Hôpital Marie Lannelongue

Heart-lung transplantation (HLTx) has become increasingly rare, with fewer than 50 procedures performed annually worldwide. This decline reflects evolving indications, notably the predominance of Eisenmenger syndrome (ES) complicating congenital heart disease (CHD). HLTx remains a complex procedure associated with significant perioperative and long-term risks, particularly in this patient population. This review synthesizes current literature and registry data to identify specific risk factors associated with HLTx in its modern indications. It examines changes in patient selection, timing of listing, perioperative challenges, and postoperative outcomes, with a focus on ES and CHD-related cases. HLTx candidates often present with prior thoracic surgeries, polycythemia, systemic arterial collaterals, and multi-organ dysfunction, all contributing to increased surgical complexity and bleeding risk. Long waitlist times and donor shortages further complicate management. Despite these challenges, recent data from expert centers show improved early survival, with 1-year survival rates exceeding 85%. HLTx may offer protective effects against chronic graft dysfunctions such as bronchiolitis obliterans syndrome and coronary artery vasculopathy compared to isolated organ transplants. HLTx remains the treatment of choice for select patients with complex cardiopulmonary disease, particularly ES with CHD. Optimizing outcomes requires early referral, careful risk stratification, and management in high-volume expert centers. Advances in surgical techniques and perioperative care have improved survival, but HLTx continues to demand multidisciplinary expertise and individualized patient assessment.

The Lifetech KONAR-MF ventricular septal defect occluder (MFO) is increasingly used for transcatheter perimembranous ventricular septal defect (pmVSD) closure. We aim to collect real-world data on patient outcomes and MFO performance in pmVSD cases. This was a nonrandomized, retrospective, multicenter, postmarketing clinical follow-up study of pmVSD patients implanted with the MFO device between 2018 and 2023. The primary endpoint was 6-month composite clinical success, defined as technical success (successful implantation and device retention at the end of the procedure), closure success (trivial or no residual shunt), absence of serious adverse events at 30 days, and no device removal or reintervention. Secondary endpoints consisted of technical success, procedural success (technical success and less than moderate residual shunt), closure success (clinically insignificant or absent residual shunt), and safety. Our cohort comprised 333 patients (51.4% male, 10.2% adults), with a median age of 4.6 [IQR, 2-10] years and a median weight of 17 [IQR, 11-32] kg. Baseline defect characteristics consisted of a left ventricular defect diameter of 8 [IQR, 7-10] mm, with 13.8% of patients having aortic valve regurgitation, 9.9% having an indirect Gerbode shunt, 10.5% having mild aortic valve prolapse, and 32.2% having subaortic rim deficiency. Closure via a retrograde approach was performed in 183 patients (55%). Technical success at procedure completion was 97.6%, and procedural success was 94.6%. Closure success at 6 months was 97.1%, while composite clinical success was 90.1%. Freedom from serious adverse events was 95.2% at 30 days. Freedom from device-related events was 96.8% at 6 months and 93.8% at 24 months. Risk factors for 6-month composite clinical failure were aortic valve prolapse (OR, 4.85; 95%CI, 2.07-11.39) and right ventricular defect diameter (OR, 1.41; 95%CI, 1.01-1.98). Transcatheter closure of pmVSD with the MFO device demonstrated feasibility, effectiveness, and safety in real-world settings.