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  • Meeting abstract
  • Open Access

Orthotopic Heart Transplantation following univentricular palliation: new challenges for the congenital cardiac surgeon

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Journal of Cardiothoracic Surgery201510 (Suppl 1) :A92

https://doi.org/10.1186/1749-8090-10-S1-A92

  • Published:

Keywords

  • Pulmonary Artery
  • Hypoplastic Left Heart Syndrome
  • Pulmonary Atresia
  • Stent Removal
  • Orthotopic Heart Transplantation

Background/Introduction

Orthotopic heart transplantation after univentricular palliation presents a difficult challenge due to the complex anatomy and prior surgeries.

Aims/Objectives

We present our surgical techniques/results in the current era.

Method

2013-2014: 23 congenital cardiac patients underwent heart transplantation. 13 of them: previous univentricular palliation: hypoplastic left heart syndrome (n = 8), d-transposition of great arteries+criss-cross-heart (n = 1), unbalanced atrioventricular septal defect (n = 1), pulmonary atresia+intact ventricular septum (n = 1) and grown-up patients (GUCH) (n = 2: 1 double-inlet-left-ventricle and 1 tricuspid atresia).

Results

Paediatric group (n = 11): age 7.1+/-4.8 years (range 1.5 months-13 years); weight 21.3+/-9.5 kilograms (range 3.5-36). GUCH-group (n = 2): age 23.5+/-0.5 years; weight 50+/-10.2 kilograms. 46.1% had undergone Fontan completion, 15.4% Fontan take-down, 30.7% bidirectional cavopulmonary shunt and 7.7% Blalock-Taussig shunt. Berlin-Heart-EXCOR-Paediatric-Device as bridge to transplantation was used in 1 patient. Bicaval technique was performed along with: hemiarch repair (15.3%,n = 2), pulmonary artery (PA) branches plasty (38.4%,n = 5), hilum-to-hilum PA reconstruction (53.8%,n = 7), superior venae cavae reconstruction (15.4%, n = 2) and stent removal from PA (61.5%,n = 8), inferior venae cavae (7.7%,n = 1) and lateral-tunnel-Fontan (7.7%,n = 1). Average cardiopulmonary-bypass time 257.6+/-79.3 minutes (range 120-431); total-ischemia-time 220.7+/-48.6 (range 140-287). One patient required ECMO; 4 underwent delayed sternal closure; 2 underwent diaphragm plication; 1 subacute-humoral-rejection treated with plasmapheresis. In-hospital stay 44+/-16 days (range 18-185). At follow-up (14.4+/-7.2 months), freedom from percutaneous procedures 83.3% (n = 10). 30-day mortality/follow-up mortality: zero. All of them remain with an optimal functional class.

Discussion/Conclusion

Heart transplantation following univentricular palliation is technically demanding but short-term results are excellent. An extensive surgical reconstruction (donor/heterologous tissues) is mandatory to improve outcomes. Further follow-up is necessary to evaluate the long-term results in this scenario.

Authors’ Affiliations

(1)
Paediatric Cardiac Surgery Department, Gregorio Marañón Hospital, Madrid, Spain
(2)
Paediatric Cardiology Department, Gregorio Marañón Hospital, Madrid, Spain

Copyright

© González-López et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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