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J Thorac Cardiovasc Surg 2005;129:416-422
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Rescue cardiac transplantation for early failure of the Fontan-type circulation in children

^a Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
^b Department of Paediatric Anaesthesiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
^c Department of Paediatric Cardio-thoracic Anaesthesiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
^d Transplant Coordinator, the Department of Cardio-Thoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
^e Department of Cardiac Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
^f Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Received for publication April 26, 2004; revisions received June 10, 2004; accepted for publication June 14, 2004.

^* Address for reprints: Milind Chaudhari, MD, Freeman Hospital, Newcastle upon Tyne, NE 7 7DN, United Kingdom (E-mail: milind.chaudhari{at}nuth.northy.nhs.uk).

OBJECTIVE: Early failure of the Fontan-type circulation is a potentially fatal complication. We review our experience with cardiac transplantation in children presenting with end-stage heart failure in this scenario.

METHODS: We performed a retrospective review. Between 1985 and 2003, 6 children aged less than 16 years were referred for cardiac transplantation. The indication for cardiac transplantation was end-stage cardiac failure early after the completion of the Fontan-type operation.

RESULTS: All 6 patients listed for transplantation underwent cardiac transplantation; the median interval to transplantation from the operation was 36 days (range, 6-180 days). Four patients had undergone the Fontan procedure, and 2 had one-and-a-half-ventricle repair. All 6 patients were ventilated and inotrope dependant, with varying degrees of multiorgan dysfunction. One patient was bridged to transplantation with extracorporeal membrane oxygenation. The median age at transplantation was 7.1 years (range, 3-12.5 years), and weight was 18.9 kg (range, 11-35 kg). One patient died on the operating table (graft failure and hemorrhage). In 5 survivors the median intensive care unit stay was 10 days (range, 8-61 days). On follow-up of 6 to 81 months, there have been no subsequent deaths, and the quality of life in survivors is good.

CONCLUSION: Rescue cardiac transplantation in the setting of an early failure of the Fontan-type circulation and end-stage cardiac failure is an effective treatment option and can be performed with acceptable early mortality and encouraging short-term to medium-term results.

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