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Khoury M, Hajihosseini M, Robertson CMT, Bond G, Freed D, Dinu I, Makarchuk S, Joffe A, Atallah J. Evaluating the Prevalence and Factors Associated With an Optimal Neurodevelopmental Outcome in 4- to 6-Year-Old Children With Fontan Circulation. Can J Cardiol 2023; 39:144-153. [PMID: 36544295 DOI: 10.1016/j.cjca.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We sought to evaluate the prevalence and factors associated with "optimal" neurodevelopmental outcomes in 4- to 6-year-old children with Fontan circulation. METHODS Patients followed through the Western Canadian Complex Pediatric Therapies Follow-Up Program, and born between September 1996 and December 2015, were included. Optimal neurodevelopmental outcome was defined as full-scale intelligence quotient; visual-motor integration; adaptive behaviour assessment system-general adaptive composite scores of ≥ 80 each; and the absence of chronic motor disability, permanent hearing loss, visual impairment, and seizure disorder. Multivariable regression models and decision algorithms evaluated variables associated with optimal outcomes. RESULTS The Fontan procedure was completed on 225 children, with neurodevelopmental outcome data available for 205 (mean [standard deviation]) age at Fontan 3.4 (0.9) years, 37% female). Optimal neurodevelopmental outcome was identified in 55% (112 of 205). Factors independently associated with optimal neurodevelopmental outcome were female sex (odds ratio [OR], 2.1; 95% confidence interval [CI] 1.1-4.1), years of maternal schooling (OR, 1.2 [1.1-1.4]), age at Fontan (years) (OR, 0.97 [0.94-1.0]), need for concomitant atrioventricular valve (AVV) intervention (OR, 0.4 [0.2-1.0]), and time (hours) for lactate to be ≤ 2 mmol/L (OR, 0.9 [0.8-1.0]). Of those with Fontan completion < 3.25 years, without concomitant AVV intervention and lactate normalization within 8 hours post-Fontan, 87% (27 of 31) had optimal neurodevelopmental outcomes. CONCLUSIONS Optimal neurodevelopmental outcome was present in more than one-half of 4- to 6-year-old children with Fontan circulation in this cohort study, with important associated factors identified, including potentially modifiable factors such as younger age at Fontan surgery and lack of concomitant AVV intervention.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | | | - Charlene M T Robertson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Gwen Bond
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Darren Freed
- Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sue Makarchuk
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Ari Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Polat AB, Ertürk M, Uzunhan O, Karademir N, Öztarhan K. 27 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital. J Cardiothorac Surg 2023; 18:38. [PMID: 36653817 PMCID: PMC9850550 DOI: 10.1186/s13019-023-02148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Fontan operation has improved the survival of children born with congenital heart disease with single ventricle physiology. The most widely adopted variations of the Fontan procedure are the extracardiac conduit, the lateral tunnel ve the intra/extracardiac conduit with fenestration. Despite advances in the treatment and prevention of early and late complications that may develop after Fontan surgery, morbidity still remains an important problem. METHODS 304 patients who underwent Fontan surgery in our center between 1995 and 2022 were included in our study. The complications that developed in patients who underwent primary Fontan or lateral tunnel surgery and extracardiac conduit Fontan application were compared. RESULTS Classic Fontan surgery and lateral tunnel surgery were performed in 26 of the patients, and extracardiac Fontan surgery was performed in 278 patients. 218 of 304 cases were patients with single ventricular pathology. 86 cases were patients with two ventricular morphologies but complex cardiac pathology. Fenestration was performed in only 6 patients, other patients did not require fenestration. The mean follow-up period of our patients was 12 years (3 months-27 years). When the complications between Fontan procedures were compared in our study, it was found that the length of hospital stay and mortality were statistically significantly reduced in patients who underwent extracardiac Fontan surgery. There was no significant difference in terms of complications that can be seen after Fontan surgery and the length of stay in the intensive care unit. CONCLUSION Fontan complex is a palliative surgery for children with complex heart disease. Palliative surgical operations aimed at the preparation of the Fontan circulation lead to the preparation of the pulmonary vascular bed and the preservation of ventricular function. The techniques applied in Fontan surgery affect the early and long-term complications and the survival of the patients. In our study, when we examined the patients who extracardiac conduit Fontan procedure for the non-cardiac route, we found that mortality and morbidity were minimal.
