title: Heart transplantation in children with a Fontan procedure.
abstract: BACKGROUND
  Previous studies have reported that children with a prior Fontan procedure have decreased survival after heart transplantation. We examined 190 primary pediatric heart transplants.
  
  
  METHODS
  Since 1988, 27 (14.2%) of 190 children less than 18 years old undergoing primary heart transplantation had a Fontan procedure 3.7 ± 4.3 years before transplantation. Compared with 163 (85.8%) non-Fontan primary transplants, the Fontan patients were similar in age (8.2 ± 5.0 vs 6.5 ± 6.0 years), presensitization, and pretransplant clinical status. More Fontan patients had prior operations (100% vs 50%; p < 0.0001) and needed pulmonary artery reconstruction (100% vs 23.5%; p < 0.0001). Twelve (44%) had protein-losing enteropathy.
  
  
  RESULTS
  Donor ischemic times (211 ± 72 vs 170 ± 61 minutes; p = 0.0018) and cardiopulmonary bypass times (197 ± 91 vs 121 ± 53 minutes; p < 0.0001) were greater in the Fontan group as were durations of ventilator support (4.9 ± 6.6 vs 2.6 ± 3.9 days; p = 0.018) and hospital stay (20.2 ± 17.5 vs 14.3 ± 12.4 days; p = 0.0435). The Fontan group had one 30-day mortality. One-year actuarial survival (81.5% vs 84.6%, Fontan vs non-Fontan) and five-year actuarial survival (65.5% vs 66.2%, Fontan vs non-Fontan) were similar, as was rejection incidence at one year (2.0 ± 2.0 vs 1.7 ± 1.9 episodes per patient; p = 0.3972). Five Fontan patients (18.5%) required retransplantation 4.9 ± 3.6 years posttransplant compared with 18 non-Fontan patients (11.0%) retransplanted 5.2 ± 3.4 years posttransplant (p = 0.3346).
  
  
  CONCLUSIONS
  Contrary to prior reports, we did not identify any early or midterm disadvantage for children undergoing heart transplantation after a previous Fontan procedure despite more complex transplant operations. We contend that carefully selected children with a failing Fontan circulation can do as well as other children with heart transplantation.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
authors.forename: Robert N
authors.initials: RN
authors.lastname: Vincent
authors.forename: Alexandria M
authors.initials: AM
authors.lastname: Berg
authors.forename: Brian E
authors.initials: BE
authors.lastname: Kogon
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
mesh_terms: D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D018729:Fontan Procedure; D005845:Georgia / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome