14th Congress of the Asian Society of TransplantationThoracic transplantationCase Series: Heart Transplantation After Fontan Operation-Single-Center Experience

- For heart transplantation following Fontan take-down, longer vessel grafts should be harvested and more anastomoses should be performed.
- Due to multiple previous surgical interventions, the thoracic cavity of Fontan failure (FF) patients is fibrotic and bleeds easily.
- In our experience, the effect of heart transplantation for FF patients is time dependent. Improvement in protein-losing enteropathy depends on waiting time from FF to heart transplantation; the earlier the heart transplantation, the better the outcome.

BackgroundFontan failure (FF) occurs rarely. In patients with Fontan failure, heart transplantation is believed to be the most effective therapy. We review our experience in heart transplantations after the Fontan operation.MethodsFrom July 1987 to December 2014, 4 of 513 patients underwent orthotopic heart transplantation (OHT). Among them, 4 were due to FF. We reviewed these 4 cases via retrospective chart review. Clinical history, laboratory data, surgical technique, perioperative variables, and outcomes of long-term follow-up are presented herein. The primary outcomes were hospital mortality, 1-year-survival rate, and 4-year-survival rate. The secondary outcome is the improvement in patients with protein-losing enteropathy.ResultsThe hospital mortality rate was 0% in the 4 FF patients receiving OHT. No surgically related hemorrhage or infection was observed. The 1-year-survival rate was 100% (n = 4) and the 4-year-survival rate 50% (n = 2). One patient died of posttransplantation lymphoproliferative disorder. Hypoalbuminemia improved in 1 of 3 patients 4 months after OHT.ConclusionsDespite technical challenges, heart transplantation can be performed successfully in patients with Fontan operation. However, protein-losing enteropathy might not be resolved quickly after heart transplantation.