Congenital heart diseaseCohort study
The Impact of Fontan Circulatory Failure on Heart Transplant Survival: A 20-Center Retrospective Cohort Study
- Retrospective cohort study
- multicentre
- 20 centres
Authors' conclusion
Patients with Fontan palliation selected for heart transplant have substantial mortality rates from waitlisting through transplant. Among FCF-specific morbidities, cyanosis is associated with worsened survival and necessitates further study.
Study context
- Population
- Fontan patients listed for heart transplant, 2008–2022341 transplanted
- Participants
- 409 patients
- Outcome
- Independent fontan circulatory failure (FCF) risk factors for death between waitlisting and 1 year after heart transplant
- Follow-up
- 1 year after heart transplant
Main finding
As reported in the abstract
Independent risk factors for death, waitlisting to 1 year post-transplant
Adjusted odds ratio (95% CI)P value
>1 hospitalization in year before waitlisting
2.0(1.0–4.1)
P = 0.05Clinical cyanosis
5.0(1.8–13.4)
P = 0.002Observational data: associations, not effects.
Further findings
Waitlist death
- Died on the waitlist
- 24 (5.9%)
- Univariate risk factors: higher aortopulmonary collateral burden, >1 hospitalization in previous year, younger age, sleep apnea, higher NYHA class, nonenrollment in school or work, single-parent home
1-year post-transplant mortality
- Did not survive to 1 year after transplant
- 27 (8.5%)
- Risk factors: HLHS diagnosis, patent fenestration, anatomic Fontan obstruction, clinical cyanosis (pulse oximetry <90%), polycythemia, portal variceal disease, mental health condition requiring treatment, higher HLA class II panel reactive antibody
Original publication
The Impact of Fontan Circulatory Failure on Heart Transplant Survival: A 20-Center Retrospective Cohort Study. Circulation. Published 9 July 2025. doi:10.1161/circulationaha.124.072961
Summarised from the published abstract; every number is checked against it