Mortality Risk Stratification in Fontan Patients Who Underwent Heart Transplantation.
The number of patients who require orthotopic heart transplantation (OHT) for failing Fontan physiology continues to grow; however, the methods and tools to evaluate risk of OHT are limited. This study aimed to identify a set of preoperative variables and characteristics that were associated with a greater risk of postoperative mortality in patients who received OHT for failing Fontan physiology. Thirty-six Fontan patients were identified as having undergone OHT at University of California-Los Angeles Medical Center from 1991 to 2014. Data were collected retrospectively and analyzed. The primary end point was designated as postoperative mortality. After an average follow-up time of 3.5 years, 17 (44%) patients suffered postoperative mortality. Patient characteristics including (1) age <18 years at the time of OHT, (2) Fontan-OHT interval of <10 years, (3) systemic ventricular ejection fraction <20%, (4) moderate-to-severe atrioventricular valve insufficiency, (5) an elevated Model of End-stage Liver Disease, eXcluding INR score, or (6) need for advanced mechanical support before surgery were associated with an increased incidence of postoperative mortality. Using these risk factors, we present a theoretical framework to stratify risk of postoperative death in failing Fontan patients after OHT. In conclusion, a method such as this may aid in the transplantation evaluation and listing process of patients with failing Fontan physiology.
David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.
Christopher J
CJ
Berg
David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Department of Medicine, University of California-Los Angeles Medical Center, Los Angeles, California; Department of Cardiology, University of California-Los Angeles Medical Center, Los Angeles, California.
Brenton S
BS
Bauer
David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Ahmanson/University of California-Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California.
Abbie
A
Hageman
David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Department of Cardiology, University of California-Los Angeles Medical Center, Los Angeles, California; Ahmanson/University of California-Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California.
Jamil A
JA
Aboulhosn
David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Department of Cardiology, University of California-Los Angeles Medical Center, Los Angeles, California; Ahmanson/University of California-Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California; Department of Pediatrics, University of California-Los Angeles Medical Center, Los Angeles, California. Electronic address: LReardon@mednet.ucla.edu.
Leigh C
LC
Reardon
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult