Fontan procedure is performed in patients with univentricular heart. Such patients have a single functional ventricle and the procedure helps in maintaining proper blood circulation. The survival rate after the Fontan procedure is around 85%. The number of patients requiring the Fontan procedure had been increased. This also increases the number of patients with Fontan failure. Such patients require heart transplants.

The authors of the study wrote, “Due to mainly small-sized studies, outcomes after heart transplantation in these patients remain unclear. The objective of this study was to review the available literature and conduct a meta-analysis to provide well-powered and generalizable estimates of outcomes after heart transplantation in patients with a failing Fontan.”

The researchers searched the databases that describe the original studies of the patients with failing Fontan and who had undergone heart transplantation. The outcome of the study includes survival (1-year and 5-year). The other outcomes were renal dysfunction, multi-organ failure, acute rejection, and sepsis. The effect of gender and age on the key outcomes was analyzed through regression analysis.

A total of 426 Fontan patients were included in the study who had undergone cardiac transplantation. The study reveals that the 1-year survival rate and 5-year survival rate were 79.9% and 72.5%, respectively. The study reveals that renal dysfunction was high in failing Fontan patients after cardiac transplantation. This may be due to varied etiologies. It is important that the surgeons should assess the kidney function prior to surgery and monitor it to avoid renal complications. Sepsis, acute rejection, and multi-organ failure were reported in 21.1%, 20.00%, and 18.6%, respectively.


Hassan, W., Kotak, S., Khatri, M. et al. Efficacy of heart transplantation in patients with a failing Fontan: a systematic review and meta-analysis. Cardiothorac Surg 29, 7 (2021).