Congenital Heart DiseaseMeta-Analysis of the Effectiveness of Heart Transplantation in Patients With a Failing Fontan
Section snippets
Methods
A comprehensive literature search of PubMed, MEDLINE, Embase, and Web of Science was conducted in March 2015. Our search strategy included keywords Fontan AND “exp. heart transplantation.” In addition to keyword searches, separate title searches were also conducted in MEDLINE, Embase, and Web of Science. No limitations were used for date or publication status. Citations of eligible studies were reviewed for additional references; however, none were identified that were not retrieved already in
Results
Database searches using the previously described strategy yielded 996 results (Figure 1). Five hundred twenty-six studies irrelevant to the topic were excluded, and 44 were excluded for factors noted in Figure 1 with the use of duplicate data being the main reason for exclusion. A total of 12 studies published between 1995 and 2015 were included in the meta-analysis, with 351 patients undergoing heart transplantation (Table 1).
All the 12 studies selected for inclusion in this meta-analysis are
Discussion
There are multiple smaller studies that report on outcomes following heart transplantation in the Fontan population. We considered it important to add to the literature a more global perspective on transplant outcomes in this complex population. Our meta-analysis, inclusive of 351 patients, revealed 1- and 5-year survival rates of 80% and 71%, respectively, in Fontan patients after heart transplantation. This mostly included studies that looked at transplantation performed in a younger
Disclosures
The authors have no conflicts of interest to disclose.
References (30)
- et al.
Transplantation for the “failed” Fontan
Prog Pediatr Cardiol
(2009) - et al.
Cardiac transplantation after the Fontan or Glenn procedure
J Am Coll Cardiol
(2004) - et al.
Heart transplantation in children with a Fontan procedure
Ann Thorac Surg
(2011) - et al.
Heart-transplantation in children with congenital heart disease
J Am Coll Cardiol
(1995) - et al.
Heart transplantation in patients with previous Fontan operations
J Thorac Cardiovasc Surg
(2004) - et al.
Rescue cardiac transplantation for early failure of the Fontan-type circulation in children
J Thorac Cardiovasc Surg
(2005) - et al.
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
J Heart Lung Transplant
(2012) - et al.
Impact of adult congenital heart disease on survival and mortality after heart transplantation
J Heart Lung Transplant
(2014) - et al.
The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease
J Am Coll Cardiol
(2009) - et al.
The role of gender in heart transplantation
Ann Thorac Surg
(1998)
A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: outcomes and factors associated with mortality and retransplantation
J Thorac Cardiovasc Surg
Evidence of pulmonary vascular disease after heart transplantation for Fontan circulation failure
J Thorac Cardiovasc Surg
Immune abnormalities in Fontan protein-losing enteropathy: a case-control study
J Pediatr
The Registry of the International Society for Heart and Lung Transplantation: seventeenth official pediatric heart transplantation report- 2014; focus theme: retransplantation
J Heart Lung Transplant
Surgical repair of tricuspid atresia
Thorax
Cited by (35)
EASL-ERN position paper on liver involvement in patients with Fontan-type circulation
2023, Journal of HepatologyOptimizing Referral Timing of Patients With Fontan Circulatory Failure for Heart Transplant
2023, Transplantation ProceedingsHeart Transplant Indications, Considerations, and Outcomes in Fontan Patients: Age-Related Nuances, Transplant Listing, and Disease-Specific Indications
2022, Canadian Journal of CardiologyCitation Excerpt :An earlier report from this registry provided the detail that 53% of HTx procedures were performed during childhood, and 47% during ACHD follow-up.16 The 2 meta-analyses of HTx for FCF that have been conducted both included data from patients across the age spectrum, the first from 351 patients (mean age: 14 years), and the second from 426 patients (mean age: 21 years).17,18 Both identified that substantially more HTx procedures have been performed in male patients, despite the approximately equal gender distribution among Fontan patients.
Heart transplantation after Fontan operation
2022, JTCVS TechniquesImproving outcomes for transplantation in failing Fontan—what is the next target?
2021, JTCVS OpenCitation Excerpt :In our cohort, mortality plateaued at 6 months, with good medium-term survival of 71% at 1 year and 67% at 5 years. These findings are in line with the results of a recently published meta-analysis that included a total of 351 Fontan patients undergoing OHT and showed 1- and 5-year survival rates of 80.3% (95% CI, 75.9%-84.2%) and 71.2% (95% CI, 66.3%-75.7%), respectively.17 Primary graft failure is a known complication after OHT for failing Fontan circulation.18,19
See page 1274 for disclosure information.