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Affiliation(s)
- Ahmet Bülent Polat
- grid.414934.f0000 0004 0644 9503Department of Cardiovascular Surgery, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Murat Ertürk
- grid.414934.f0000 0004 0644 9503Department of Cardiovascular Surgery, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Ozan Uzunhan
- grid.414934.f0000 0004 0644 9503Department of Newborn, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Nur Karademir
- grid.414934.f0000 0004 0644 9503Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Kazım Öztarhan
- grid.414934.f0000 0004 0644 9503Department of Pediatric Cardiology, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
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Arrigoni SC, IJsselhof R, Postmus D, Vonk JM, François K, Bové T, Hazekamp MG, Rijnberg FM, Meyns B, van Puyvelde J, Poncelet AJ, de Beco G, van de Woestijne PC, Bogers AJJC, Schoof PH, Ebels T. Long-term outcomes of atrioventricular septal defect and single ventricle: A multicenter study. J Thorac Cardiovasc Surg 2021; 163:1166-1175. [PMID: 34099273 DOI: 10.1016/j.jtcvs.2021.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/12/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to analyze survival and incidence of Fontan completion of patients with single-ventricle and concomitant unbalanced atrioventricular septal defect. METHODS Data from 4 Dutch and 3 Belgian institutional databases were retrospectively collected. A total of 151 patients with single-ventricle atrioventricular septal defect were selected; 36 patients underwent an atrioventricular valve procedure (valve surgery group). End points were survival, incidence of Fontan completion, and freedom from atrioventricular valve reoperation. RESULTS Median follow-up was 13.4 years. Cumulative survival was 71.2%, 70%, and 68.5% at 10, 15, and 20 years, respectively. An atrioventricular valve procedure was not a risk factor for mortality. Patients with moderate-severe or severe atrioventricular valve regurgitation at echocardiographic follow-up had a significantly worse 15-year survival (58.3%) compared with patients with no or mild regurgitation (89.2%) and patients with moderate regurgitation (88.6%) (P = .033). Cumulative incidence of Fontan completion was 56.5%, 71%, and 77.6% at 5, 10, and 15 years, respectively. An atrioventricular valve procedure was not associated with the incidence of Fontan completion. In the valve surgery group, freedom from atrioventricular valve reoperation was 85.7% at 1 year and 52.6% at 5 years. CONCLUSIONS The long-term survival and incidence of Fontan completion in our study were better than previously described for patients with single-ventricle atrioventricular septal defect. A concomitant atrioventricular valve procedure did not increase the mortality rate or decrease the incidence of Fontan completion, whereas patients with moderate-severe or severe valve regurgitation at follow-up had a worse survival. Therefore, in patients with single-ventricle atrioventricular septal defect when atrioventricular valve regurgitation exceeds a moderate degree, the atrioventricular valve should be repaired.
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Affiliation(s)
- Sara C Arrigoni
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Rinske IJsselhof
- Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Katrien François
- Department of Cardiac Surgery, University Hospital of Gent, Gent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, University Hospital of Gent, Gent, Belgium
| | - Mark G Hazekamp
- Department of Pediatric Cardiac Surgery, University Medical Center Leiden, Leiden, The Netherlands
| | - Friso M Rijnberg
- Department of Pediatric Cardiac Surgery, University Medical Center Leiden, Leiden, The Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Joeri van Puyvelde
- Department of Cardiac Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Alain J Poncelet
- Department of Cardiac Surgery, University Hospital of Louvain, Bruxelles, Belgium
| | - Geoffroy de Beco
- Department of Cardiac Surgery, University Hospital of Louvain, Bruxelles, Belgium
| | - Pieter C van de Woestijne
- Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul H Schoof
- Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tjark Ebels
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sethasathien S, Silvilairat S, Kraikruan H, Sittiwangkul R, Makonkawkeyoon K, Pongprot Y, Woragidpoonpol S. Survival and predictors of mortality in patients after the Fontan operation. Asian Cardiovasc Thorac Ann 2020; 28:572-576. [PMID: 32777943 DOI: 10.1177/0218492320949655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. METHODS In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. RESULTS The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). CONCLUSIONS Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.
