The Impact of Fontan Circulatory Failure on Heart Transplant Survival : Experience from 20 Centers скачать в хорошем качестве

The Impact of Fontan Circulatory Failure on Heart Transplant Survival : Experience from 20 Centers

BACKGROUND : Fontan circulatory failure (FCF) is a chronic state in palliated single ventricle heart disease with high morbidity and mortality rates, including heart failure, multisystem end-organ disease, and need for heart transplant. Specific FCF morbidities have not been rigorously defined, limiting study of how FCF morbidities affect pre–heart transplant and post–heart transplant outcomes. We hypothesized that FCF-related morbidities affect survival from heart transplant waitlisting through 1 year after heart transplant. METHODS : This 20-center, retrospective cohort study collected data in Fontan patients who were listed for heart transplant from 2008 through 2022. RESULTS : Of 409 waitlisted patients, 5.9% died on the waitlist. Of the 83.4% who underwent transplant, 8.5% did not survive to 1 year. Univariate risk factors for waitlist death included higher aortopulmonary collateral burden, more than 1 hospitalization in the previous year, younger age, sleep apnea, higher New York Heart Association class, nonenrollment in school or work, and single-parent home. Risk factors for 1-year post–heart transplant mortality included hypoplastic left heart syndrome diagnosis, patent fenestration, anatomic Fontan obstruction, clinical cyanosis (pulse oximetry less than 90%), polycythemia, portal variceal disease, mental health condition requiring treatment, and higher human leukocyte antigen class II panel reactive antibody. Of the patients not surviving from waitlisting to 1 year after heart transplant, independent risk factors for death included more than 1 hospitalization in the year before waitlisting and clinical cyanosis. CONCLUSIONS: Patients with Fontan palliation selected for heart transplant have substantial mortality rates from waitlisting through transplant. Among FCF-specific morbidities, cyanosis is associated with worsened survival and necessitates further study. Clinical morbidity of any type requiring repeated hospital admission also should prompt consideration of heart transplant.