Jeon Bo Bae, Park Chun Soo, Yun Tae-Jin
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Korean J Thorac Cardiovasc Surg. 2018 Jun;51(3):167-171. doi: 10.5090/kjtcs.2018.51.3.167. Epub 2018 Jun 5.
Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half (1½) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx.
From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or 1½ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3-24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS.
No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54-68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62-128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP.
Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or 1½ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.
对于单心室姑息治疗或一又二分之一（1½）心室修复失败的患者，心脏移植（HTx）可能是一种挽救生命的手术。然而，既往存在双向腔肺分流（BCS）需要进行广泛的肺动脉血管成形术，这可能导致更差的预后。我们旨在评估既往有BCS的患者HTx后的结局，并评估在HTx期间保留BCS的技术可行性。
1992年至2017年，峨山医学中心对因Fontan（n = 7）、BCS（n = 3）或一又二分之一心室（n = 1）生理功能衰竭的患者进行了11例HTx。HTx时的中位年龄为12.0岁（范围3 - 24岁）。3例患者（27.3%）在未拆除既往BCS的情况下接受了HTx。
未观察到早期死亡。1例患者在HTx后3.5年死于急性排斥反应。2年时的总生存率为91%。在3例未拆除BCS的患者中，中位吻合时间为65分钟（范围54 - 68分钟），短于拆除BCS的患者（93分钟；范围62 - 128分钟），而术后中心静脉压（CVP）与术前CVP相当。
单心室姑息治疗或一又二分之一心室修复后的终末期先天性心脏病患者可以成功进行移植。在HTx期间保留BCS可能会简化手术操作，且不会导致显著不良后果。
