The influence of initial Norwood palliation on cardiac transplantation in the failing Fontan: A dual-institution study

Objective

To explore the differences in perioperative cardiac transplant courses and outcomes between patients with failed Fontan physiology who initially underwent a Norwood procedure and those who did not.

Methods

A retrospective review of 78 cardiac transplant patients with failed Fontan physiology from 1994 to 2021 was conducted; 42 had a previous Norwood procedure (FFN) and 36 did not (FF).

Results

Although patients in the FFN group appeared to have a more complex perioperative course, they experienced better discharge and 1-year survival compared with patients in the FF group: discharge survival of 81% of patients in the FFN group compared with 75% of patients in the FF group (P = .5256); 1-year survival of 80.5% of patients in the FFN group compared with 73.5% of patients in the FF group (P = .4737). Notable trends in the perioperative courses of the FFN cohort compared with the FF cohort included: more frequent neoaortic reconstruction at the time of transplant (7 patients in the FFN group [16.7%] vs 1 patient in the FF group [2.8%], P = .0627), greater rate of sternal re-entry events (5 patients in the FFN group [11.9%] vs 2 patients in the FF group [5.7%], P = .4454), longer median duration of surgery (FFN 611.5 minutes vs FF 556 minutes, P = .3928), longer median cardiopulmonary bypass times (FFN 222.5 minutes vs FF 202 minutes, P = .1584), more use of open sternal management (14 patients in the FFN group [33.3%] vs 7 patients in the FF group [20%], P = .1908), and longer median length of hospital stay (FFN 41 days vs FF 30 days, P = .4035).

Conclusions

Despite patients in the FFN group exhibiting a more complex operative and perioperative course, discharge and 1-year survival were better than those of patients in the FF group.