Outcomes of Adolescents and Adults Undergoing Primary Fontan Procedure
Patients who have undergone the Fontan procedure in later adolescence and adulthood represent a unique population at risk for significant morbidity and mortality. The optimal strategy for long-term management of such patients is unknown. The aim of this study was to evaluate outcomes of patients who...
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| Veröffentlicht in: | The American journal of cardiology 2013-12, Vol.112 (12), p.1938-1942 |
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| container_title | The American journal of cardiology |
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| creator | Valente, Anne Marie, MD Lewis, Matthew, MD Vaziri, Sonya M., MD, MPH Bautista-Hernandez, Victor, MD Harmon, Amy, BA Kim, Yuli, MD Wu, Fred M., MD Joyce, Caitlyn, MHP, PA-C Loyola, Hugo, MSc Mayer, John E., MD Bacha, Emile, MD Landzberg, Michael J., MD |
| description | Patients who have undergone the Fontan procedure in later adolescence and adulthood represent a unique population at risk for significant morbidity and mortality. The optimal strategy for long-term management of such patients is unknown. The aim of this study was to evaluate outcomes of patients who had undergone Fontan surgery later in life, focusing on late survivorship, mode of death, and predictors of mortality. Eighty-eight patients were identified who had their initial Fontan operation from 1973 to 2007 at ≥15 years of age. A standardized tiered contact protocol was followed to capture the recent health status of each patient; the probability of survival was 83%, 71%, and 66% at 5, 10, and 15 years of follow-up, respectively. Despite focused efforts, the modes of death were not available in 48% of the patients. A prolonged intensive care unit stay at the time of operation was the single predictor of mortality (p = 0.0123). In conclusion, this investigation highlights the significant mortality that exists in patients who undergo a Fontan procedure later in life and the difficulties in achieving standardized medical follow-up for this high-risk group of patients. |
| doi_str_mv | 10.1016/j.amjcard.2013.08.021 |
| format | Article |
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The optimal strategy for long-term management of such patients is unknown. The aim of this study was to evaluate outcomes of patients who had undergone Fontan surgery later in life, focusing on late survivorship, mode of death, and predictors of mortality. Eighty-eight patients were identified who had their initial Fontan operation from 1973 to 2007 at ≥15 years of age. A standardized tiered contact protocol was followed to capture the recent health status of each patient; the probability of survival was 83%, 71%, and 66% at 5, 10, and 15 years of follow-up, respectively. Despite focused efforts, the modes of death were not available in 48% of the patients. A prolonged intensive care unit stay at the time of operation was the single predictor of mortality (p = 0.0123). In conclusion, this investigation highlights the significant mortality that exists in patients who undergo a Fontan procedure later in life and the difficulties in achieving standardized medical follow-up for this high-risk group of patients.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2013.08.021</identifier><identifier>PMID: 24063828</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Age ; Body mass index ; Cardiovascular ; Cardiovascular disease ; Children & youth ; Female ; Follow-Up Studies ; Fontan Procedure - mortality ; Health Status ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Heart Ventricles - abnormalities ; Hospitals ; Humans ; Internal medicine ; Male ; Medical records ; Mortality ; Patients ; Pediatrics ; Pulmonary arteries ; Retrospective Studies ; Social networks ; Surgery ; Survival Analysis ; Treatment Outcome ; Tricuspid Atresia - mortality ; Tricuspid Atresia - surgery ; Young Adult</subject><ispartof>The American journal of cardiology, 2013-12, Vol.112 (12), p.1938-1942</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Dec 15, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-4c4cd5fa669773db8821a144d2dad0842194605d3c1cdd65681e3c7d07969c03</citedby><cites>FETCH-LOGICAL-c448t-4c4cd5fa669773db8821a144d2dad0842194605d3c1cdd65681e3c7d07969c03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1464952647?