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Technical modifications for transplant in the failing Fontan

Published online by Cambridge University Press:  19 November 2020

Juan-Miguel Gil-Jaurena Open the ORCID record for Juan-Miguel Gil-Jaurena [Opens in a new window] ,
Carlos Pardo ,
Ana Pita ,
Ramón Pérez-Caballero ,
José Zamorano ,
Manuela Camino ,
Nuria Gil-Villanueva ,
Eduardo Zataráin  and
Raquel Prieto
Juan-Miguel Gil-Jaurena*
Affiliation:
Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
Carlos Pardo
Affiliation:
Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
Ana Pita
Affiliation:
Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
Ramón Pérez-Caballero
Affiliation:
Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
José Zamorano
Affiliation:
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Perfusionist, Hospital Gregorio Marañón, Madrid, Spain
Manuela Camino
Affiliation:
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Pediatric Cardiology, Transplant Unit, Hospital Gregorio Marañón, Madrid, Spain
Nuria Gil-Villanueva
Affiliation:
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Pediatric Cardiology, Transplant Unit, Hospital Gregorio Marañón, Madrid, Spain
Eduardo Zataráin
Affiliation:
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Adult Cardiology, Hospital Gregorio Marañón and CIBER-CV Instituto de Salud Carlos III, Madrid, Spain
Raquel Prieto
Affiliation:
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Adult Cardiology, Hospital Gregorio Marañón and CIBER-CV Instituto de Salud Carlos III, Madrid, Spain
*
Author for correspondence: Juan-Miguel Gil-Jaurena, MD, Pediatric Cardiac Surgery, Hospital Gregorio Marañón, C/O’Donnell, No. 50, 28009 Madrid, Spain. Tel/Fax: +34 91 529 0041. E-mail: [email protected]
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Abstract

Introduction:

Heart transplant after Fontan completion poses a unique surgical challenge. Twenty patients are presented, stressing the technical hints performed in the five anastomoses to match the graft in the recipient.

Methods:

Data are collected from 20 Fontan patients between 2013 and 2019. Age (13 years), weight (37 kg.), and time interval between Fontan and transplant (7 years) are presented as median. Extracardiac conduit (size 18/20) was implanted in 15 patients, whereas atrio-pulmonary connection was performed in 4 and lateral tunnel in 1. Six patients developed protein-losing enteropathy. Seventeen stents had been previously deployed.

Results:

The five anastomoses underwent some changes. Left atrium once, aorta 9 times, superior vena cava 7 times, pulmonary branches 15 times, and inferior vena cava 12 times. Follow-up was complete for a median of 42 months (range 6–84). Two patients died. ECMO was needed in six cases for pulmonary hypertension. Four patients had collateral vessels occluded in the cath lab, and stents were placed in superior vena cava (1) and aorta (1) post-transplant. Protein-losing enteropathy was resolved in five patients. Interestingly, one patient was on a systemic assist device before transplant (Levitronix) and right assistance (ECMO) afterwards.

Conclusions:

Transplant in Fontan patients is actually challenging. Hints in every of the five proposed anastomoses must be anticipated, including stents removal. Extra tissue from the donor (innominate vein, aortic arch, and pericardium) is strongly advisable. ECMO for right ventricular dysfunction was needed in nearly one-third of the cases. Overall results can match other transplant cohorts.

Keywords

TransplantFontanChildren
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 400 - 405
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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