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Evans WN, Acherman RJ, Galindo A, Rothman A, Ciccolo ML, Lehoux J, Restrepo H. Hepatic Fibrosis Risk Factors in Extracardiac-Fontan Patients: Observations From a Single Center. World J Pediatr Congenit Heart Surg 2023; 14:345-349. [PMID: 36883214 DOI: 10.1177/21501351231154216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Objective: We reviewed our experience with transvenous liver biopsy-derived hepatic fibrosis scores and possible associated risk factors in those postextracardiac Fontan patients. Methods: We identified extracardiac-Fontan patients with postoperative durations <20 years who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and July 2022. If a patient underwent two liver biopsies, we averaged the two total fibrosis scores and concurrent time, pressure, and oxygen saturation data. We grouped patients by the following factors: (1) sex, (2) venovenous collaterals, and (3) type of functionally univentricular heart. We identified potential hepatic fibrosis risk factors as the following: female, presence of venovenous collaterals, and a functional univentricle of right-ventricular type. For statistical analysis, we used Kruskal-Wallis nonparametric testing. Results: We identified 127 patients who underwent 165 transvenous biopsies, with 38 patients undergoing 2 biopsies. We found that females with two additional risk factors had the highest median total fibrosis scores, 4 (1-8); males with <2 risk factors had the lowest median total fibrosis scores, 2 (0-5); and females with <2 additional risk factors and males with two risk factors were in the middle, median total fibrosis score 3 (0-6), P =.002; and there were no statistical differences for the other demographic or hemodynamic variables. Conclusions: For extracardiac-Fontan patients with similar demographic and hemodynamic variables, identifiable risk factors are associated with the degree of hepatic fibrosis.
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Affiliation(s)
- William N Evans
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
| | - Ruben J Acherman
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
| | - Alvaro Galindo
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
| | - Abraham Rothman
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, 212548Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Juan Lehoux
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA
| | - Humberto Restrepo
- Congenital 20567Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
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Evans WN, Acherman RJ, Restrepo H. Hepatic fibrosis gender differences in extracardiac Fontan patients. J Card Surg 2022; 37:3520-3524. [PMID: 36057990 DOI: 10.1111/jocs.16880] [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: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated possible gender differences for hepatic fibrosis in extracardiac-Fontan patients. METHODS We identified extracardiac Fontan, performed between 2000 and 2016, who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and June 2022. We divided the patients by gender for analysis. RESULTS We identified 116 patients who underwent 145 transvenous biopsies, with 29 patients undergoing 2 biopsies at an average interval of 5 ± 1 years. We divided the 145 biopsies into two groups: 1) 98/145 (68%) males and 2) 47/145 (32%) females. For the 47 female liver biopsy specimens, the median total fibrosis score was 3 (0-8), and for the 98 male liver biopsy specimens, the median total fibrosis score was 2 (0-6), p = .007. The average age at surgery for females was 3 ± 1 years and for males 3 ± 1 years, p = .99. Average Fontan duration at biopsy for females was 11 ± 5 years and for males, 10 ± 4 years, p = .23. No other demographic, anatomic, echocardiographic, laboratory, or hemodynamic findings demonstrated statistically significant gender differences. CONCLUSIONS Females had statistically significantly higher median total fibrosis scores than males for the similar average age at extracardiac Fontan and average Fontan duration.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
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