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- W2477510109 abstract "El trasplante cardiaco tras un Fontan supone un reto quirúrgico. Presentamos a 10 pacientes, destacando las variantes técnicas en las anastomosis previas a la implantación del injerto. Recogemos 8 casos de Fontan y 2 «take-down» consecutivos durante 32 meses, con medianas de edad (9 años), peso (30 kg) e intervalo entre Fontan y trasplante de 3 años. Siete pacientes presentaban conducto extracardiaco (diámetro 18/20), 2 conexión aurículo-pulmonar y uno, túnel lateral. Tres niños desarrollaron enteropatía pierde-proteínas. Nueve «stents» fueron implantados previamente. Hubo modificaciones en las 5 anastomosis. Una vez en la aurícula izquierda (sutura en ambas aurículas del receptor), 2 en la aorta (hemiarco), 2 en vena cava superior (plastia en vena innominada), 7 veces en la arteria pulmonar (parche de aorta/pericardio donante de hilio a hilio tras retirada de «stents»), vena cava inferior en 7 ocasiones (manguito de conducto). El seguimiento fue completo con una mediana de 25 meses (rango 3-34). Un paciente falleció. Dos precisaron extracorporeal membrane oxygenation por hipertensión pulmonar. Tres pacientes requirieron cierre de colaterales en hemodinámica, incluyendo colocación de «stent» en cava superior (1) y aorta (1). Se resolvió la enteropatía pierde-proteínas en 2 pacientes. Trasplantar a pacientes con Fontan previo es un reto. Podemos anticipar variantes en cada una de las 5 anastomosis previstas. Es recomendable obtener tejido extra del donante (aorta y arco, vena cava superior e innominada, pericardio). Los resultados pueden superponerse a otras series de trasplante cardiaco. Heart transplantation after a Fontan procedure poses a unique challenge from a surgical point of view. The cases of ten patients are presented, stressing the technical variations performed in the five anastomoses in order to match the graft in the recipient. Eight Fontan and two takedown patients were included over 32 consecutive months. The median age was 9 years, median weight was 30 Kg, with a median time interval of 3 years between Fontan and transplant. An extra-cardiac conduit (size 18/20) was implanted in seven patients, whereas an atriopulmonary connection was found in two, and lateral tunnel in one. Three patients developed protein-losing enteropathy. Nine stents were previously implanted. The five anastomoses underwent some changes. Left atrium once (enlargement with recipient both atria), aorta twice (hemi-arch repair), superior vena cava twice (innominate donor plasty), pulmonary branches seven times (hilum to hilum plasty with donor aorta/pericardium patch after complete stent removal), and inferior vena cava seven times (conduit sleeve anastomoses). The patients were followed-up for a median of 25 months (range 5-34). One patient died. Extracorporeal membrane oxygenation was needed in two cases due to pulmonary hypertension. Three patients had collateral vessels occluded in the catheter laboratory, and stents placed in superior vena cava (1) and aorta (1). The protein-losing enteropathy was resolved in two children. Transplant in Fontan patients is currently challenging. Variations in each of the five proposed anastomoses must be anticipated. Extra tissue from the donor (innominate vein, aortic arch, pericardium) is strongly advisable. Overall results can match other transplants cohorts." @default.
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- W2477510109 date "2016-09-01" @default.
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- W2477510109 title "Trasplante después del Fontan. Aspectos quirúrgicos" @default.
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