title: Improved survival after heart transplant for failed Fontan patients with preserved ventricular function.
abstract: Patients with a failing Fontan continue to have decreased survival after heart transplant (HT), particularly those with preserved ventricular function (PVF) compared with impaired ventricular function (IVF). In this study we evaluated the effect of institutional changes on post-HT outcomes.
  
  
  
  Data were retrospectively collected for all Fontan patients who underwent HT. Mode of failure was defined by the last echocardiogram before HT, with mild or no dysfunction considered PVF and moderate or severe considered IVF. Outcomes were compared between early era (EE, 1995 to 2008) and current era (CE, 2009 to 2014). Management changes in the CE included volume load reduction with aortopulmonary collateral (APC) embolization, advanced cardiothoracic imaging, higher goal donor/recipient weight ratio and aggressive monitoring for post-HT vasoplegia.
  
  
  
  A total of 47 patients were included: 27 in the EE (13 PVF, 14 IVF) and 20 in the CE (12 PVF, 8 IVF). Groups were similar pre-HT, except for more PLE in PVF patients. More patients underwent APC embolization in the CE (80% vs 28%, p < 0.01). There was no difference in donor/recipient weight ratio between eras. There was a trend toward higher primary graft failure for PVF in the EE (77% vs 36%, p = 0.05) but not the CE (42% vs 75%, p = 0.20). Overall, 1-year survival improved in the CE (90%) from the EE (63%) (p = 0.05), mainly due to increased survival for PVF (82 vs 38%, p = 0.04).
  
  
  
  Post-HT survival for failing Fontan patients has improved, particularly for PVF. In the CE, our Fontan patients had a 1-year post-HT survival similar to other indications.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Miller
authors.affiliation: Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Simpson
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Epstein
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Lancaster
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Henn
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schuessler
authors.affiliation: Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Balzer
authors.affiliation: Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Shabana
authors.initials: S
authors.lastname: Shahanavaz
authors.affiliation: Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Murphy
authors.affiliation: Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Canter
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.affiliation: Department of Surgery, Division of Pediatric Cardiac Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Electronic address: uboston@uthsc.edu.
authors.forename: Umar S
authors.initials: US
authors.lastname: Boston
mesh_terms: D004452:Echocardiography; D018729:Fontan Procedure; D006330:Heart Defects, Congenital; D016027:Heart Transplantation; D006801:Humans; D012189:Retrospective Studies; D016276:Ventricular Function
keywords: Fontan; aortopulmonary collateral; failing Fontan physiology; heart transplant; preserved ventricular function; single ventricle