Cardiac Transplantation of the Fontan Patient with a Prior Norwood Procedure

Abstract

Single-ventricle palliation starting with a Norwood procedure which culminates in a failed Fontan palliation poses certain unique operative challenges for cardiac transplantation. In this manuscript, we describe some of these challenges and our particular approach in management. Single-ventricle palliation starting with a Norwood procedure which culminates in a failed Fontan palliation poses certain unique operative challenges for cardiac transplantation. In this manuscript, we describe some of these challenges and our particular approach in management. Commentary: Transplantation After Norwood Palliation: Proper Preparation Minimizes the RiskOperative Techniques in Thoracic and Cardiovascular SurgeryPreviewAs the population with a Fontan circulation continues to grow, there is an increasing rate of patients with Fontan failure being referred for heart transplantation.1 Importantly, there has been an increase in the proportion of patients with hypoplastic left heart syndrome surviving to achieve Fontan completion, and these patients represent the highest complexity for heart transplantation due to their aortic arch and pulmonary artery anatomy. The mortality rate for transplantation in patients with single ventricle palliation has been reported to be as high as 20-30%,2-4 and it is likely that many have been denied transplantation due to the perceived extremely high risk. Full-Text PDF