Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery
Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts. This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk. A North American multicenter retrospective cohort study enrolled 522 patients with Fontan...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2019-08, Vol.74 (8), p.1071-1081 |
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| creator | Deshaies, Catherine Hamilton, Robert M. Shohoudi, Azadeh Trottier, Helen Poirier, Nancy Aboulhosn, Jamil Broberg, Craig S. Cohen, Scott Cook, Stephen Dore, Annie Fernandes, Susan M. Fournier, Anne Kay, Joseph Mondésert, Blandine Mongeon, François-Pierre Opotowsky, Alexander R. Proietti, Anna Ting, Jennifer Zaidi, Ali Khairy, Paul |
| description | Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.
This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.
A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complications and new-onset atrial arrhythmia were reviewed and classified by a blinded adjudicating committee. Thromboembolic risk across surgical techniques was assessed by multivariable competing-risk survival regression.
Over a median follow-up of 11.6 years, 10- and 20-year freedom from Fontan conversion, transplantation, or death was 94.7% and 78.9%, respectively. New-onset atrial arrhythmias occurred in 4.4, 1.2, and 1.0 cases per 100 person-years with APC, LT, and EC, respectively. APC was associated with a 2.82-fold higher risk of developing atrial arrhythmias (p |
| doi_str_mv | 10.1016/j.jacc.2019.06.051 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2336984771</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109719357651</els_id><sourcerecordid>2275909848</sourcerecordid><originalsourceid>FETCH-LOGICAL-c450t-a9778fcd9be736f68fe7e56929129bf8aba8bce8208a5eb3c2d493b62820e9653</originalsourceid><addsrcrecordid>eNp9kc1qFEEUhQtRzBh9ARfS4MZFuq2fqT9wMwyJCQwIOq6L6urbWm131VjVHczb5FnyZNYw0YULF5cLl-8cLucg9JrghmAi3g_NYJ1rKCa6waLBnDxBK8K5qhnX8ilaYcl4TbCWZ-hFzgPGWCiin6MzRtZMUyJXyO2_pzi1EcqM3lWfff5RbfoZUrWZk4-HZZxisOnuotrZcrVjtV9CgPGisqGrLn_NyTqbOm9dtY2hW_z8cH8Vw2zDw_2XJX2DdPcSPevtmOHV4z5HX68u99vrevfp4812s6vdmuO5tlpK1btOtyCZ6IXqQQIXmmpCddsr21rVOlAUK8uhZY52a81aQcsFtODsHL07-R5S_LlAns3ks4NxtAHikg1lTGi1lpIU9O0_6BCXFMp3hlLJNS6cKhQ9US7FnBP05pD8VMIwBJtjBWYwxwrMsQKDhSkVFNGbR-ulnaD7K_mTeQE-nAAoWdx6SCY7D8FB5xO42XTR_8__N39OmVk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2275909848</pqid></control><display><type>article</type><title>Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Deshaies, Catherine ; Hamilton, Robert M. ; Shohoudi, Azadeh ; Trottier, Helen ; Poirier, Nancy ; Aboulhosn, Jamil ; Broberg, Craig S. ; Cohen, Scott ; Cook, Stephen ; Dore, Annie ; Fernandes, Susan M. ; Fournier, Anne ; Kay, Joseph ; Mondésert, Blandine ; Mongeon, François-Pierre ; Opotowsky, Alexander R. ; Proietti, Anna ; Ting, Jennifer ; Zaidi, Ali ; Khairy, Paul</creator><creatorcontrib>Deshaies, Catherine ; Hamilton, Robert M. ; Shohoudi, Azadeh ; Trottier, Helen ; Poirier, Nancy ; Aboulhosn, Jamil ; Broberg, Craig S. ; Cohen, Scott ; Cook, Stephen ; Dore, Annie ; Fernandes, Susan M. ; Fournier, Anne ; Kay, Joseph ; Mondésert, Blandine ; Mongeon, François-Pierre ; Opotowsky, Alexander R. ; Proietti, Anna ; Ting, Jennifer ; Zaidi, Ali ; Khairy, Paul ; Alliance for Adult Research in Congenital Cardiology (AARCC)</creatorcontrib><description>Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.
This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.
