Korean J Thorac Cardiovasc Surg.  2018 Jun;51(3):167-171. 10.5090/kjtcs.2018.51.3.167.

Heart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience

• Jeon BB
• Park CS
• Yun TJ

• KMID: 2413056
• DOI: http://doi.org/10.5090/kjtcs.2018.51.3.167

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.

Keyword

Heart transplantation; Fontan procedure; One and a half ventricle repair

MeSH Terms

Angioplasty
Central Venous Pressure
Chungcheongnam-do
Fontan Procedure
Heart Defects, Congenital
Heart Transplantation*
Heart*
Humans
Mortality
Physiology
Pulmonary Artery*
Surgical Procedures, Operative
Survival Rate
Vena Cava, Superior*