Management of early Fontan failure: a single-institution experience
OBJECTIVE To analyse the incidence and outcomes of early Fontan failure (EFF) in a large contemporary cohort of palliated patients. METHODS A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, nee...
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Veröffentlicht in: | European journal of cardio-thoracic surgery 2014-09, Vol.46 (3), p.458-464 |
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container_title | European journal of cardio-thoracic surgery |
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creator | Murphy, Michael O. Glatz, Andrew C. Goldberg, David J. Rogers, Lindsay S. Ravishankar, Chitra Nicolson, Susan C. Steven, James M. Fuller, Stephanie Spray, Thomas L. Gaynor, J. William |
description | OBJECTIVE
To analyse the incidence and outcomes of early Fontan failure (EFF) in a large contemporary cohort of palliated patients.
METHODS
A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, need for extracorporeal membrane oxygenation (ECMO), Fontan takedown to superior cavopulmonary connection (SCPC) or transplantation within 30 days of the Fontan procedure. The incidence and outcomes were summarized with descriptive statistics, and risk factors for EFF were identified.
RESULTS
A total of 592 patients underwent primary Fontan procedure during the study period; 67% had a dominant right ventricle. An extracardiac conduit (ECC) was used for Fontan completion in 60.5%, with the remainder having a lateral tunnel. EFF occurred in 11 patients (1.9%), all of whom had ECC. ECMO was used in 5 patients, 5 had Fontan takedown and 2 had heart transplantation. Five of eleven, or 46%, study subjects died as opposed to an overall mortality for primary Fontan of 0.8%. Among patients who had Fontan takedown to SCPC, long-term survival was 80%. By univariate analysis, elevated ventricular end-diastolic pressure (9.5 ± 3.3 vs 7.4 ± 2.7 mmHg, P = 0.019) and total circulatory support time (99 ± 33 vs 71 ± 23 min, P = 0.001) were risk factors for EFF. The mean follow-up for the 6 hospital survivors was 5.9 years. There was one late transplant-related death. Of the 4 surviving patients who had Fontan takedown to a SCPC, 3 underwent subsequent Fontan completion and 1 underwent biventricular repair.
CONCLUSIONS
EFF is rare in the current era, but is associated with significant mortality. High filling pressures and a prolonged intraoperative course are risk factors for EFF. Of the management strategies available, Fontan takedown to an intermediate pathway appears to be associated with the best outcomes. |
doi_str_mv | 10.1093/ejcts/ezu022 |
format | Article |
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To analyse the incidence and outcomes of early Fontan failure (EFF) in a large contemporary cohort of palliated patients.
METHODS
A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, need for extracorporeal membrane oxygenation (ECMO), Fontan takedown to superior cavopulmonary connection (SCPC) or transplantation within 30 days of the Fontan procedure. The incidence and outcomes were summarized with descriptive statistics, and risk factors for EFF were identified.
RESULTS
A total of 592 patients underwent primary Fontan procedure during the study period; 67% had a dominant right ventricle. An extracardiac conduit (ECC) was used for Fontan completion in 60.5%, with the remainder having a lateral tunnel. EFF occurred in 11 patients (1.9%), all of whom had ECC. ECMO was used in 5 patients, 5 had Fontan takedown and 2 had heart transplantation. Five of eleven, or 46%, study subjects died as opposed to an overall mortality for primary Fontan of 0.8%. Among patients who had Fontan takedown to SCPC, long-term survival was 80%. By univariate analysis, elevated ventricular end-diastolic pressure (9.5 ± 3.3 vs 7.4 ± 2.7 mmHg, P = 0.019) and total circulatory support time (99 ± 33 vs 71 ± 23 min, P = 0.001) were risk factors for EFF. The mean follow-up for the 6 hospital survivors was 5.9 years. There was one late transplant-related death. Of the 4 surviving patients who had Fontan takedown to a SCPC, 3 underwent subsequent Fontan completion and 1 underwent biventricular repair.
