Hemodynamic Determinants of Mortality after Fontan Operation
Background Elevated central venous pressure (CVP), low cardiac output and mild hypoxia are common early and late after Fontan operation. However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan oper...
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| Veröffentlicht in: | The American heart journal 2017-07, Vol.189, p.9-18 |
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| creator | Ohuchi, Hideo Miyazaki, Aya Negishi, Jun Hayama, Yosuke Nakai, Michikazu Nishimura, Kunihiro Ichikawa, Hajime Shiraishi, Isao Yamada, Osamu |
| description | Background Elevated central venous pressure (CVP), low cardiac output and mild hypoxia are common early and late after Fontan operation. However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan operation. Method We evaluated early (group Early; 0.5 to 5 years postoperatively, n = 387) and late (group Late; ≥15 years postoperatively, n = 161) Fontan hemodynamics that included CVP (mmHg), cardiac index (CI; L/min/m2 ), systemic ventricular end-diastolic volume index (EDVI; ml/m2 ), ejection fraction (EF; %), and arterial blood oxygen saturation (SaO2 ; %). We examined the effect of these variables on 5-year all-cause mortality. Results Mortality was higher in group Late than in group Early (17 vs. 11, P < .0001). In both Groups, higher CVP (hazard ratio [HR]:1.46 and 1.38, respectively, P < .001–0.0001) and lower SaO2 (HR: 1.12, P < .001 for both) were associated with increased mortality. Greater EDVI (HR per 20: 1.73) and lower EF (HR per 10%: 3.38) were associated with increased mortality only in group Early ( P < .0001 for both). In contrast, only in group Late was higher CI associated with increased mortality (HR: 2.50, 95% confidence interval: [1.30–4.55], P < .01). Seven patients in group Late with both high CVP (≥14) and CI (≥3.0) had the highest mortality (HR: 18.1, [5.55–52.4], P < .0001). Conclusions Elevated CVP and low SaO2 correlate with mortality in both early and late Fontan survivors. EDVI and EF are associated with mortality only in the earlier cohort, whereas interestingly, elevated cardiac output is associated with increased mortality in the later cohort. |
| doi_str_mv | 10.1016/j.ahj.2017.03.020 |
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However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan operation. Method We evaluated early (group Early; 0.5 to 5 years postoperatively, n = 387) and late (group Late; ≥15 years postoperatively, n = 161) Fontan hemodynamics that included CVP (mmHg), cardiac index (CI; L/min/m2 ), systemic ventricular end-diastolic volume index (EDVI; ml/m2 ), ejection fraction (EF; %), and arterial blood oxygen saturation (SaO2 ; %). We examined the effect of these variables on 5-year all-cause mortality. Results Mortality was higher in group Late than in group Early (17 vs. 11, P < .0001). In both Groups, higher CVP (hazard ratio [HR]:1.46 and 1.38, respectively, P < .001–0.0001) and lower SaO2 (HR: 1.12, P < .001 for both) were associated with increased mortality. Greater EDVI (HR per 20: 1.73) and lower EF (HR per 10%: 3.38) were associated with increased mortality only in group Early ( P < .0001 for both). In contrast, only in group Late was higher CI associated with increased mortality (HR: 2.50, 95% confidence interval: [1.30–4.55], P < .01). Seven patients in group Late with both high CVP (≥14) and CI (≥3.0) had the highest mortality (HR: 18.1, [5.55–52.4], P < .0001). Conclusions Elevated CVP and low SaO2 correlate with mortality in both early and late Fontan survivors. EDVI and EF are associated with mortality only in the earlier cohort, whereas interestingly, elevated cardiac output is associated with increased mortality in the later cohort.]]></description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2017.03.020</identifier><identifier>PMID: 28625386</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Age Factors ; Blood ; Cardiac output ; Cardiovascular ; Cardiovascular disease ; Child ; Child, Preschool ; Congenital diseases ; Exercise ; Female ; Follow-Up Studies ; Fontan Procedure ; Gene expression ; Heart ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Heart diseases ; Heart surgery ; Hemodynamics ; Hemodynamics - physiology ; Humans ; Hypoxia ; Infant ; Intubation ; Japan - epidemiology ; Male ; Mercury ; Mortality ; Oxygen ; Oxygen content ; Patients ; Pulmonary arteries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Rodents ; Saturation ; Survival Rate - trends ; Ventricle ; Young Adult</subject><ispartof>The American heart journal, 2017-07, Vol.189, p.9-18</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jul 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-12fafb0ba709adec66738f1d81d208da203a70bbb3395ba72c996da88e75579d3</citedby><cites>FETCH-LOGICAL-c502t-12fafb0ba709adec66738f1d81d208da203a70bbb3395ba72c996da88e75579d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1922855949?