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Affiliation(s)
- Saviga Sethasathien
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Silvilairat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hathaiporn Kraikruan
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krit Makonkawkeyoon
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yupada Pongprot
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Garcia AM, Beatty JT, Nakano SJ. Heart failure in single right ventricle congenital heart disease: physiological and molecular considerations. Am J Physiol Heart Circ Physiol 2020; 318:H947-H965. [PMID: 32108525 PMCID: PMC7191494 DOI: 10.1152/ajpheart.00518.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 12/27/2022]
Abstract
Because of remarkable surgical and medical advances over the past several decades, there are growing numbers of infants and children living with single ventricle congenital heart disease (SV), where there is only one functional cardiac pumping chamber. Nevertheless, cardiac dysfunction (and ultimately heart failure) is a common complication in the SV population, and pharmacological heart failure therapies have largely been ineffective in mitigating the need for heart transplantation. Given that there are several inherent risk factors for ventricular dysfunction in the setting of SV in addition to probable differences in molecular adaptations to heart failure between children and adults, it is perhaps not surprising that extrapolated adult heart failure medications have had limited benefit in children with SV heart failure. Further investigations into the molecular mechanisms involved in pediatric SV heart failure may assist with risk stratification as well as development of targeted, efficacious therapies specific to this patient population. In this review, we present a brief overview of SV anatomy and physiology, with a focus on patients with a single morphological right ventricle requiring staged surgical palliation. Additionally, we discuss outcomes in the current era, risk factors associated with the progression to heart failure, present state of knowledge regarding molecular alterations in end-stage SV heart failure, and current therapeutic interventions. Potential avenues for improving SV outcomes, including identification of biomarkers of heart failure progression, implications of personalized medicine and stem cell-derived therapies, and applications of novel models of SV disease, are proposed as future directions.
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Affiliation(s)
- Anastacia M Garcia
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Jonathan-Thomas Beatty
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Stephanie J Nakano
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
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Rochelson E, Richmond ME, LaPar DJ, Torres A, Anderson BR. Identification of Risk Factors for Early Fontan Failure. Semin Thorac Cardiovasc Surg 2020; 32:522-528. [PMID: 32087242 DOI: 10.1053/j.semtcvs.2020.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/11/2022]
Abstract
Despite improvements in operative and perioperative care, the risk of significant morbidity and mortality for children undergoing Fontan procedures persists. Previous investigations have identified peri-Fontan characteristics that may predict early adverse events. The purpose of this study was to identify characteristics from throughout a patient's lifespan, including all perioperative stages, that might predict early Fontan failure-defined as death, Fontan takedown, or listing for cardiac transplantation before hospital discharge or within 30 postoperative days. A single-center retrospective study of all patients undergoing a Fontan procedure was performed. Patient and intervention-related characteristics were examined from birth through Fontan. Data were described using standard summary statistics. Univariable, logistic regression was used to examine associations with early Fontan failure. In total, 191 patients met inclusion criteria. The incidence of early Fontan failure was 4% (n = 8: 6 deaths, 2 Fontan takedowns). Neonatal balloon atrial septostomy was the only patient characteristic significantly associated with Fontan failure. Patients who underwent balloon septostomy had 8.5 times higher odds of Fontan failure (confidence interval (CI) 2.6-28.1, P < 0.001) than those who did not. Children who require balloon septostomy as neonates remain at higher risk of Fontan takedown, listing for heart transplantation, or death in the early post-Fontan period.
