CARDIAC TRANSPLANTATION FOR CONGENITAL HE ART-DISEASE AFTER MULTIPLE PRIOR PALLIATIVE PROCEDURES

Of the 100 consecutive patients undergoing cardiac transplantation bet ween January 1988 and October 1993, 4 patients had terminal cardiac fa ilure related to congenital heart disease after multiple prior palliat ive procedures (transposition of the great arteries, N = 1, tricuspid atresia, N = 1, single ventricle, N = 2). The prior palliative or cura tive operations (average 3.75 procedures per patient) modified essenti ally the systemic venous return and the pulmonary arteries. The techni que of ''subtotal'' cardiac transplantation enabled anatomical reconst ruction without prosthetic material in all cases by extensive usage of the donor tissue. There was no hospital mortality. There were no spec ific postoperative complications. The long-term results were comparabl e to those of the rest of the transplanted population. Patients with c ongenital heart disease in a terminal condition should be considered a s candidates for cardiac transplantation. The difficulties related to anatomical abnormalities caused by prior surgery may be overcome and s hould not be considered a contra-indication to transplantation, provid ing pulmonary arterial resistances are taken into consideration.