to transplant assessment (at |
| doi_str_mv | 10.1016/S1010-7940(98)00130-4 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_73926060</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>73926060</sourcerecordid><originalsourceid>FETCH-LOGICAL-c358t-1cb11a0b1dcf8d1a209f35ad6c22f90829f8e7528542a5906bdf414301d4483e3</originalsourceid><addsrcrecordid>eNo9j8tKAzEUhoMotV4eoTALEV2MnlwmySylVCsVXHhp6WZIM4mNTmdqkoK-vUFrN-fC93E4P0IDDFcYML9-ShVyUTK4KOUlAKaQsz3Ux1LQXFA220_zv3KIjkJ4BwBOieihXikI5yD7aPTo47KL3drpTCtfO6Wz6FUb1o1qo4quazPb-SwuTWaVa1z7lvZE2kw7rzfNr3KCDqxqgjnd9mP0cjt6Ho7zh8e7--HNQ65pIWOO9QJjBQtcaytrrAiUlhaq5poQW4IkpZVGFEQWjKiiBL6oLcOMAq4Zk9TQY3T-d3ftu8-NCbFauaBNk3413SZUgpaEA4ckDrbiZrEydbX2bqX8d7XNnfjZlqugVWNTYu3CTiOUClzQpOV_mgvRfO2w8h8VF1QU1Xg2r9iTnE6mk3n1Sn8Akid3Cw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>73926060</pqid></control><display><type>article</type><title>Orthotopic cardiac transplantation for the failing fontan circulation</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Carey, John A. ; Hamilton, J.R. Leslie ; Hilton, Colin J. ; Dark, John H. ; Forty, Jonathon ; Parry, Gareth ; Hasan, Asif</creator><creatorcontrib>Carey, John A. ; Hamilton, J.R. Leslie ; Hilton, Colin J. ; Dark, John H. ; Forty, Jonathon ; Parry, Gareth ; Hasan, Asif</creatorcontrib><description>Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulation and transplantation results. Methods: Retrospective review of patients referred to a single centre for cardiac transplant assessment. Results: Between 1985 and 1996, 46 of 448 cardiac transplants were performed for congenital heart disease. Nine of these were performed in patients with a failing Fontan circulation (four adults, five children). In six cases, the dominant ventricle had left ventricular (LV) morphology. Congenital anomalies included double outlet right ventricle (three cases), double inlet left ventricle (two cases), tricuspid atresia (two cases), and pulmonary atresia with intact ventricular septum (one case). Fontan procedures were performed in absence of sinus rhythm (four cases), atrio-ventricular (AV) valve regurgitation (two cases), aortic regurgitation and systolic LV dysfunction (one case), elevated mean pulmonary artery pressure (one case), and older age (>7 years, eight cases). Three patients required early re-operation and two needed permanent pacing. Subsequent deterioration associated with loss of sinus rhythm (four cases) and progressive AV valve regurgitation (seven cases) led to transplant assessment (at <1 year, five cases; at 2–12 years, four cases). All patients were listed for transplantation. Three patients required intravenous inotropic support and three patients with lymphocytotoxic antibodies needed prospective crossmatching. Donor cardiectomy was modified to facilitate implantation. The recipient operation involved pulmonary artery re-construction (using pericardium), modified atrial and direct caval anastomoses. Three patients died within 24 h of surgery (two graft failures, one haemorrhage). In operative survivors (n=6), intensive care stay was 3–16 days, and hospital stay ranged from 14 to 32 days. There have been no subsequent deaths (follow up, 0.5–4.7 years). Conclusion: In high-risk Fontan candidates, transplantation may be preferable at the outset. Previous surgery, lymphocytotoxic antibodies, indeterminate pulmonary vascular resistance, emergency status, sub-optimal donor selection, and perioperative bleeding contribute to peri-operative mortality. In survivors, the outcome remains very encouraging.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1016/S1010-7940(98)00130-4</identifier><identifier>PMID: 9726608</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Amsterdam: Elsevier Science B.V</publisher><subject>Antilymphocyte Serum ; Biological and medical sciences ; Cardiac transplantation ; Cardiomyopathies - surgery ; Child, Preschool ; Congenital heart disease ; Fontan Procedure ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Heart Transplantation - mortality ; Hospital Mortality ; Humans ; Infant ; Lymphocytotoxic antibodies ; Medical sciences ; Myocardial Ischemia - surgery ; Pulmonary Artery - physiopathology ; Pulmonary vascular disease ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Treatment Failure ; Vascular Resistance</subject><ispartof>European journal of cardio-thoracic surgery, 1998-07, Vol.14 (1), p.7-14</ispartof><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-1cb11a0b1dcf8d1a209f35ad6c22f90829f8e7528542a5906bdf414301d4483e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2337153$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9726608$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carey, John A.</creatorcontrib><creatorcontrib>Hamilton, J.R. Leslie</creatorcontrib><creatorcontrib>Hilton, Colin J.