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Affiliation(s)
- Ellis Rochelson
- Department of Pediatrics, NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York
| | - Marc E Richmond
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Damien J LaPar
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Alejandro Torres
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York.
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Dennis M, Zannino D, du Plessis K, Bullock A, Disney PJS, Radford DJ, Hornung T, Grigg L, Cordina R, d'Udekem Y, Celermajer DS. Clinical Outcomes in Adolescents and Adults After the Fontan Procedure. J Am Coll Cardiol 2019; 71:1009-1017. [PMID: 29495980 DOI: 10.1016/j.jacc.2017.12.054] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/27/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term outcomes of Fontan patients who survive to age ≥16 years have not been well characterized. The Australian and New Zealand Fontan Registry (ANZFR) provides a unique opportunity to understand survival and complication rates in Fontan patients who transition to adult congenital heart disease centers. OBJECTIVES This study sought to describe the survival and complications of adult patients who have had a Fontan procedure. METHODS The study analyzed outcomes in patients ≥16 years of age who were prospectively enrolled in the ANZFR. RESULTS Data from all 683 adult survivors from the ANZFR were analyzed. Mortality status was confirmed from the National Death Index. There were 201 atriopulmonary (AP) connections and 482 total cavopulmonary connections (249 lateral tunnels and 233 extracardiac conduits). For these subjects, the survival rate at age 30 years was 90% (95% CI: 87% to 93%), and it was 80% (95% CI: 75% to 87%) at 40 years of age. Survival at age 30 years was significantly worse for the patients with AP connections (p = 0.03). At latest follow-up, only 53% of patients were in New York Heart Association functional class I. After the age of 16 years, 136 (20%) had experienced at least 1 new arrhythmia, 42 (6%) required a permanent pacemaker, 45 (7%) had a thromboembolic event, and 135 (21%) required a surgical reintervention. Only 41% (95% CI: 33% to 51%) of Fontan patients were free of serious adverse events at 40 years of age. CONCLUSIONS This comprehensively followed cohort showed that a variety of morbid complications is common in Fontan adults, and that there is a substantial incidence of premature death, particularly in patients with AP connections.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Andrew Bullock
- Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Australia
| | - Patrick J S Disney
- Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Dorothy J Radford
- Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Australia
| | - Tim Hornung
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand
| | - Leeanne Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Rachael Cordina
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia; Departments of Cardiac Surgery and Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia.
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Sugano M, Murata M, Ide Y, Ito H, Kanno K, Imai K, Ishidou M, Fukuba R, Sakamoto K. Midterm results and risk factors of functional single ventricles with extracardiac total anomalous pulmonary venous connection. Gen Thorac Cardiovasc Surg 2019; 67:941-948. [PMID: 31134530 DOI: 10.1007/s11748-019-01141-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the clinical outcomes of surgical repair of an extracardiac total anomalous pulmonary venous connection (TAPVC) in a functional single-ventricle (f-SV) strategy. METHODS This was a retrospective analysis of 48 consecutive cases of extracardiac TAPVC repair, from 1998 to 2015. Demographic and clinical variables were as follows: median age, 24 (range 0-744) days; median weight, 3.1 (range 2.0-9.6) kg; type of TAPVC-supracardiac, 21 patients, infracardiac, 8, and mixed, 19; right atrial isomerism, 45 patients; pulmonary atresia, 24 patients; and obstructed TAPVC, 30 patients. Concomitant procedures included systemic-to-pulmonary shunting in 15 patients, pulmonary artery banding in 12, ventricle-to-pulmonary artery shunting in 2, a Norwood procedure in one, a bidirectional Glenn procedure in 16, and a Fontan procedure in 1. RESULTS The 1- and 5-year cumulative survival rates were 66.0% and 58.0%, respectively. Of the 28 survivors, 22 (78.6%) underwent Fontan completion and 4 (14.3%) a bidirectional Glenn procedure, and 1 (3.6%) was awaiting a bidirectional Glenn procedure. Recurrent pulmonary venous stenosis (PVS) was observed in 17 patients, with a 1- and 5-year rates of freedom from recurrent PVS 59.8% and 53.5%, respectively. Of the 20 post-operative deaths, only 4 were PVS related. Only pre-operative pulmonary atresia was identified as an independent risk factor of mortality after TAPVC repair. CONCLUSIONS The midterm surgical outcomes of f-SV with extracardiac TAPVC were acceptable. Moreover, among survivors, Fontan completion can be sufficiently expected. Further improvement, with the development of a comprehensive treatment strategy, is required for this patient group.
