Heart Transplantation Outcomes in Single Ventricle Patients

Background Patients with single ventricle physiology represent a high-risk group for heart transplantation. Due to complex anatomical and physiological challenges, including multiple prior sternotomies, pulmonary artery abnormalities, and systemic consequences of altered circulation they represent both surgical and clinical challenge. We aimed to analyse perioperative challenges, early and long-term complications in this specific group of patients. Methods: We performed retrospective data analysis of high-volume heart transplant center focusing on patients with single ventricle physiology who were scheduled for heart transplantation due to end-stage heart failure. We retrospectively analyzed period from the beginning of transplant program in November 1985 to the end of November 2024. Results Among 1,553 transplanted patients (adults and children) 29 were transplanted due to congenital heart disease (congenital valvular disease not counted). In this group nine patients were transplanted due to end stage heart failure in the course of single ventricle physiology. Among this group two patients underwent Bidirectional Glenn Procedure and seven Fontan Procedure with seven patients had undergone three prior sternotomies, and two patients had undergone two. All the patients, presented significant mediastinal adhesions. Perioperative transplant surgical strategies included femoral cannulation in four cases and standard aortic and caval cannulation in five. Pulmonary artery reconstruction was necessary in the whole group of patients. Extended donor pulmonary arteries were applied in eight cases, while a bifurcated Dacron prosthesis was utilized in one patient. Perioperative mortality was 33%, with three deaths attributed to bleeding and hemodynamic instability, while overall mortality was 44% due to one late non-transplant-related death. PLE, though persistent in the immediate postoperative period, resolved in all surviving patients, underscoring the transformative impact of transplantation. Conclusions These findings emphasize the importance of individualized surgical planning, extended donor pulmonary artery harvesting, and careful preoperative coordination. The use of pulmonary homografts may offer a superior solution for arterial reconstruction compared to synthetic alternatives. Heart transplantation remains a viable and life-extending option for selected single ventricle patients, despite the significant technical and clinical challenges involved.