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Editorial
. 2022 Feb 15:13:182-191.
doi: 10.1016/j.xjtc.2022.01.020. eCollection 2022 Jun.

Heart transplantation after Fontan operation

Igor E Konstantinov  1   2   3   4 , Antonia Schulz  1 , Edward Buratto  1   2   3
Affiliations
Editorial

Heart transplantation after Fontan operation

Igor E Konstantinov et al. JTCVS Tech. .
No abstract available

Keywords: Fontan; single ventricle; transplantation.

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Figures

None
Drs Igor E. Konstantinov, Antonia Schulz, and Edward Buratto at the Royal Children's Hospital in Melbourne.
Figure 1
Figure 1
Increased proportion of patients with HLHS in 1290 survivors with Fontan circulation in Australia and New Zealand. HLHS, Hypoplastic left heart syndrome.
Figure 2
Figure 2
Durable VAD support in patients with Fontan circulation. Pulsatile VAD is used to support systemic (A) or pulmonary (B) circulation or both (C) in smaller children, whereas continuous flow VAD is used to support systemic (D) or pulmonary (E) circulation or both (F) in older children and adults. SVC, Superior vena cava; IVC, inferior vena cava; PA, pulmonary artery.
Figure 3
Figure 3
Complexity of surgical preparation for heart transplantation in patients with HLHS after Fontan operation. A, Enlarged aortic root after initial aortic reconstruction often compresses the pulmonary artery, and the latter may require stenting. Thus, anatomic separation of the aortic arch is often impossible, and the aortic arch replacement is required. B, In addition to reconstruction of aortic arch and central pulmonary arteries, patients with heterotaxy and anomalous systemic venous drainage require reconstruction of systemic venous pathways. C, Sequential reconstruction of aortic arch (C1), central pulmonary arteries (C2), and systemic venous drainage (C3) must be accomplished before arrival of the heart to minimize ischemic time of the donor heart. D, After heart transplantation, meticulous hemostasis is required to minimize bleeding from the numerous suture lines and ensure judicious use of blood products. LSVC, Left superior vena cava; RSVC, right superior vena cava; RPA, right pulmonary artery; LPA, left pulmonary artery; VAD, ventricular assist device; Ao, aorta; IVC, inferior vena cava.
Figure 4
Figure 4
Aortic reconstruction after en bloc removal of the ascending aorta, aortic arch, and pulmonary arteries. A, A graft sutured to the femoral artery is cannulated. After hypothermia is achieved, the ascending aortic cannular is introduced into the innominate artery and the arch branches are snagged. B, A balloon catheter is introduced into the descending aorta via the graft so that a continuous lower body perfusion is maintained in addition to cerebral perfusion. C, Once left common carotid and left subclavian arteries are anastomosed, the balloon catheter is removed, the aorta is crossclamped between the carotid arteries and the antegrade perfusion of the whole body is reestablished. Once the innominate artery is reanastomosed, the aortic crossclamped is repositioned onto ascending aorta. If the time permit, while awaiting for the donor heart to arrive, the femoral artery can be reconstructed at this stage.
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References

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