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Affiliation(s)
- Mikio Sugano
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Masaya Murata
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Yujiro Ide
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Kazuyoshi Kanno
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Kenta Imai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Motonori Ishidou
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Ryohei Fukuba
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan
| | - Kisaburou Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan.
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He F, Jiao Y, Ma K, Hua Z, Zhang H, Yan J, Yang K, Pang K, Zhang S, Qi L, Wang G, Feng Z, Li S. Outcomes of Common Atrioventricular Valve Repair in Patients With Single-Ventricle Physiology - Indication, Timing and Repair Techniques. Circ J 2019; 83:647-653. [PMID: 30745490 DOI: 10.1253/circj.cj-18-0916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Common atrioventricular valve (CAVV) repair in patients with a single ventricle remains a great challenge and a refractory issue for pediatric cardiac surgeons. Methods and Results: From January 2007 to April 2018, 37 consecutive patients with a single ventricle who underwent CAVV repair were included in the study group. Patients were divided into 2 groups based on the repair technique: patients in Group A were treated using the bivalvation technique, and patients in Group B underwent conventional repair techniques; baseline data were similar between groups. The inhospital and follow-up mortality were 5.4% (2/37) and 11.4% (4/35), respectively. After a follow-up of 65.5±29.3 months, the estimated 1-, 5-, and 10-year overall survival rates were 94.6%, 83.4%, and 77.0%, respectively. The rates of freedom from CAVV failure were 94.3%, 72.7%, and 62.9% after 1, 5, and 10 years, respectively. In the multivariate analysis, the independent factors for CAVV repair failure were repair technique (P=0.004) and heterotaxy syndrome (P=0.003). A total of 30 patients (81.1%) completed total cavopulmonary connection (TCPC); 3 patients required re-intervention; 24 of 31 patients (77.4%) were in New York Heart Association classes II and I at the latest follow-up. CONCLUSIONS Outcomes of CAVV repair in patients palliated by single-ventricular surgery are acceptable. The bivalvation technique is a simple and effective technique.
