دورية أكاديمية
أعرض في EDS

The majority of pediatric Fontan patients have excellent post-transplant survival.

التفاصيل البيبلوغرافية
العنوان: The majority of pediatric Fontan patients have excellent post-transplant survival.
المؤلفون: Kulshrestha K; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: kulshrkn@ucmail.uc.edu., Greenberg JW; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Kennedy JT 3rd; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Hogue S; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Winlaw DS; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Ashfaq A; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Zafar F; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio., Morales DLS; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio.
المصدر: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Jun; Vol. 167 (6), pp. 2193-2203. Date of Electronic Publication: 2023 Sep 27.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
مواضيع طبية MeSH: Fontan Procedure*/mortality , Fontan Procedure*/adverse effects , Heart Transplantation*/mortality , Heart Transplantation*/adverse effects , Heart Defects, Congenital*/surgery , Heart Defects, Congenital*/mortality, Humans ; Child ; Male ; Female ; Child, Preschool ; Time Factors ; Treatment Outcome ; Retrospective Studies ; Risk Factors ; Adolescent ; United States/epidemiology ; Waiting Lists/mortality ; Registries ; Postoperative Complications/mortality
مستخلص: Objective: Many pediatric Fontan patients require heart transplant, but this cohort is understudied given the difficulty in identifying these patients in national registries. We sought to characterize survival post-transplant in a large cohort of pediatric patients undergoing the Fontan.
Methods: The United Network for Organ Sharing and Pediatric Health Information System were used to identify Fontan heart transplant recipients aged less than 18 years (n = 241) between 2005 and 2022. Decompensation was defined as the presence of extracorporeal membrane oxygenation, ventilation, hepatic/renal dysfunction, paralytics, or total parenteral nutrition at transplant.
Results: Median age at transplant was 9 (interquartile range, 5-12) years. Median waitlist time was 107 (37-229) days. Median volume across 32 center was 8 (3-11) cases. Approximately half (n = 107, 45%) of recipients had 1A/1 initial listing status. Sixty-four patients (28%) were functionally impaired at transplant, 10 patients (4%) were ventilated, and 18 patients (8%) had ventricular assist device support. Fifty-nine patients (25%) had hepatic dysfunction, and 15 patients (6%) had renal dysfunction. Twenty-one patients (9%) were dependent on total parenteral nutrition. Median postoperative stay was 24 (14-46) days, and in-hospital mortality was 7%. Kaplan-Meier analysis showed 1- and 5-year survivals of 89% (95% CI, 85-94) and 74% (95% CI, 81-86), respectively. Kaplan-Meier of Fontan patients without decompensation (n = 154) at transplant demonstrated 1- and 5-year survivals of 93% (95% CI, 88-97) and 88% (95% CI, 82-94), respectively. In-hospital mortality was higher in decompensated patients (11% vs 4%, P = .023). Multivariable analysis showed that decompensation predicted worse post-transplant survival (hazard ratio, 2.47; 95% CI, 1.16-5.22; P = .018), whereas older age at transplant predicted superior post-transplant survival (hazard ratio, 0.89/year; 95% CI, 0.80-0.98; P = .019).
Conclusions: Pediatric Fontan post-transplant outcomes are promising, although early mortality remains high. For nondecompensated pediatric patients at transplant without end-organ disease (>63% of cohort), early mortality is circumvented and post-transplant survival is excellent and similar to all pediatric transplantation.
Competing Interests: Conflict of Interest Statement D.L.S.M. is a consultant for Abbott, Inc, Azyio, Inc, Berlin Heart, Inc, CorMatrix, Inc, Peca, Inc, Syncardia, Inc, and Xeltis, Inc, and serves as a principal investigator for Food and Drug Administration trials sponsored by Peca, Inc, and Xeltis, Inc. F.Z. has a financial relationship (employment) with TransMedics, Inc. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
(Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: R01 HL147957 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: Fontan; modifiable risk factors; pediatric heart transplant; post-transplant survival
تواريخ الأحداث: Date Created: 20230929 Date Completed: 20240515 Latest Revision: 20240517
رمز التحديث: 20240517
مُعرف محوري في PubMed: PMC10965507
DOI: 10.1016/j.jtcvs.2023.09.044
PMID: 37774778
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-685X
DOI:10.1016/j.jtcvs.2023.09.044