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24063828$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Valente, Anne Marie, MD</creatorcontrib><creatorcontrib>Lewis, Matthew, MD</creatorcontrib><creatorcontrib>Vaziri, Sonya M., MD, MPH</creatorcontrib><creatorcontrib>Bautista-Hernandez, Victor, MD</creatorcontrib><creatorcontrib>Harmon, Amy, BA</creatorcontrib><creatorcontrib>Kim, Yuli, MD</creatorcontrib><creatorcontrib>Wu, Fred M., MD</creatorcontrib><creatorcontrib>Joyce, Caitlyn, MHP, PA-C</creatorcontrib><creatorcontrib>Loyola, Hugo, MSc</creatorcontrib><creatorcontrib>Mayer, John E., MD</creatorcontrib><creatorcontrib>Bacha, Emile, MD</creatorcontrib><creatorcontrib>Landzberg, Michael J., MD</creatorcontrib><title>Outcomes of Adolescents and Adults Undergoing Primary Fontan Procedure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Patients who have undergone the Fontan procedure in later adolescence and adulthood represent a unique population at risk for significant morbidity and mortality. The optimal strategy for long-term management of such patients is unknown. The aim of this study was to evaluate outcomes of patients who had undergone Fontan surgery later in life, focusing on late survivorship, mode of death, and predictors of mortality. Eighty-eight patients were identified who had their initial Fontan operation from 1973 to 2007 at ≥15 years of age. A standardized tiered contact protocol was followed to capture the recent health status of each patient; the probability of survival was 83%, 71%, and 66% at 5, 10, and 15 years of follow-up, respectively. Despite focused efforts, the modes of death were not available in 48% of the patients. A prolonged intensive care unit stay at the time of operation was the single predictor of mortality (p = 0.0123). In conclusion, this investigation highlights the significant mortality that exists in patients who undergo a Fontan procedure later in life and the difficulties in achieving standardized medical follow-up for this high-risk group of patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Body mass index</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Children & youth</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fontan Procedure - mortality</subject><subject>Health Status</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Ventricles - abnormalities</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Male</subject><subject>Medical records</subject><subject>Mortality</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pulmonary arteries</subject><subject>Retrospective Studies</subject><subject>Social networks</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Tricuspid Atresia - mortality</subject><subject>Tricuspid Atresia - surgery</subject><subject>Young Adult</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUFrFTEQgINY7LP6E5QFL152O5Nkk-xFKcVXC4UWrOeQJnll192kJruF_nuzvKeFXjxlBr6ZzHxDyAeEBgHF6dCYabAmuYYCsgZUAxRfkQ0q2dXYIXtNNgBA6w55d0ze5jyUFLEVb8gx5SCYompDttfLbOPkcxV31ZmLo8_WhzlXJriSL2MJfwbn033sw311k_rJpKdqG8NsQkmj9W5J_h052pkx-_eH94Tcbr_dnn-vr64vLs_PrmrLuZprbrl17c4I0UnJ3J1SFA1y7qgzDhSn2HEBrWMWrXOiFQo9s9KB7ERngZ2Qz_u2Dyn-Xnye9dSXecfRBB-XrJELKgUHkAX99AId4pJCGW6leNdSwVeq3VM2xZyT3-mH_YYaQa-e9aAPnvXqWYPSxXOp-3jovtxN3v2r-iu2AF_3gC82HnufdLa9D8VWn7ydtYv9f7_48qKDHfvQWzP-8k8-P2-jM9Wgf6zHXm-NDFACk-wPPlWj8g</recordid><startdate>20131215</startdate><enddate>20131215</enddate><creator>Valente, Anne Marie, MD</creator><creator>Lewis, Matthew, MD</creator><creator>Vaziri, Sonya M., MD, MPH</creator><creator>Bautista-Hernandez, Victor, MD</creator><creator>Harmon, Amy, BA</creator><creator>Kim, Yuli, MD</creator><creator>Wu, Fred M., MD</creator><creator>Joyce, Caitlyn, MHP, PA-C</creator><creator>Loyola, Hugo, MSc</creator><creator>Mayer, John E., MD</creator><creator>Bacha, Emile, MD</creator><creator>Landzberg, Michael J., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20131215</creationdate><title>Outcomes of Adolescents and Adults Undergoing Primary Fontan Procedure</title><author>Valente, Anne Marie, MD ; Lewis, Matthew, MD ; Vaziri, Sonya M., MD, MPH ; Bautista-Hernandez, Victor, MD ; Harmon, Amy, BA ; Kim, Yuli, MD ; Wu, Fred M., MD ; Joyce, Caitlyn, MHP, PA-C ; Loyola, Hugo, MSc ; Mayer, John E., MD ; Bacha, Emile, MD ; Landzberg, Michael J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-4c4cd5fa669773db8821a144d2dad0842194605d3c1cdd65681e3c7d07969c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Body mass index</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Children & youth</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fontan Procedure - mortality</topic><topic>Health Status</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Ventricles - abnormalities</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Male</topic><topic>Medical records</topic><topic>Mortality</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pulmonary arteries</topic><topic>Retrospective Studies</topic><topic>Social networks</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Tricuspid Atresia - mortality</topic><topic>Tricuspid Atresia - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Valente, Anne Marie, MD</creatorcontrib><creatorcontrib>Lewis, Matthew, MD</creatorcontrib><creatorcontrib>Vaziri, Sonya M., MD, MPH</creatorcontrib><creatorcontrib>Bautista-Hernandez, Victor, MD</creatorcontrib><creatorcontrib>Harmon, Amy, BA</creatorcontrib><creatorcontrib>Kim, Yuli, MD</creatorcontrib><creatorcontrib>Wu, Fred M., MD</creatorcontrib><creatorcontrib>Joyce, Caitlyn, MHP, PA-C</creatorcontrib><creatorcontrib>Loyola, Hugo, MSc</creatorcontrib><creatorcontrib>Mayer, John E., MD</creatorcontrib><creatorcontrib>Bacha, Emile, MD</creatorcontrib><creatorcontrib>Landzberg, Michael J., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Valente, Anne Marie, MD</au><au>Lewis, Matthew, MD</au><au>Vaziri, Sonya M., MD, MPH</au><au>Bautista-Hernandez, Victor, MD</au><au>Harmon, Amy, BA</au><au>Kim, Yuli, MD</au><au>Wu, Fred M., MD</au><au>Joyce, Caitlyn, MHP, PA-C</au><au>Loyola, Hugo, MSc</au><au>Mayer, John E., MD</au><au>Bacha, Emile, MD</au><au>Landzberg, Michael J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Adolescents and Adults Undergoing Primary Fontan Procedure</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2013-12-15</date><risdate>2013</risdate><volume>112</volume><issue>12</issue><spage>1938</spage><epage>1942</epage><pages>1938-1942</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Patients who have undergone the Fontan procedure in later adolescence and adulthood represent a unique population at risk for significant morbidity and mortality. The optimal strategy for long-term management of such patients is unknown. The aim of this study was to evaluate outcomes of patients who had undergone Fontan surgery later in life, focusing on late survivorship, mode of death, and predictors of mortality. Eighty-eight patients were identified who had their initial Fontan operation from 1973 to 2007 at ≥15 years of age. A standardized tiered contact protocol was followed to capture the recent health status of each patient; the probability of survival was 83%, 71%, and 66% at 5, 10, and 15 years of follow-up, respectively. Despite focused efforts, the modes of death were not available in 48% of the patients. A prolonged intensive care unit stay at the time of operation was the single predictor of mortality (p = 0.0123). In conclusion, this investigation highlights the significant mortality that exists in patients who undergo a Fontan procedure later in life and the difficulties in achieving standardized medical follow-up for this high-risk group of patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24063828</pmid><doi>10.1016/j.amjcard.2013.08.021</doi><tpages>5</tpages></addata></record> |
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| subjects | Adolescent Adult Age Body mass index Cardiovascular Cardiovascular disease Children & youth Female Follow-Up Studies Fontan Procedure - mortality Health Status Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Heart Ventricles - abnormalities Hospitals Humans Internal medicine Male Medical records Mortality Patients Pediatrics Pulmonary arteries Retrospective Studies Social networks Surgery Survival Analysis Treatment Outcome Tricuspid Atresia - mortality Tricuspid Atresia - surgery Young Adult |
| title | Outcomes of Adolescents and Adults Undergoing Primary Fontan Procedure |
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