Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience

Weiyi Tan; Leigh Reardon; Jeannette Lin; Gentian Lluri; Prashanth Venkatesh; Katia Bravo-Jaimes; Reshma Biniwale; Glen Van Arsdell; Reid D. Ponder; Jamil Aboulhosn

International Journal of Cardiology Congenital Heart Disease (Dec 2021)

Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience

Weiyi Tan,
Leigh Reardon,
Jeannette Lin,
Gentian Lluri,
Prashanth Venkatesh,
Katia Bravo-Jaimes,
Reshma Biniwale,
Glen Van Arsdell,
Reid D. Ponder,
Jamil Aboulhosn

Affiliations

Weiyi Tan: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Adult Congenital Heart Disease, Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX, USA; Corresponding author. UTSW Adult Congenital Heart Disease Center, 2001 Inwood Road, 5th Floor, 75390, Dallas, TX, USA.
Leigh Reardon: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; UCLA Mattel Children's Hospital, Division of Pediatric Cardiology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
Jeannette Lin: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Gentian Lluri: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Prashanth Venkatesh: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Katia Bravo-Jaimes: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Reshma Biniwale: Congenital Cardiovascular Surgery, Division of Cardiac Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
Glen Van Arsdell: Congenital Cardiovascular Surgery, Division of Cardiac Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
Reid D. Ponder: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Jamil Aboulhosn: Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

Journal volume & issue: Vol. 6
p. 100260

Abstract

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Background: Single ventricle patients palliated with the Fontan operation may eventually require heart (OHT) or combined heart-liver transplantation (CHLT) to treat Fontan circulatory failure. This study aims to characterize the safety and tolerability of coiling aortopulmonary and venovenous collaterals and its impact on morbidity and mortality in patients with Fontan circulatory failure undergoing OHT or CHLT. Methods: This retrospective observational cohort study included patients with Fontan circulatory failure who underwent OHT or CHLT between January 1, 2004 and December 30, 2020. Patients were separated into two groups; those who underwent procedure(s) for comprehensive coil embolization of aortopulmonary and venovenous collaterals prior to listing for transplantation (coiling), and those who did not (no coiling). Collateral burden quantification and procedural characteristics were recorded for the coiling group and perioperative outcomes were compared between the two groups. Results: Twenty-nine patients were in the study. The coiling (n = 10) group had a significant reduction in intraoperative collateral flow when compared to the no coiling (n = 19) group (10% versus 42% with severe collateral flow, p = 0.002). While there was no significant difference in blood product transfusion requirements or in the morbidity/mortality between the two groups, there was a trend towards a reduction in postoperative bleeding complications and reoperations for bleeding in the subgroup of patients receiving CHLT and coiling compared to those without coiling. Conclusions: Elimination of collaterals prior to OHT and CHLT is a safe and well-tolerated procedure in patients with Fontan circulatory failure and appears to decrease collateral bleeding during the transplant operation.

Published in International Journal of Cardiology Congenital Heart Disease

ISSN: 2666-6685 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/international-journal-of-cardiology-congenital-heart-disease

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