Evaluating Outcomes and Perioperative Complications of Combined Heart and Liver Transplantation in Patients With Failing Fontan Physiology: A Systematic Review

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Significant advancements in treating single-ventricle congenital heart disease have improved survival rates, leading to an increase in adults with Fontan physiology who require heart transplants due to end-stage heart failure. Concurrently, the incidence of Fontan-associated liver disease (FALD) has risen, necessitating more combined heart and liver transplants (CHLT). However, data on posttransplant outcomes for these patients remain limited and inconclusive. This systematic review evaluates perioperative complications, post-transplant survival, and factors influencing outcomes in patients undergoing CHLT for FALD, aiming to improve patient selection and timing for these complex procedures. Methods: This systematic review followed Cochrane guidelines and PRISMA standards to evaluate CHLT outcomes for failing Fontan physiology. Comprehensive searches across PubMed, Embase, Web of Science, and Cochrane CENTRAL up to May 2024 included randomized controlled trials and observational studies. Data extraction used PICOS criteria via Excel. Due to varied findings, a meta-analysis was not feasible; thus, a narrative synthesis was conducted. Results: From 437 screened studies, 8 studies encompassing 305 patients undergoing CHLT for FALD and heart failure were included. The mean patient age was 37.7±14 years, and 45% were male. The mean cardiopulmonary bypass time was 282±125 minutes. Red blood cell transfusions ranged from 3 to 46 units. Intensive care unit stay ranged from 7.5 to 11 days, and hospital length of stay varied from 16 to 42 days. Mechanical circulatory support was required in 15% of patients, while renal replacement therapy was needed in 26%. Tracheostomy was performed in 19% of patients. The overall survival rate was 82% at one year and 74% at 5 years. Infection rates varied, with 7 out of 9 patients affected, and reoperation rates due to complications were noted. Conclusion: This systematic review highlights the complexity of CHLT for patients with failing Fontan physiology, including FALD. Despite diverse perioperative outcomes, the high one-year and 5-year survival rates affirm the viability and advantages of CHLT. Future research should focus on refining patient selection, optimizing perioperative outcomes, and comparing CHLT to orthotopic heart transplantation (OHT) to establish comprehensive guidelines for managing failing Fontan physiology.

Volume

119

Issue

10

First Page

S1377

Find It @ Sladen

Share

COinS