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Affiliation(s)
- Fengpu He
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Yiping Jiao
- Psychological Teaching and Research Department, Hangzhou Armed Police Officer School
| | - Kai Ma
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hao Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Keming Yang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Kunjing Pang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Sen Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Lei Qi
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Guanxi Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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King G, d’Udekem Y. Atrioventricular valve replacement in single-ventricle circulation: a viable option? Interact Cardiovasc Thorac Surg 2018; 27:900-901. [DOI: 10.1093/icvts/ivy197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gregory King
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Heart Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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11
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Kverneland LS, Kramer P, Ovroutski S. Five decades of the Fontan operation: A systematic review of international reports on outcomes after univentricular palliation. CONGENIT HEART DIS 2018; 13:181-193. [DOI: 10.1111/chd.12570] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/08/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Laura S. Kverneland
- Department of Internal Medicine; Herlev Hospital; Copenhagen Denmark
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease/Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
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12
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Hypoplastic Left Heart Syndrome Is Not a Predictor of Worse Intermediate Mortality Post Fontan. Ann Thorac Surg 2017; 104:2037-2044. [DOI: 10.1016/j.athoracsur.2017.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022]
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Kido T, Kawata H, Iwai S, Nishigaki K, Ueno T, Ozawa H, Sawa Y. Clinical standard for valve area after common atrioventricular valve plasty for a single ventricle. Interact Cardiovasc Thorac Surg 2017; 25:727-733. [PMID: 28575209 DOI: 10.1093/icvts/ivx156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/20/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine a clinical standard for post-repair common atrioventricular valve orifice area based on mid- to long-term valve function in patients with a functional single ventricle. METHODS The medical records of 19 single-ventricle patients who underwent common atrioventricular valve plasty from July 1988 to January 2013 were retrospectively reviewed. Bivalvation valvuloplasty was performed in 7 patients with relatively hypoplastic leaflets. The relationship between the orifice area of the repaired common atrioventricular valve measured intraoperatively and valve function and ventricular volume in the early postoperative period (median, 9.5 months) and at mid- to long-term follow-up (median, 4 years) were analysed. RESULTS Post-repair valve area was significantly positively correlated with valve regurgitation severity in the early postoperative period (P = 0.001, r = 0.69) and at mid- to long-term follow-up (P = 0.02, r = 0.57). Patients who did not undergo bivalvation had favourable valve function at mid- to long-term follow-up and in the early postoperative period when the post-repair valve area was 96-136% of the normal mitral valve area. Bivalvation patients had significantly more valve regurgitation in the early postoperative period than patients without bivalvation, despite equivalent repaired valve area (P = 0.02). CONCLUSIONS The post-repair orifice area of the common atrioventricular valve is significantly related to postoperative valve function. The clinical standard of post-repair valve orifice area might be 96-136% of the normal mitral valve area in patients undergoing repair without bivalvation. Patients undergoing bivalvation require greater reduction to obtain favourable mid- to long-term valve function.
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Affiliation(s)
- Takashi Kido
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroaki Kawata
- Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Murodocho, Izumi, Osaka, Japan
| | - Shigemitsu Iwai
- Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Murodocho, Izumi, Osaka, Japan
| | - Kyoichi Nishigaki
- Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hideto Ozawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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14
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Clinical-Physiological Considerations in Patients Undergoing Staged Palliation for a Functionally Single Ventricle. Pediatr Crit Care Med 2016; 17:S347-55. [PMID: 27490622 DOI: 10.1097/pcc.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this review are to discuss the pathophysiology of the circulation with a functionally univentricular heart, with a focus on the unique physiologic characteristics, which provide the underpinnings for the management of these complex patients. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS The circulation of the patient with a functionally univentricular heart displays unique physiologic characteristics, which are quite different from those of the normal biventricular circulation. There are profound differences within the heart itself in terms of ventricular function, interventricular interactions, and myocardial architecture, which are likely to have significant implications for the efficiency of ventricular ejection and metabolism. The coupling between the systemic ventricle and the aorta also displays unique features. The 3D orientation of the Fontan anastomosis itself can profoundly impact cardiac output, although the "portal" pulmonary arterial bed is a crucial determinant of overall cardiovascular function. As a result, disease-specific approaches to improve cardiovascular function are required at all stages during the care of these complex patients.
