title: Comparison of risk factors and outcomes for pediatric patients listed for heart transplantation after bidirectional Glenn and after Fontan: an analysis from the Pediatric Heart Transplant Study.
abstract: BACKGROUND
  Patients listed for transplant after the bidirectional Glenn (BDG) may have better outcomes than patients listed after Fontan. This study examined and compared outcomes after listing for BDG and Fontan patients.
  
  
  METHODS
  All patients listed for transplant after the BDG in the Pediatric Heart Transplant Study between January 1993 and December 2008 were evaluated. Comparisons were made with Fontan patients and with a matched cohort of congenital heart disease patients. Competing outcomes analysis and actuarial survival were evaluated for the study populations, including an examination of various risk factors.
  
  
  RESULTS
  Competing outcomes analysis for BDG and Fontan patients after listing were similar. There was no difference in actuarial survival after listing or transplant among the 3 cohorts. Mechanical ventilation, United Network of Organ Sharing status, and age were risk factors for death after listing in BDG and Fontan patients, but ventilation at the time of transplant was significant only for the Fontan patients. Mortality was increased in Fontan patients listed < 6 months after surgery compared with patients listed > 6 months after surgery, but no difference was observed in BDG patients. There was a trend toward improved survival after listing for both populations across 3 eras of the study, but this did not reach statistical significance.
  
  
  CONCLUSIONS
  Outcomes after listing for BDG and Fontan patients are similar. Mechanical ventilation at the time of transplant remains a significant risk factor for death in the Fontan population, as does listing for transplant soon after the Fontan, suggesting that some patients may benefit from transplant instead of Fontan completion.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. jrkovach@yahoo.com
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Kovach
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.forename: F Bennett
authors.initials: FB
authors.lastname: Pearce
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Tresler
authors.forename: R Erik
authors.initials: RE
authors.lastname: Edens
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Shuhaiber
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: Steven D
authors.initials: SD
authors.lastname: Zangwill
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018729:Fontan Procedure / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D014850:Waiting Lists / Q000401:mortality