CONCLUSIONS
EFF is rare in the current era, but is associated with significant mortality. High filling pressures and a prolonged intraoperative course are risk factors for EFF. Of the management strategies available, Fontan takedown to an intermediate pathway appears to be associated with the best outcomes.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezu022</identifier><identifier>PMID: 24554071</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Analysis of Variance ; Child, Preschool ; Extracorporeal Membrane Oxygenation ; Fontan Procedure - methods ; Heart Defects, Congenital - surgery ; Humans ; Infant ; Retrospective Studies ; Treatment Failure</subject><ispartof>European journal of cardio-thoracic surgery, 2014-09, Vol.46 (3), p.458-464</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-4a68cb33952bbfcfdcee3240c2c24a7ce01016255cebe8abe1c2b0c1ad5309843</citedby><cites>FETCH-LOGICAL-c361t-4a68cb33952bbfcfdcee3240c2c24a7ce01016255cebe8abe1c2b0c1ad5309843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24554071$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Murphy, Michael O.</creatorcontrib><creatorcontrib>Glatz, Andrew C.</creatorcontrib><creatorcontrib>Goldberg, David J.</creatorcontrib><creatorcontrib>Rogers, Lindsay S.</creatorcontrib><creatorcontrib>Ravishankar, Chitra</creatorcontrib><creatorcontrib>Nicolson, Susan C.</creatorcontrib><creatorcontrib>Steven, James M.</creatorcontrib><creatorcontrib>Fuller, Stephanie</creatorcontrib><creatorcontrib>Spray, Thomas L.</creatorcontrib><creatorcontrib>Gaynor, J. William</creatorcontrib><title>Management of early Fontan failure: a single-institution experience</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVE
To analyse the incidence and outcomes of early Fontan failure (EFF) in a large contemporary cohort of palliated patients.
METHODS
A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, need for extracorporeal membrane oxygenation (ECMO), Fontan takedown to superior cavopulmonary connection (SCPC) or transplantation within 30 days of the Fontan procedure. The incidence and outcomes were summarized with descriptive statistics, and risk factors for EFF were identified.
RESULTS
A total of 592 patients underwent primary Fontan procedure during the study period; 67% had a dominant right ventricle. An extracardiac conduit (ECC) was used for Fontan completion in 60.5%, with the remainder having a lateral tunnel. EFF occurred in 11 patients (1.9%), all of whom had ECC. ECMO was used in 5 patients, 5 had Fontan takedown and 2 had heart transplantation. Five of eleven, or 46%, study subjects died as opposed to an overall mortality for primary Fontan of 0.8%. Among patients who had Fontan takedown to SCPC, long-term survival was 80%. By univariate analysis, elevated ventricular end-diastolic pressure (9.5 ± 3.3 vs 7.4 ± 2.7 mmHg, P = 0.019) and total circulatory support time (99 ± 33 vs 71 ± 23 min, P = 0.001) were risk factors for EFF. The mean follow-up for the 6 hospital survivors was 5.9 years. There was one late transplant-related death. Of the 4 surviving patients who had Fontan takedown to a SCPC, 3 underwent subsequent Fontan completion and 1 underwent biventricular repair.
CONCLUSIONS
EFF is rare in the current era, but is associated with significant mortality. High filling pressures and a prolonged intraoperative course are risk factors for EFF. Of the management strategies available, Fontan takedown to an intermediate pathway appears to be associated with the best outcomes.</description><subject>Analysis of Variance</subject><subject>Child, Preschool</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Fontan Procedure - methods</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Retrospective Studies</subject><subject>Treatment Failure</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQQBdRbK3ePEtuejB29itJvUmxKlS8KHgLm-2kbEk2cXcD1l9vaqpHYWDm8HgMj5BzCjcUZnyKGx38FL86YOyAjGmW8jjl4v2wv4FCnM4EjMiJ9xsASDhLj8mICSkFpHRM5s_KqjXWaEPUlBEqV22jRWODslGpTNU5vI1U5I1dVxgb64MJXTCNjfCzRWfQajwlR6WqPJ7t94S8Le5f54_x8uXhaX63jDVPaIiFSjJdcD6TrChKXa40ImcCNNNMqFRj_y1NmJQaC8xUgVSzAjRVK8lhlgk-IVeDt3XNR4c-5LXxGqtKWWw6n1MpOYXd9Oj1gGrXeO-wzFtnauW2OYV8ly3_yZYP2Xr8Ym_uihpXf_Bvpx64HICma_9XfQMJYHhy</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Murphy, Michael O.</creator><creator>Glatz, Andrew C.</creator><creator>Goldberg, David J.</creator><creator>Rogers, Lindsay S.