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KMID : 0364020180510030167
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Korean Journal of Thoracic and Cardiovascular Surgery
2018 Volume.51 No. 3 p.167 ~ p.171
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Heart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience
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Jeon Bo-Bae
Park Chun-Soo
Yun Tae-Jin
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Abstract
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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.
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KEYWORD
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Heart transplantation, Fontan procedure, One and a half ventricle repair
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