A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complications and new-onset atrial arrhythmia were reviewed and classified by a blinded adjudicating committee. Thromboembolic risk across surgical techniques was assessed by multivariable competing-risk survival regression.
Over a median follow-up of 11.6 years, 10- and 20-year freedom from Fontan conversion, transplantation, or death was 94.7% and 78.9%, respectively. New-onset atrial arrhythmias occurred in 4.4, 1.2, and 1.0 cases per 100 person-years with APC, LT, and EC, respectively. APC was associated with a 2.82-fold higher risk of developing atrial arrhythmias (p < 0.001), with no difference between LT and EC (p = 0.95). A total of 71 thromboembolic events, 32 systemic and 39 venous, occurred in 12.8% of subjects, for an overall incidence of 1.1%/year. In multivariable analyses, EC was independently associated with a lower risk of systemic (hazard ratio [HR]: 0.20 vs. LT; 95% confidence interval [CI]: 0.04 to 0.97) and combined (HR: 0.34 vs. LT; 95% CI: 0.13 to 0.91) thromboembolic events. A lower incidence of combined thromboembolic events was also observed with antiplatelet agents (HR: 0.54; 95% CI: 0.32 to 0.92) but not anticoagulation (p = 0.53).
The EC Fontan was independently associated with a lower thromboembolic risk after controlling for time-varying effects of atrial arrhythmias and thromboprophylaxis.
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2019.06.051</identifier><identifier>PMID: 31439217</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Anticoagulants ; Arrhythmia ; Arrhythmias, Cardiac - diagnosis ; Arrhythmias, Cardiac - epidemiology ; Arrhythmias, Cardiac - surgery ; atrial arrhythmia ; Cardiac arrhythmia ; Cardiology ; Child ; Child, Preschool ; Cohort Studies ; Complications ; Confidence intervals ; Congenital diseases ; Data collection ; Female ; Follow-Up Studies ; Fontan procedure ; Fontan Procedure - adverse effects ; Fontan Procedure - trends ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - epidemiology ; Heart Defects, Congenital - surgery ; Heart failure ; Heart surgery ; Humans ; Hypertension ; Incidence ; Male ; Morbidity ; Palliation ; Patients ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Pulmonary arteries ; Quality control ; Retrospective Studies ; Risk Factors ; Risk management ; single ventricle ; Statistical analysis ; Surgery ; Thromboembolism ; thromboprophylaxis univentricular heart ; Transplantation ; Treatment Outcome ; Univentricular Heart - diagnosis ; Univentricular Heart - epidemiology ; Univentricular Heart - surgery ; Venous Thromboembolism - diagnosis ; Venous Thromboembolism - epidemiology ; Young Adult</subject><ispartof>Journal of the American College of Cardiology, 2019-08, Vol.74 (8), p.1071-1081</ispartof><rights>2019 American College of Cardiology Foundation</rights><rights>Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>2019. American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-a9778fcd9be736f68fe7e56929129bf8aba8bce8208a5eb3c2d493b62820e9653</citedby><cites>FETCH-LOGICAL-c450t-a9778fcd9be736f68fe7e56929129bf8aba8bce8208a5eb3c2d493b62820e9653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109719357651$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31439217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deshaies, Catherine</creatorcontrib><creatorcontrib>Hamilton, Robert M.</creatorcontrib><creatorcontrib>Shohoudi, Azadeh</creatorcontrib><creatorcontrib>Trottier, Helen</creatorcontrib><creatorcontrib>Poirier, Nancy</creatorcontrib><creatorcontrib>Aboulhosn, Jamil</creatorcontrib><creatorcontrib>Broberg, Craig S.</creatorcontrib><creatorcontrib>Cohen, Scott</creatorcontrib><creatorcontrib>Cook, Stephen</creatorcontrib><creatorcontrib>Dore, Annie</creatorcontrib><creatorcontrib>Fernandes, Susan M.</creatorcontrib><creatorcontrib>Fournier, Anne</creatorcontrib><creatorcontrib>Kay, Joseph</creatorcontrib><creatorcontrib>Mondésert, Blandine</creatorcontrib><creatorcontrib>Mongeon, François-Pierre</creatorcontrib><creatorcontrib>Opotowsky, Alexander R.</creatorcontrib><creatorcontrib>Proietti, Anna</creatorcontrib><creatorcontrib>Ting, Jennifer</creatorcontrib><creatorcontrib>Zaidi, Ali</creatorcontrib><creatorcontrib>Khairy, Paul</creatorcontrib><creatorcontrib>Alliance for Adult Research in Congenital Cardiology (AARCC)</creatorcontrib><title>Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.