</creatorcontrib><creatorcontrib>Dark, John H.</creatorcontrib><creatorcontrib>Forty, Jonathon</creatorcontrib><creatorcontrib>Parry, Gareth</creatorcontrib><creatorcontrib>Hasan, Asif</creatorcontrib><title>Orthotopic cardiac transplantation for the failing fontan circulation</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulation and transplantation results. Methods: Retrospective review of patients referred to a single centre for cardiac transplant assessment. Results: Between 1985 and 1996, 46 of 448 cardiac transplants were performed for congenital heart disease. Nine of these were performed in patients with a failing Fontan circulation (four adults, five children). In six cases, the dominant ventricle had left ventricular (LV) morphology. Congenital anomalies included double outlet right ventricle (three cases), double inlet left ventricle (two cases), tricuspid atresia (two cases), and pulmonary atresia with intact ventricular septum (one case). Fontan procedures were performed in absence of sinus rhythm (four cases), atrio-ventricular (AV) valve regurgitation (two cases), aortic regurgitation and systolic LV dysfunction (one case), elevated mean pulmonary artery pressure (one case), and older age (>7 years, eight cases). Three patients required early re-operation and two needed permanent pacing. Subsequent deterioration associated with loss of sinus rhythm (four cases) and progressive AV valve regurgitation (seven cases) led to transplant assessment (at <1 year, five cases; at 2–12 years, four cases). All patients were listed for transplantation. Three patients required intravenous inotropic support and three patients with lymphocytotoxic antibodies needed prospective crossmatching. Donor cardiectomy was modified to facilitate implantation. The recipient operation involved pulmonary artery re-construction (using pericardium), modified atrial and direct caval anastomoses. Three patients died within 24 h of surgery (two graft failures, one haemorrhage). In operative survivors (n=6), intensive care stay was 3–16 days, and hospital stay ranged from 14 to 32 days. There have been no subsequent deaths (follow up, 0.5–4.7 years). Conclusion: In high-risk Fontan candidates, transplantation may be preferable at the outset. Previous surgery, lymphocytotoxic antibodies, indeterminate pulmonary vascular resistance, emergency status, sub-optimal donor selection, and perioperative bleeding contribute to peri-operative mortality. In survivors, the outcome remains very encouraging.</description><subject>Antilymphocyte Serum</subject><subject>Biological and medical sciences</subject><subject>Cardiac transplantation</subject><subject>Cardiomyopathies - surgery</subject><subject>Child, Preschool</subject><subject>Congenital heart disease</subject><subject>Fontan Procedure</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Transplantation - mortality</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Lymphocytotoxic antibodies</subject><subject>Medical sciences</subject><subject>Myocardial Ischemia - surgery</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary vascular disease</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Treatment Failure</subject><subject>Vascular Resistance</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9j8tKAzEUhoMotV4eoTALEV2MnlwmySylVCsVXHhp6WZIM4mNTmdqkoK-vUFrN-fC93E4P0IDDFcYML9-ShVyUTK4KOUlAKaQsz3Ux1LQXFA220_zv3KIjkJ4BwBOieihXikI5yD7aPTo47KL3drpTCtfO6Wz6FUb1o1qo4quazPb-SwuTWaVa1z7lvZE2kw7rzfNr3KCDqxqgjnd9mP0cjt6Ho7zh8e7--HNQ65pIWOO9QJjBQtcaytrrAiUlhaq5poQW4IkpZVGFEQWjKiiBL6oLcOMAq4Zk9TQY3T-d3ftu8-NCbFauaBNk3413SZUgpaEA4ckDrbiZrEydbX2bqX8d7XNnfjZlqugVWNTYu3CTiOUClzQpOV_mgvRfO2w8h8VF1QU1Xg2r9iTnE6mk3n1Sn8Akid3Cw</recordid><startdate>19980701</startdate><enddate>19980701</enddate><creator>Carey, John A.</creator><creator>Hamilton, J.R. Leslie</creator><creator>Hilton, Colin J.</creator><creator>Dark, John H.</creator><creator>Forty, Jonathon</creator><creator>Parry, Gareth</creator><creator>Hasan, Asif</creator><general>Elsevier Science B.V</general><general>Elsevier Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19980701</creationdate><title>Orthotopic cardiac transplantation for the failing fontan circulation</title><author>Carey, John A. ; Hamilton, J.R. Leslie ; Hilton, Colin J. ; Dark, John H. ; Forty, Jonathon ; Parry, Gareth ; Hasan, Asif</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-1cb11a0b1dcf8d1a209f35ad6c22f90829f8e7528542a5906bdf414301d4483e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Antilymphocyte Serum</topic><topic>Biological and medical sciences</topic><topic>Cardiac transplantation</topic><topic>Cardiomyopathies - surgery</topic><topic>Child, Preschool</topic><topic>Congenital heart disease</topic><topic>Fontan Procedure</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Transplantation - mortality</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infant</topic><topic>Lymphocytotoxic antibodies</topic><topic>Medical sciences</topic><topic>Myocardial Ischemia - surgery</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary vascular disease</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Treatment Failure</topic><topic>Vascular Resistance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carey, John A.