Evaluating failing Fontans for heart transplantation: predictors of death - PubMed (original) (raw)

Evaluating failing Fontans for heart transplantation: predictors of death

Eric R Griffiths et al. Ann Thorac Surg. 2009 Aug.

Abstract

Background: Late complications of the Fontan operation represent a significant management challenge. Failing Fontan patients have two modes of presentation: impaired ventricular function (IVF) and those with preserved ventricular function (PVF) but with failing Fontan physiology (protein-losing enteropathy [PLE] and plastic bronchitis [PB]). This study evaluated whether failing Fontan patients referred for heart transplantation had a different outcome based on the mode of presentation.

Methods: The medical records of all Fontan patients evaluated for heart transplantation at a single institution from 1994 to 2008 were retrospectively reviewed. Demographic, hemodynamic, and laboratory data were collected. Patients were stratified into an IVF or PVF group by echocardiographic criteria. Descriptive statistics and Kaplan-Meier analysis were used for hypothesis testing.

Results: Thirty-four Fontan patients were evaluated for heart transplantation. According to echo description of systolic function, 18 were categorized as IVF and 16 as PVF. The IVF group had a significantly lower cardiac index and venous oxygen saturation, and significantly higher systemic vascular resistance vs the PVF group (p < 0.05). PLE or PB was present in 13 PVF patients and none in the IVF group. Twenty patients underwent transplantation, with similar rates amongst the IVF and PVF groups. Within 1 year from evaluation, 2 IVG patients and 7 PVF patients had died (p = 0.052).

Conclusions: Failing Fontan patients with PVF have decreased overall survival independent of whether they underwent transplantation. This trend indicates a need to improve the management and timing for transplantation amongst this population.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Listing for Transplantation

Figure 2

Figure 2

Actuarial Survival from Time of Evaluation for Heart Transplantation. IVF, impaired ventricular function group; PVF, preserved ventricular function group. Patients were censored at time of last follow-up date. Mean follow-up time 55.2 ± 50 months.

Figure 3

Figure 3

Actuarial Survival for Transplantation Patients were censored at time of last follow-up date. Mean follow-up time 55.2 ± 50 months.

Similar articles

Cited by

References

    1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971;26(3):240–248. - PMC - PubMed
    1. Fontan F, Deville C, Quaegebeur J, Ottenkamp J, Sourdille N, Choussat A, Brom GA. Repair of tricuspid atresia in 100 patients. The Journal of thoracic and cardiovascular surgery. 1983;85(5):647–660. - PubMed
    1. de Leval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. The Journal of thoracic and cardiovascular surgery. 1988;96(5):682–695. - PubMed
    1. Marcelletti C, Corno A, Giannico S, Marino B. Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. The Journal of thoracic and cardiovascular surgery. 1990;100(2):228–232. - PubMed
    1. Alphonso N, Baghai M, Sundar P, Tulloh R, Austin C, Anderson D. Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. Eur J Cardiothorac Surg. 2005;28(4):529–535. - PubMed

Publication types

MeSH terms

LinkOut - more resources