Failing Fontan cardiovascular support: Review.

Autor: Zwischenberger JB; Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA., Breetz KA; College of Medicine, University of Kentucky, Lexington, Kentucky, USA., Ballard-Croft C; Division of Surgical Research, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA., Wang D; Division of Surgical Research, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2022 Dec; Vol. 37 (12), pp. 5257-5261. Date of Electronic Publication: 2022 Nov 02.
DOI: 10.1111/jocs.17094
Abstrakt: Background: Although all congenital heart defects (CHD) present unique challenges, univentricular CHD are especially challenging given the difficulty of passively perfusing pulmonary blood flow. Three surgical procedures are required within the first years of life, with the final completing a Fontan circulation in which the inferior vena cava is connected to the pulmonary artery and previously connected superior vena cava. This allows passive venous return to the pulmonary circulation then flow into the single ventricle for systemic circulation.
Methods: Although a Fontan provides successful palliation for two to three decades, many complications can arise as pulmonary resistance must remain low to allow adequate forward flow. Eventually, the failing Fontan circulation requires temporary support as the patient awaits a heart transplant. We reviewed PubMed, Google Scholar, and U. Kentucky library for different techniques evaluated to support a failing Fontan circulation.
Results: Multiple technologies have been developed as a bridge to transplant to decrease morbidity. Innovative types of extracorporeal membrane oxygenation, ventricular assist devices, and total artificial hearts have been attempted in laboratory settings as well as in Fontan patients with varying degrees of success. This article emphasizes the strengths and weaknesses of each technology in the context of Fontan physiology.
Conclusion: The end game for these patients remains a heart transplant. Without easy access to donors, each of the options discussed is a potential bridge to limit morbidity and mortality until a suitable donor heart becomes available.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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