Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective
Objective: Prior studies suggest that prolonged donor heart warm ischemia time increases heart transplant mortality. Patients with single-ventricle heart disease requiring transplant with concomitant aortic arch or central pulmonary artery reconstruction present technical challenges that extend dono...
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Elsevier
2024-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724003572 |
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| author | Charles D. Fraser, III, MD Raveendra Morchi, MD Matthew L. Stone, MD James Jaggers, MD David Campbell, MD Max B. Mitchell, MD |
| author_facet | Charles D. Fraser, III, MD Raveendra Morchi, MD Matthew L. Stone, MD James Jaggers, MD David Campbell, MD Max B. Mitchell, MD |
| author_sort | Charles D. Fraser, III, MD |
| collection | DOAJ |
| description | Objective: Prior studies suggest that prolonged donor heart warm ischemia time increases heart transplant mortality. Patients with single-ventricle heart disease requiring transplant with concomitant aortic arch or central pulmonary artery reconstruction present technical challenges that extend donor warm ischemia time using conventional techniques. Studies in larger pediatric and adult patients with single-ventricle anatomy have described the use of prosthetic material for concomitant great vessel reconstruction. We have used donor free arterial grafts to simplify concomitant great vessel reconstructions and reduce warm donor ischemia time in small patients with single-ventricle physiology undergoing heart transplant. The purpose of this study is to review our results in these patients. Methods: Children with single-ventricle heart disease who underwent free donor arterial graft great vessel reconstruction at heart transplant were identified, divided into aortic arch and central pulmonary artery groups, and retrospectively reviewed. Warm and total ischemia times were recorded contemporaneously at transplant. Results: Fifteen pediatric patients with single-ventricle physiology underwent donor free arterial graft great vessel reconstructions (9 aortic arch, 6 pulmonary artery). Mean donor warm and total ischemia times for the entire cohort were 52.8 ± 10.7 and 341.7 ± 41.2 minutes. Two patients required postoperative extracorporeal membrane oxygenation. Hospital survival was 94% (1 death). There were no late deaths, and 2 patients had late retransplant. There were no early or late aortic or pulmonary artery obstructions, reinterventions, or complications at median follow-up of 14.2 years (interquartile range, 4.2-16.3 years). Conclusions: Donor free arterial grafts for concomitant great vessel reconstruction during heart transplant in small, single-ventricle patients reduces warm ischemia time, simplifies technical demands, and preserves growth potential. |
| format | Article |
| id | doaj-art-1a2f68dfe6d1491aaa9a65febf9d954d |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-1a2f68dfe6d1491aaa9a65febf9d954d2025-08-20T03:36:38ZengElsevierJTCVS Techniques2666-25072024-12-012813213810.1016/j.xjtc.2024.08.022Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspectiveCharles D. Fraser, III, MD0Raveendra Morchi, MD1Matthew L. Stone, MD2James Jaggers, MD3David Campbell, MD4Max B. Mitchell, MD5Address for reprints: Charles D. Fraser III, MD, Section of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, 13123 E 16th Ave, B-200, Aurora, CO 80045.; Section of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoSection of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoSection of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoSection of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoSection of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoSection of Pediatric Cardiac Surgery, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, ColoObjective: Prior studies suggest that prolonged donor heart warm ischemia time increases heart transplant mortality. Patients with single-ventricle heart disease requiring transplant with concomitant aortic arch or central pulmonary artery reconstruction present technical challenges that extend donor warm ischemia time using conventional techniques. Studies in larger pediatric and adult patients with single-ventricle anatomy have described the use of prosthetic material for concomitant great vessel reconstruction. We have used donor free arterial grafts to simplify concomitant great vessel reconstructions and reduce warm donor ischemia time in small patients with single-ventricle physiology undergoing heart transplant. The purpose of this study is to review our results in these patients. Methods: Children with single-ventricle heart disease who underwent free donor arterial graft great vessel reconstruction at heart transplant were identified, divided into aortic arch and central pulmonary artery groups, and retrospectively reviewed. Warm and total ischemia times were recorded contemporaneously at transplant. Results: Fifteen pediatric patients with single-ventricle physiology underwent donor free arterial graft great vessel reconstructions (9 aortic arch, 6 pulmonary artery). Mean donor warm and total ischemia times for the entire cohort were 52.8 ± 10.7 and 341.7 ± 41.2 minutes. Two patients required postoperative extracorporeal membrane oxygenation. Hospital survival was 94% (1 death). There were no late deaths, and 2 patients had late retransplant. There were no early or late aortic or pulmonary artery obstructions, reinterventions, or complications at median follow-up of 14.2 years (interquartile range, 4.2-16.3 years). Conclusions: Donor free arterial grafts for concomitant great vessel reconstruction during heart transplant in small, single-ventricle patients reduces warm ischemia time, simplifies technical demands, and preserves growth potential.http://www.sciencedirect.com/science/article/pii/S2666250724003572single ventriclecongenital heart diseasepediatric heart transplantation |
| spellingShingle | Charles D. Fraser, III, MD Raveendra Morchi, MD Matthew L. Stone, MD James Jaggers, MD David Campbell, MD Max B. Mitchell, MD Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective JTCVS Techniques single ventricle congenital heart disease pediatric heart transplantation |
| title | Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective |
| title_full | Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective |
| title_fullStr | Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective |
| title_full_unstemmed | Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective |
| title_short | Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationCentral MessagePerspective |
| title_sort | donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantationcentral messageperspective |
| topic | single ventricle congenital heart disease pediatric heart transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724003572 |
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