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Zhang T, Shi Y, Wu K, Hua Z, Li S, Hu S, Zhang H. Uncontrolled Antegrade Pulmonary Blood Flow and Delayed Fontan Completion After the Bidirectional Glenn Procedure: Real-World Outcomes in China. Ann Thorac Surg 2016; 101:1530-8. [PMID: 26794884 DOI: 10.1016/j.athoracsur.2015.10.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 10/18/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the low rate of Fontan completion, an aggressive policy for maintaining antegrade pulmonary blood flow (AnPBF) during the bidirectional Glenn procedure (BDG) was developed for the functional single ventricle. METHODS From 2008 to 2013, 294 patients who underwent the BDG were divided into two groups: group 1 (uncontrolled AnPBF, n = 270) and group 2 (controlled AnPBF, n = 24). Pulmonary artery banding was performed because of the high central venous pressure in group 2. In group 1, the patients who underwent BDG from 2008 to 2012 were further divided into group DF (delayed Fontan completion, n = 109) and group FC (Fontan completion, n = 42). RESULTS The Fontan completion rate was 16.3%, and the average interval time was 2.2 ± 1.1 years. The delay of Fontan completion did not reduce body weight gain or the survival rate. Furthermore, oxygen saturation was slightly reduced in group DF. Although no impairments of heart function were observed, the uncontrolled AnPBF in group DF resulted in an increase in ventricular end-diastolic diameter and aggravation of atrioventricular valve regurgitation over 24 months after BDG. Logistic regression analysis revealed that systemic right ventricular morphology was a risk factor for the aggravation of valve regurgitation. CONCLUSIONS The low Fontan achievement rate is a critical issue in China. Although the patients with delayed Fontan completion exhibited an acceptable survival rate and acceptable body weight gain, uncontrolled AnPBF was associated with ventricular enlargement and aggravation of valve regurgitation. Strategies for improving the Fontan completion rate in China should be explored and could benefit outcomes.
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Affiliation(s)
- Tao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China; Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shandong, China
| | - Yisheng Shi
- Department of Echocardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Kaihong Wu
- Department Cardiac Surgery, Nanjing Children Hospital, Nanjing, China
| | - Zhongdong Hua
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Shoujun Li
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Shengshou Hu
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China.
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Liu VJ, Yong MS, d’Udekem Y, Weintraub RG, Praporski S, Brizard CP, Konstantinov IE. Outcomes of Atrioventricular Valve Operation in Patients With Fontan Circulation. Ann Thorac Surg 2015; 99:1632-8. [DOI: 10.1016/j.athoracsur.2015.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/27/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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17
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Podzolkov VP, Chiaureli MR, Yurlov IA, Zelenikin MM, Kovalev DV, Dontsova VI, Astrakhantseva TO, Putiato NA, Zaets SB. Results of Fontan operation in patients with atrioventricular valve regurgitation. Eur J Cardiothorac Surg 2014; 48:308-14; discussion 314-5. [DOI: 10.1093/ejcts/ezu489] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/24/2014] [Indexed: 11/14/2022] Open
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Liang F, Senzaki H, Kurishima C, Sughimoto K, Inuzuka R, Liu H. Hemodynamic performance of the Fontan circulation compared with a normal biventricular circulation: a computational model study. Am J Physiol Heart Circ Physiol 2014; 307:H1056-72. [DOI: 10.1152/ajpheart.00245.2014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The physiological limitations of the Fontan circulation have been extensively addressed in the literature. Many studies emphasized the importance of pulmonary vascular resistance in determining cardiac output (CO) but gave little attention to other cardiovascular properties that may play considerable roles as well. The present study was aimed to systemically investigate the effects of various cardiovascular properties on clinically relevant hemodynamic variables (e.g., CO and central venous pressure). To this aim, a computational modeling method was employed. The constructed models provided a useful tool for quantifying the hemodynamic effects of any cardiovascular property of interest by varying the corresponding model parameters in model-based simulations. Herein, the Fontan circulation was studied compared with a normal biventricular circulation so as to highlight the unique characteristics of the Fontan circulation. Based on a series of numerical experiments, it was found that 1) pulmonary vascular resistance, ventricular diastolic function, and systemic vascular compliance play a major role, while heart rate, ventricular contractility, and systemic vascular resistance play a secondary role in the regulation of CO in the Fontan circulation; 2) CO is nonlinearly related to any single cardiovascular property, with their relationship being simultaneously influenced by other cardiovascular properties; and 3) the stability of central venous pressure is significantly reduced in the Fontan circulation. The findings suggest that the hemodynamic performance of the Fontan circulation is codetermined by various cardiovascular properties and hence a full understanding of patient-specific cardiovascular conditions is necessary to optimize the treatment of Fontan patients.