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>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28625386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ohuchi, Hideo</creatorcontrib><creatorcontrib>Miyazaki, Aya</creatorcontrib><creatorcontrib>Negishi, Jun</creatorcontrib><creatorcontrib>Hayama, Yosuke</creatorcontrib><creatorcontrib>Nakai, Michikazu</creatorcontrib><creatorcontrib>Nishimura, Kunihiro</creatorcontrib><creatorcontrib>Ichikawa, Hajime</creatorcontrib><creatorcontrib>Shiraishi, Isao</creatorcontrib><creatorcontrib>Yamada, Osamu</creatorcontrib><title>Hemodynamic Determinants of Mortality after Fontan Operation</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description><![CDATA[Background Elevated central venous pressure (CVP), low cardiac output and mild hypoxia are common early and late after Fontan operation. However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan operation. Method We evaluated early (group Early; 0.5 to 5 years postoperatively, n = 387) and late (group Late; ≥15 years postoperatively, n = 161) Fontan hemodynamics that included CVP (mmHg), cardiac index (CI; L/min/m2 ), systemic ventricular end-diastolic volume index (EDVI; ml/m2 ), ejection fraction (EF; %), and arterial blood oxygen saturation (SaO2 ; %). We examined the effect of these variables on 5-year all-cause mortality. Results Mortality was higher in group Late than in group Early (17 vs. 11, P < .0001). In both Groups, higher CVP (hazard ratio [HR]:1.46 and 1.38, respectively, P < .001–0.0001) and lower SaO2 (HR: 1.12, P < .001 for both) were associated with increased mortality. Greater EDVI (HR per 20: 1.73) and lower EF (HR per 10%: 3.38) were associated with increased mortality only in group Early ( P < .0001 for both). In contrast, only in group Late was higher CI associated with increased mortality (HR: 2.50, 95% confidence interval: [1.30–4.55], P < .01). Seven patients in group Late with both high CVP (≥14) and CI (≥3.0) had the highest mortality (HR: 18.1, [5.55–52.4], P < .0001). Conclusions Elevated CVP and low SaO2 correlate with mortality in both early and late Fontan survivors. EDVI and EF are associated with mortality only in the earlier cohort, whereas interestingly, elevated cardiac output is associated with increased mortality in the later cohort.]]></description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Blood</subject><subject>Cardiac output</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Congenital diseases</subject><subject>Exercise</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fontan Procedure</subject><subject>Gene expression</subject><subject>Heart</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Hemodynamics</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Infant</subject><subject>Intubation</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Mercury</subject><subject>Mortality</subject><subject>Oxygen</subject><subject>Oxygen content</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Rodents</subject><subject>Saturation</subject><subject>Survival Rate - trends</subject><subject>Ventricle</subject><subject>Young Adult</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</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>eNp9kUFrFTEQx4NY7LP6AbzIghcvu06S3c0GRZBqbaGlBxW8hWwyi1l3k2eSJ7xvbx6vKvTQS0KY33-Y_IaQFxQaCrR_Mzf6x9wwoKIB3gCDR2RDQYq6F237mGwAgNWDAH5KnqY0l2fPhv4JOS0n6_jQb8i7S1yD3Xu9OlN9xIxxdV77nKowVTchZr24vK_0VCrVRfBZ--p2i1FnF_wzcjLpJeHzu_uMfLv49PX8sr6-_Xx1_uG6Nh2wXFM26WmEUQuQ2qLpe8GHidqBWgaD1Qx4KY3jyLnsCsWMlL3Vw4Ci64S0_Iy8PvbdxvBrhymr1SWDy6I9hl1SVFLKADhtC_rqHjqHXfRlukIxNnSdbGWh6JEyMaQUcVLb6FYd94qCOqhVsypq1UGtAq6K2pJ5edd5N65o_yX-uizA2yOARcVvh1El49AbtC6iycoG92D79_fSZnHeGb38xD2m_79QiSlQXw67PayWCg6Utt_5HzgEnNc</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Ohuchi, Hideo</creator><creator>Miyazaki, Aya</creator><creator>Negishi, Jun</creator><creator>Hayama, Yosuke</creator><creator>Nakai, Michikazu</creator><creator>Nishimura, Kunihiro</creator><creator>Ichikawa, Hajime</creator><creator>Shiraishi, Isao</creator><creator>Yamada, Osamu</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>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</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>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Hemodynamic Determinants of Mortality after Fontan Operation</title><author>Ohuchi, Hideo ; Miyazaki, Aya ; Negishi, Jun ; Hayama, Yosuke ; Nakai, Michikazu ; Nishimura, Kunihiro ; Ichikawa, Hajime ; Shiraishi, Isao ; Yamada, Osamu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-12fafb0ba709adec66738f1d81d208da203a70bbb3395ba72c996da88e75579d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Blood</topic><topic>Cardiac