Mortality Risk Stratification in Fontan Patients Undergoing Heart Transplantation

• Published in: The American journal of cardiology
• Main Authors: Berg, Christopher J., MS, Bauer, Brenton S., MD, Hageman, Abbie, BS, Aboulhosn, Jamil A., MD, Reardon, Leigh C., MD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Cardiovascular; Fontan procedure; risk stratification; heart transplantation; single ventricle; congenital heart disease
• ISSN: 0002-9149
• DOI: 10.1016/j.amjcard.2017.02.005

Abstract The number of patients who require orthotopic heart transplantation (OHT) for failing Fontan physiology continues to grow; however, the methods and tools to evaluate risk of OHT are limited. This study aimed to identify a set of preoperative variables and characteristics that were associated with a greater risk of postoperative mortality in patients who received OHT for failing Fontan physiology. 36 Fontan patients were identified as having undergone OHT at UCLA Medical Center from 1991 to 2014. Data was collected retrospectively and analyzed. The primary endpoint was designated as postoperative mortality. After an average follow-up time of 3.5 years, 17 (44%) patients suffered postoperative mortality. Patient characteristics including: 1. age <18 years at time of OHT, 2. Fontan-OHT interval of <10 years, 3. systemic ventricular ejection fraction (EF) <20%, 4. moderate-to-severe atrioventricular (AV) valve insufficiency, 5. an elevated Model of End-Stage Liver Disease, Excluding INR (MELD-XI) score, or 6. need for advanced mechanical support prior to surgery, were associated with an increased incidence of postoperative mortality. Using these risk factors, we present a theoretical framework to stratify risk of postoperative death in failing Fontan patients after OHT. In conclusion, a method such as this may aid in the transplantation evaluation and listing process of patients with failing Fontan physiology.