</creator><creator>Ravishankar, Chitra</creator><creator>Nicolson, Susan C.</creator><creator>Steven, James M.</creator><creator>Fuller, Stephanie</creator><creator>Spray, Thomas L.</creator><creator>Gaynor, J. William</creator><general>Oxford University Press</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>7X8</scope></search><sort><creationdate>20140901</creationdate><title>Management of early Fontan failure: a single-institution experience</title><author>Murphy, Michael O. ; Glatz, Andrew C. ; Goldberg, David J. ; Rogers, Lindsay S. ; Ravishankar, Chitra ; Nicolson, Susan C. ; Steven, James M. ; Fuller, Stephanie ; Spray, Thomas L. ; Gaynor, J. William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-4a68cb33952bbfcfdcee3240c2c24a7ce01016255cebe8abe1c2b0c1ad5309843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Analysis of Variance</topic><topic>Child, Preschool</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Fontan Procedure - methods</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Retrospective Studies</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murphy, Michael O.</creatorcontrib><creatorcontrib>Glatz, Andrew C.</creatorcontrib><creatorcontrib>Goldberg, David J.</creatorcontrib><creatorcontrib>Rogers, Lindsay S.</creatorcontrib><creatorcontrib>Ravishankar, Chitra</creatorcontrib><creatorcontrib>Nicolson, Susan C.</creatorcontrib><creatorcontrib>Steven, James M.</creatorcontrib><creatorcontrib>Fuller, Stephanie</creatorcontrib><creatorcontrib>Spray, Thomas L.</creatorcontrib><creatorcontrib>Gaynor, J. William</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murphy, Michael O.</au><au>Glatz, Andrew C.</au><au>Goldberg, David J.</au><au>Rogers, Lindsay S.</au><au>Ravishankar, Chitra</au><au>Nicolson, Susan C.</au><au>Steven, James M.</au><au>Fuller, Stephanie</au><au>Spray, Thomas L.</au><au>Gaynor, J. William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of early Fontan failure: a single-institution experience</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>46</volume><issue>3</issue><spage>458</spage><epage>464</epage><pages>458-464</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>OBJECTIVE
To analyse the incidence and outcomes of early Fontan failure (EFF) in a large contemporary cohort of palliated patients.
METHODS
A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, need for extracorporeal membrane oxygenation (ECMO), Fontan takedown to superior cavopulmonary connection (SCPC) or transplantation within 30 days of the Fontan procedure. The incidence and outcomes were summarized with descriptive statistics, and risk factors for EFF were identified.
RESULTS
A total of 592 patients underwent primary Fontan procedure during the study period; 67% had a dominant right ventricle. An extracardiac conduit (ECC) was used for Fontan completion in 60.5%, with the remainder having a lateral tunnel. EFF occurred in 11 patients (1.9%), all of whom had ECC. ECMO was used in 5 patients, 5 had Fontan takedown and 2 had heart transplantation. Five of eleven, or 46%, study subjects died as opposed to an overall mortality for primary Fontan of 0.8%. Among patients who had Fontan takedown to SCPC, long-term survival was 80%. By univariate analysis, elevated ventricular end-diastolic pressure (9.5 ± 3.3 vs 7.4 ± 2.7 mmHg, P = 0.019) and total circulatory support time (99 ± 33 vs 71 ± 23 min, P = 0.001) were risk factors for EFF. The mean follow-up for the 6 hospital survivors was 5.9 years. There was one late transplant-related death. Of the 4 surviving patients who had Fontan takedown to a SCPC, 3 underwent subsequent Fontan completion and 1 underwent biventricular repair.
CONCLUSIONS
EFF is rare in the current era, but is associated with significant mortality. High filling pressures and a prolonged intraoperative course are risk factors for EFF. Of the management strategies available, Fontan takedown to an intermediate pathway appears to be associated with the best outcomes.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>24554071</pmid><doi>10.1093/ejcts/ezu022</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Analysis of Variance Child, Preschool Extracorporeal Membrane Oxygenation Fontan Procedure - methods Heart Defects, Congenital - surgery Humans Infant Retrospective Studies Treatment Failure |
title | Management of early Fontan failure: a single-institution experience |
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