</creatorcontrib><creatorcontrib>Hamilton, J.R. Leslie</creatorcontrib><creatorcontrib>Hilton, Colin J.</creatorcontrib><creatorcontrib>Dark, John H.</creatorcontrib><creatorcontrib>Forty, Jonathon</creatorcontrib><creatorcontrib>Parry, Gareth</creatorcontrib><creatorcontrib>Hasan, Asif</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carey, John A.</au><au>Hamilton, J.R. Leslie</au><au>Hilton, Colin J.</au><au>Dark, John H.</au><au>Forty, Jonathon</au><au>Parry, Gareth</au><au>Hasan, Asif</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Orthotopic cardiac transplantation for the failing fontan circulation</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>1998-07-01</date><risdate>1998</risdate><volume>14</volume><issue>1</issue><spage>7</spage><epage>14</epage><pages>7-14</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract>Objective: Modified Fontan procedures are now employed in several conditions unsuitable for bi-ventricular repair. Selection criteria have been relaxed. The procedure is palliative. Longterm outlook is unknown. This study evaluated factors associated with the development of a failing Fontan circulation and transplantation results. Methods: Retrospective review of patients referred to a single centre for cardiac transplant assessment. Results: Between 1985 and 1996, 46 of 448 cardiac transplants were performed for congenital heart disease. Nine of these were performed in patients with a failing Fontan circulation (four adults, five children). In six cases, the dominant ventricle had left ventricular (LV) morphology. Congenital anomalies included double outlet right ventricle (three cases), double inlet left ventricle (two cases), tricuspid atresia (two cases), and pulmonary atresia with intact ventricular septum (one case). Fontan procedures were performed in absence of sinus rhythm (four cases), atrio-ventricular (AV) valve regurgitation (two cases), aortic regurgitation and systolic LV dysfunction (one case), elevated mean pulmonary artery pressure (one case), and older age (>7 years, eight cases). Three patients required early re-operation and two needed permanent pacing. Subsequent deterioration associated with loss of sinus rhythm (four cases) and progressive AV valve regurgitation (seven cases) led to transplant assessment (at <1 year, five cases; at 2–12 years, four cases). All patients were listed for transplantation. Three patients required intravenous inotropic support and three patients with lymphocytotoxic antibodies needed prospective crossmatching. Donor cardiectomy was modified to facilitate implantation. The recipient operation involved pulmonary artery re-construction (using pericardium), modified atrial and direct caval anastomoses. Three patients died within 24 h of surgery (two graft failures, one haemorrhage). In operative survivors (n=6), intensive care stay was 3–16 days, and hospital stay ranged from 14 to 32 days. There have been no subsequent deaths (follow up, 0.5–4.7 years). Conclusion: In high-risk Fontan candidates, transplantation may be preferable at the outset. Previous surgery, lymphocytotoxic antibodies, indeterminate pulmonary vascular resistance, emergency status, sub-optimal donor selection, and perioperative bleeding contribute to peri-operative mortality. In survivors, the outcome remains very encouraging.</abstract><cop>Amsterdam</cop><pub>Elsevier Science B.V</pub><pmid>9726608</pmid><doi>10.1016/S1010-7940(98)00130-4</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of cardio-thoracic surgery, 1998-07, Vol.14 (1), p.7-14 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Antilymphocyte Serum Biological and medical sciences Cardiac transplantation Cardiomyopathies - surgery Child, Preschool Congenital heart disease Fontan Procedure Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart Transplantation - mortality Hospital Mortality Humans Infant Lymphocytotoxic antibodies Medical sciences Myocardial Ischemia - surgery Pulmonary Artery - physiopathology Pulmonary vascular disease Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Treatment Failure Vascular Resistance |
| title | Orthotopic cardiac transplantation for the failing fontan circulation |
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