{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:53:48Z","timestamp":1782867228174,"version":"3.54.5"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,8,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Fontan circulatory failure (FCF) is a chronic state in palliated single ventricle heart disease with high morbidity and mortality rates, including heart failure, multisystem end-organ disease, and need for heart transplant. Specific FCF morbidities have not been rigorously defined, limiting study of how FCF morbidities affect pre\u2013heart transplant and post\u2013heart transplant outcomes. We hypothesized that FCF-related morbidities affect survival from heart transplant waitlisting through 1 year after heart transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This 20-center, retrospective cohort study collected demographic, medical\/surgical history, waitlist, and peri- and post\u2013heart transplant data, and a priori defined FCF-specific morbidities, in Fontan patients who were listed for heart transplant from 2008 through 2022. Univariate 2-group statistics compared surviving individuals with those who died anytime from waitlisting to 1 year after heart transplant, died on the waitlist, or underwent transplant and died within 1 year after transplant. Using covariates from both univariate analyses, multivariable logistic regression determined the primary study outcome of independent FCF risk factors for death between waitlist and 1 year after heart transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 409 waitlisted patients, 24 (5.9%) died on the waitlist. Of the 341 (83.4%) who underwent transplant, 27 (8.5%) did not survive to 1 year. Univariate risk factors for waitlist death included higher aortopulmonary collateral burden, &gt;1 hospitalization in the previous year, younger age, sleep apnea, higher New York Heart Association class, nonenrollment in school or work, and single-parent home. Risk factors for 1-year post\u2013heart transplant mortality included hypoplastic left heart syndrome diagnosis, patent fenestration, anatomic Fontan obstruction, clinical cyanosis (pulse oximetry &lt;90%), polycythemia, portal variceal disease, mental health condition requiring treatment, and higher human leukocyte antigen class II panel reactive antibody. Of the patients not surviving from waitlisting to 1 year after heart transplant, independent risk factors for death included &gt;1 hospitalization in the year before waitlisting (adjusted odds ratio, 2.0 [95% CI, 1.0\u20134.1];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.05) and clinical cyanosis (adjusted odds ratio, 5.0 [95% CI, 1.8\u201313.4];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>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. Clinical morbidity of any type requiring repeated hospital admission also should prompt consideration of heart transplant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.124.072961","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T11:40:45Z","timestamp":1752061245000},"page":"508-518","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Fontan Circulatory Failure on Heart Transplant Survival: A 20-Center Retrospective Cohort Study"],"prefix":"10.1161","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-736X","authenticated-orcid":true,"given":"Kurt R.","family":"Schumacher","sequence":"first","affiliation":[{"name":"Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor (K.R.S., A.B., S.Y., G.R., M.K.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-2759","authenticated-orcid":true,"given":"David N.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Palo Alto, CA (D.N.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2131-423X","authenticated-orcid":true,"given":"Adriana","family":"Batazzi","sequence":"additional","affiliation":[{"name":"Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor (K.R.S., A.B., S.Y., G.R., M.K.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3995-1765","authenticated-orcid":true,"given":"Sunkyung","family":"Yu","sequence":"additional","affiliation":[{"name":"Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor (K.R.S., A.B., S.Y., G.R., M.K.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2944-1668","authenticated-orcid":true,"given":"Garrett","family":"Reichle","sequence":"additional","affiliation":[{"name":"Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor (K.R.S., A.B., S.Y., G.R., M.K.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1279-8369","authenticated-orcid":true,"given":"Maria","family":"Bano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, Children\u2019s Health, UT Southwestern, Dallas, TX (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-9783","authenticated-orcid":true,"given":"Shriprasad R.","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Children\u2019s National Hospital, George Washington University, Washington, DC (S.R.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3012-5464","authenticated-orcid":true,"given":"Matthew","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, PA (M.O., H.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1572-4840","authenticated-orcid":true,"given":"Humera","family":"Ahmed","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, PA (M.O., H.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City (S.C., M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8852-9838","authenticated-orcid":true,"given":"Lydia K.","family":"Wright","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, OH (L.K.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-6942","authenticated-orcid":true,"given":"Steven J.","family":"Kindel","sequence":"additional","affiliation":[{"name":"Children\u2019s Wisconsin Herma Heart Institute, Department of Pediatrics, Medical College of Wisconsin, Milwaukee (S.J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2223-0045","authenticated-orcid":true,"given":"Anna","family":"Joong","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Ann &amp; Robert Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL (A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Ploutz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City (S.C., M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4244-709X","authenticated-orcid":true,"given":"Brian","family":"Feingold","sequence":"additional","affiliation":[{"name":"Pediatrics and Clinical and Translational Science, University of Pittsburgh, PA (B.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Godown","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Division of Pediatric Cardiology, Nashville, TN (J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6765-5621","authenticated-orcid":true,"given":"Chad Y.","family":"Mao","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta, Emory University, GA (C.Y.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Lorts","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati College of Medicine, OH (A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6303-1264","authenticated-orcid":true,"given":"Kathleen E.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora (K.E.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1813-407X","authenticated-orcid":true,"given":"Aecha","family":"Ybarra","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO (A.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5491-8085","authenticated-orcid":true,"given":"Marc E.","family":"Richmond","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians &amp; 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