(135) Can Hemodynamics Impact Neurologic Events in Fontan Patients Undergoing Cardiac Transplantation?

Introduction: The 30-year survival in single ventricle patients requiring Fontan palliation has increased to 85% in recent years. With Fontan failure, patients are subjected to low cardiac output. Following transplantation, cardiac output is dramatically increased resulting in higher cerebral perfusion. There are additional risks due to prothrombic states and multiple palliations. We aim to describe perioperative neurological events (PNE) in patients with Fontan circulation post cardiac transplantation.

Methods: This is a retrospective, single-center study that includes patients with Fontan physiology who underwent heart transplantation at our institution from 2006 to 2021. Forty-six patients ranging from 4 years to 53 years were included. Points of evaluation included neurological signs and symptoms in the first month after surgery, findings on CT and MRI, abnormalities on electroencephalography (EEG), neurology consult, and the initiation of antiepileptics. Preoperative hemodynamics were evaluated included Fontan pressure, systolic function, and systemic atrioventricular (AV) valve regurgitation.

Results: Twelve of forty-six patients (26%) experienced PNE. EEG changes were appreciated in seven patients (15%) with seizure activity in three. Eleven of the forty-six patients (23%) had findings on head imaging including infarcts (n=4), acute subdural hematoma (n=4), and subarachnoid hemorrhage (n=2). The overall survival was 94% with none of the patients having long-term neurological disability. The average Fontan pressure of patients with PNE was 22.3 compared to 19.2 in the group without events. 41% of patients with PNE had depressed systolic function versus 31% of the patients without PNE. Interestingly, 41% of patients with PNE had severe systemic AV valve regurgitation compared to 50% in the group without PNE.

Conclusions: This study demonstrates the need for close neurological monitoring including EEG in Fontan patients undergoing heart transplantation, particularly patients with a Fontan pressure of greater than 20 and a history of severely depressed systolic cardiac function. With diligent care our center demonstrated a survival of 94%. A larger cohort of patients can help better delineate factors that increase the risk of neurological events.