TY - JOUR
T1 - Cardiac transplantation for end-stage congenital heart defects
T2 - The Mayo Clinic experience
AU - Speziali, Giovanni
AU - Driscoll, David J.
AU - Danielson, Gordon K.
AU - Julsrud, Paul R.
AU - Porter, Coburn J.
AU - Dearani, Joseph A.
AU - Daly, Richard C.
AU - McGregor, Christopher G.A.
PY - 1998
Y1 - 1998
N2 - Objective: To review the outcome of cardiac transplantation undertaken in patients with congenital heart defects. Material and Methods: Between November 1991 and March 1998 at our institution, cardiac transplantation was performed in 16 patients with congenital heart disease (age range, 3 to 57 years; mean, 26.1). Preoperative diagnoses included univentricular heart (N = 4); complete transposition of the great arteries (N = 3); Ebstein's anomaly (N = 2); tetralogy of Fallot (N = 2); levotransposition (N = 2); dextrocardia, corrected transposition, ventricular and atrial septal defects, and pulmonary stenosis (N = 1); double-outlet right ventricle (N = 1); and hypertrophic obstructive cardiomyopathy (N = 1). All patients had undergone from one to five previous palliative operations. Results: Four patients required permanent pacemaker implantation during the first month postoperatively because of bradycardia; more than 2 years later, another patient required a permanent pacemaker because of sick sinus syndrome. In addition, one patient had an automatic implantable cardioverter- defibrillator. Three patients required reconstruction of cardiovascular structures with use of prosthetic material (Teflon patches or donor tissue) at the time of cardiac transplantation. Actuarial, 1-, 2-, and 5-year survival was 86.2±9.1%. During the first year after transplantation, two deaths occurred-one at 41 days of putative vascular rejection and the second at 60 days of severe cellular rejection. All other patients are alive and functionally rehabilitated; the mean follow-up period has been 26.1 months (range, 2 to 89.6). Conclusion: Cardiac transplantation for patients with congenital heart disease can be accomplished with a low perioperative mortality and an excellent medium-term survival despite the challenges presented by the technical difficulties during invasive diagnostic procedures and at operation and the need for adherence to long-term multiple-drug therapy in this patient population.
AB - Objective: To review the outcome of cardiac transplantation undertaken in patients with congenital heart defects. Material and Methods: Between November 1991 and March 1998 at our institution, cardiac transplantation was performed in 16 patients with congenital heart disease (age range, 3 to 57 years; mean, 26.1). Preoperative diagnoses included univentricular heart (N = 4); complete transposition of the great arteries (N = 3); Ebstein's anomaly (N = 2); tetralogy of Fallot (N = 2); levotransposition (N = 2); dextrocardia, corrected transposition, ventricular and atrial septal defects, and pulmonary stenosis (N = 1); double-outlet right ventricle (N = 1); and hypertrophic obstructive cardiomyopathy (N = 1). All patients had undergone from one to five previous palliative operations. Results: Four patients required permanent pacemaker implantation during the first month postoperatively because of bradycardia; more than 2 years later, another patient required a permanent pacemaker because of sick sinus syndrome. In addition, one patient had an automatic implantable cardioverter- defibrillator. Three patients required reconstruction of cardiovascular structures with use of prosthetic material (Teflon patches or donor tissue) at the time of cardiac transplantation. Actuarial, 1-, 2-, and 5-year survival was 86.2±9.1%. During the first year after transplantation, two deaths occurred-one at 41 days of putative vascular rejection and the second at 60 days of severe cellular rejection. All other patients are alive and functionally rehabilitated; the mean follow-up period has been 26.1 months (range, 2 to 89.6). Conclusion: Cardiac transplantation for patients with congenital heart disease can be accomplished with a low perioperative mortality and an excellent medium-term survival despite the challenges presented by the technical difficulties during invasive diagnostic procedures and at operation and the need for adherence to long-term multiple-drug therapy in this patient population.
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U2 - 10.4065/73.10.923
DO - 10.4065/73.10.923
M3 - Article
C2 - 9787738
AN - SCOPUS:0031694567
SN - 0025-6196
VL - 73
SP - 923
EP - 928
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 10
ER -