This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.
A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complications and new-onset atrial arrhythmia were reviewed and classified by a blinded adjudicating committee. Thromboembolic risk across surgical techniques was assessed by multivariable competing-risk survival regression.
Over a median follow-up of 11.6 years, 10- and 20-year freedom from Fontan conversion, transplantation, or death was 94.7% and 78.9%, respectively. New-onset atrial arrhythmias occurred in 4.4, 1.2, and 1.0 cases per 100 person-years with APC, LT, and EC, respectively. APC was associated with a 2.82-fold higher risk of developing atrial arrhythmias (p < 0.001), with no difference between LT and EC (p = 0.95). A total of 71 thromboembolic events, 32 systemic and 39 venous, occurred in 12.8% of subjects, for an overall incidence of 1.1%/year. In multivariable analyses, EC was independently associated with a lower risk of systemic (hazard ratio [HR]: 0.20 vs. LT; 95% confidence interval [CI]: 0.04 to 0.97) and combined (HR: 0.34 vs. LT; 95% CI: 0.13 to 0.91) thromboembolic events. A lower incidence of combined thromboembolic events was also observed with antiplatelet agents (HR: 0.54; 95% CI: 0.32 to 0.92) but not anticoagulation (p = 0.53).
The EC Fontan was independently associated with a lower thromboembolic risk after controlling for time-varying effects of atrial arrhythmias and thromboprophylaxis.
[Display omitted]</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anticoagulants</subject><subject>Arrhythmia</subject><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Arrhythmias, Cardiac - epidemiology</subject><subject>Arrhythmias, Cardiac - surgery</subject><subject>atrial arrhythmia</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>Congenital diseases</subject><subject>Data collection</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fontan procedure</subject><subject>Fontan Procedure - adverse effects</subject><subject>Fontan Procedure - trends</subject><subject>Heart Defects, Congenital - diagnosis</subject><subject>Heart Defects, Congenital - epidemiology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart failure</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Incidence</subject><subject>Male</subject><subject>Morbidity</subject><subject>Palliation</subject><subject>Patients</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Pulmonary arteries</subject><subject>Quality control</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Risk management</subject><subject>single ventricle</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Thromboembolism</subject><subject>thromboprophylaxis univentricular heart</subject><subject>Transplantation</subject><subject>Treatment Outcome</subject><subject>Univentricular Heart - diagnosis</subject><subject>Univentricular Heart - epidemiology</subject><subject>Univentricular Heart - surgery</subject><subject>Venous Thromboembolism - diagnosis</subject><subject>Venous Thromboembolism - epidemiology</subject><subject>Young Adult</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1qFEEUhQtRzBh9ARfS4MZFuq2fqT9wMwyJCQwIOq6L6urbWm131VjVHczb5FnyZNYw0YULF5cLl-8cLucg9JrghmAi3g_NYJ1rKCa6waLBnDxBK8K5qhnX8ilaYcl4TbCWZ-hFzgPGWCiin6MzRtZMUyJXyO2_pzi1EcqM3lWfff5RbfoZUrWZk4-HZZxisOnuotrZcrVjtV9CgPGisqGrLn_NyTqbOm9dtY2hW_z8cH8Vw2zDw_2XJX2DdPcSPevtmOHV4z5HX68u99vrevfp4812s6vdmuO5tlpK1btOtyCZ6IXqQQIXmmpCddsr21rVOlAUK8uhZY52a81aQcsFtODsHL07-R5S_LlAns3ks4NxtAHikg1lTGi1lpIU9O0_6BCXFMp3hlLJNS6cKhQ9US7FnBP05pD8VMIwBJtjBWYwxwrMsQKDhSkVFNGbR-ulnaD7K_mTeQE-nAAoWdx6SCY7D8FB5xO42XTR_8__N39OmVk</recordid><startdate>20190827</startdate><enddate>20190827</enddate><creator>Deshaies, Catherine</creator><creator>Hamilton, Robert M.</creator><creator>Shohoudi, Azadeh</creator><creator>Trottier, