초록접수 현황
| 17F-049 | 포럼 발표 |
Heart Transplantation for Failing from Single Ventricle Palliation or One-and-a-half Ventricle Physiology: A Single-institution Experience
Bo Bae Jeon, Chun Soo Park, Tae-Jin Yun
Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Heart transplantation (HTx) can be a life-saving procedure for patients who are failing from single ventricle palliation or one-and-a-half (1 and 1/2) ventricle repair. The purpose of this study was to assess the overall outcome after HTx for failing Fontan or 1 and 1/2 repair, and to assess the technical feasibility of leaving BCS upon HTx.
Methods : Of the 666 HTx at Asan Medical Center from 1992 to 2017, 11 HTx were performed for patients who are failing from Fontan (n=8), bidirectional cavopulmonary shunt (BCS, n=2), and 1 and 1/2 ventricle (n=1) physiology. Median age at HTx was 12.0 years (range, 3 to 24 years), and median interval from the last operation to HTx was 8.6 years (range, 1.7 to 18.6 years). The most common initial diagnosis was TGA with VSD (n=4). Of all, three patients (27.3%) underwent HTx without take-down of the previous BCS.
Results : There was no early death and 1 late death due to graft failure at post-operative 3.5 years. Overall survival was 90.9 %, and median rejection free interval was 1.15 years (range, 0.08 to 9.66 years). The total procedure time and bypass time was significantly shorter in leaving BCS group (408 vs 503 and 228 vs 249.5 minutes, p<0.0001), while postoperative central venous pressure (CVP) was comparable to preoperative CVP.
Conclusion : Transplantation can be performed successfully in patients with end-stage congenital heart disease after single ventricle palliation or 1 and 1/2 repair. Leaving BCS upon HTx may simplify the operative procedure without significant adverse outcome.
Methods : Of the 666 HTx at Asan Medical Center from 1992 to 2017, 11 HTx were performed for patients who are failing from Fontan (n=8), bidirectional cavopulmonary shunt (BCS, n=2), and 1 and 1/2 ventricle (n=1) physiology. Median age at HTx was 12.0 years (range, 3 to 24 years), and median interval from the last operation to HTx was 8.6 years (range, 1.7 to 18.6 years). The most common initial diagnosis was TGA with VSD (n=4). Of all, three patients (27.3%) underwent HTx without take-down of the previous BCS.
Results : There was no early death and 1 late death due to graft failure at post-operative 3.5 years. Overall survival was 90.9 %, and median rejection free interval was 1.15 years (range, 0.08 to 9.66 years). The total procedure time and bypass time was significantly shorter in leaving BCS group (408 vs 503 and 228 vs 249.5 minutes, p<0.0001), while postoperative central venous pressure (CVP) was comparable to preoperative CVP.
Conclusion : Transplantation can be performed successfully in patients with end-stage congenital heart disease after single ventricle palliation or 1 and 1/2 repair. Leaving BCS upon HTx may simplify the operative procedure without significant adverse outcome.
첨부파일 : 2017 흉부외과 추계 초록.pptx
책임저자: Tae-Jin Yun
Divisional Head and Full Professor, Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Bo Bae Jeon, E-mail : jeonbol@naver.com