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Affiliation(s)
- Fuyou Liang
- Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hideaki Senzaki
- Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Clara Kurishima
- Department of Pediatrics and Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Koichi Sughimoto
- Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ryo Inuzuka
- Pediatrics, University Hospital University of Tokyo, Tokyo, Japan; and
| | - Hao Liu
- Shanghai Jiao Tong University-Chiba University International Cooperative Research Center, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- Graduate School of Engineering, Chiba University, Inage, Chiba, Japan
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Fontan Conversion: Identifying the High-Risk Patient. Ann Thorac Surg 2014; 97:2115-21; discussion 2121-2. [DOI: 10.1016/j.athoracsur.2014.01.083] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 11/19/2022]
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Iyengar AJ, Winlaw DS, Galati JC, Wheaton GR, Gentles TL, Grigg LE, Justo RN, Radford DJ, Weintraub RG, Bullock A, Celermajer DS, d'Udekem Y. The extracardiac conduit Fontan procedure in Australia and New Zealand: hypoplastic left heart syndrome predicts worse early and late outcomes. Eur J Cardiothorac Surg 2014; 46:465-73; discussion 473. [PMID: 24578409 DOI: 10.1093/ejcts/ezu015] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To identify factors associated with hospital and long-term outcomes in a binational cohort of extracardiac conduit (ECC) Fontan recipients. METHODS All patients who underwent an ECC Fontan procedure from 1997 to 2010 in Australia and New Zealand were identified, and perioperative, follow-up, echocardiographic and reintervention data collected. Risk factors for early and late mortality, failure and adverse outcomes were analysed. RESULTS A total of 570 patients were identified, and late follow-up was available in 529 patients. The mean follow-up was 6.7 years (standard deviation: 3.5) and completeness of the follow-up was 98%. There were seven hospital mortalities (1%) and 21 patients (4%) experienced early failure (death, Fontan takedown/revision or mechanical circulatory support). Prolonged length of stay occurred in 10% (57 patients), and prolonged effusions in 9% (51 patients). Overall survival at 14 years was 96% (95% confidence interval [CI]: 93-98%), and late survival for patients discharged with intact Fontan was 98% (95% CI: 94-99%). The rates of late failure (late death, transplantation, takedown, New York Heart Association class III/IV or protein-losing enteropathy) and adverse events (late failure, reoperation, percutaneous intervention, pacemaker, thromboembolic event or supraventricular tachycardia) per 100 patient-years were 0.8 and 3.8, and their 14-year freedoms were 83% (95% CI: 70-91%) and 53% (95% CI: 41-64%), respectively. After adjustment for confounders, hypoplastic left heart syndrome (HLHS) was strongly associated with prolonged effusions (OR: 2.9, 95% CI: 1.4-5.9), late failure (hazard ratio [HR]: 2.8, 95% CI: 1.1-7.5) and adverse events (HR: 3.6, 95% CI: 1.3-7.5). CONCLUSIONS The extracardiac Fontan procedure provides excellent survival into the second decade of life, but half of patients will suffer a late adverse event by 14 years. Patients with HLHS are at higher risk of late adverse events than other morphological groups, but their survival is still excellent.
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Affiliation(s)
- Ajay J Iyengar
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Melbourne, VIC, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia University of Sydney, Sydney, Australia
| | - John C Galati
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia
| | - Gavin R Wheaton
- Department of Cardiology, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Thomas L Gentles
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Leeanne E Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Robert N Justo
- Paediatric Cardiology, Queensland Paediatric Cardiac Service, Mater Children's Hospital, Brisbane, QLD, Australia
| | - Dorothy J Radford
- Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Robert G Weintraub
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Andrew Bullock
- Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - David S Celermajer
- University of Sydney, Sydney, Australia Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Melbourne, VIC, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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