output</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Congenital diseases</topic><topic>Exercise</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fontan Procedure</topic><topic>Gene expression</topic><topic>Heart</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart diseases</topic><topic>Heart surgery</topic><topic>Hemodynamics</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hypoxia</topic><topic>Infant</topic><topic>Intubation</topic><topic>Japan - epidemiology</topic><topic>Male</topic><topic>Mercury</topic><topic>Mortality</topic><topic>Oxygen</topic><topic>Oxygen content</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Rodents</topic><topic>Saturation</topic><topic>Survival Rate - trends</topic><topic>Ventricle</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ohuchi, Hideo</creatorcontrib><creatorcontrib>Miyazaki, Aya</creatorcontrib><creatorcontrib>Negishi, Jun</creatorcontrib><creatorcontrib>Hayama, Yosuke</creatorcontrib><creatorcontrib>Nakai, Michikazu</creatorcontrib><creatorcontrib>Nishimura, Kunihiro</creatorcontrib><creatorcontrib>Ichikawa, Hajime</creatorcontrib><creatorcontrib>Shiraishi, Isao</creatorcontrib><creatorcontrib>Yamada, Osamu</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>Biotechnology Research Abstracts</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>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</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>British Nursing Database</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>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</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 Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ohuchi, Hideo</au><au>Miyazaki, Aya</au><au>Negishi, Jun</au><au>Hayama, Yosuke</au><au>Nakai, Michikazu</au><au>Nishimura, Kunihiro</au><au>Ichikawa, Hajime</au><au>Shiraishi, Isao</au><au>Yamada, Osamu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic Determinants of Mortality after Fontan Operation</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>189</volume><spage>9</spage><epage>18</epage><pages>9-18</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract><![CDATA[Background Elevated central venous pressure (CVP), low cardiac output and mild hypoxia are common early and late after Fontan operation. However, the association of these characteristics with late mortality is unclear. We aimed to elucidate the hemodynamic determinants of mortality after Fontan operation. Method We evaluated early (group Early; 0.5 to 5 years postoperatively, n = 387) and late (group Late; ≥15 years postoperatively, n = 161) Fontan hemodynamics that included CVP (mmHg), cardiac index (CI; L/min/m2 ), systemic ventricular end-diastolic volume index (EDVI; ml/m2 ), ejection fraction (EF; %), and arterial blood oxygen saturation (SaO2 ; %). We examined the effect of these variables on 5-year all-cause mortality. Results Mortality was higher in group Late than in group Early (17 vs. 11, P < .0001). In both Groups, higher CVP (hazard ratio [HR]:1.46 and 1.38, respectively, P < .001–0.0001) and lower SaO2 (HR: 1.12, P < .001 for both) were associated with increased mortality. Greater EDVI (HR per 20: 1.73) and lower EF (HR per 10%: 3.38) were associated with increased mortality only in group Early ( P < .0001 for both). In contrast, only in group Late was higher CI associated with increased mortality (HR: 2.50, 95% confidence interval: [1.30–4.55], P < .01). Seven patients in group Late with both high CVP (≥14) and CI (≥3.0) had the highest mortality (HR: 18.1, [5.55–52.4], P < .0001). Conclusions Elevated CVP and low SaO2 correlate with mortality in both early and late Fontan survivors. EDVI and EF are associated with mortality only in the earlier cohort, whereas interestingly, elevated cardiac output is associated with increased mortality in the later cohort.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28625386</pmid><doi>10.1016/j.ahj.2017.03.020</doi><tpages>10</tpages></addata></record> |
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| subjects | Adolescent Age Factors Blood Cardiac output Cardiovascular Cardiovascular disease Child Child, Preschool Congenital diseases Exercise Female Follow-Up Studies Fontan Procedure Gene expression Heart Heart Defects, Congenital - mortality Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart diseases Heart surgery Hemodynamics Hemodynamics - physiology Humans Hypoxia Infant Intubation Japan - epidemiology Male Mercury Mortality Oxygen Oxygen content Patients Pulmonary arteries Retrospective Studies Risk Assessment Risk Factors Rodents Saturation Survival Rate - trends Ventricle Young Adult |
| title | Hemodynamic Determinants of Mortality after Fontan Operation |
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