Challenges of Cardiac Transplantation Following the Fontan Procedure

Failing Fontan circulation poses risk factors for cardiac transplantation that are distinct from patients needing transplantation for other congenital heart diseases. In this review, Kirklin and colleagues discuss the circulatory, lymphatic, and hepatic vulnerabilities associated with Fontan circulation that make early referral for heart transplant important for these patients. The authors also review the surgical challenges of transplantation after a Fontan operation, and they present approaches that are key to improved patient outcomes.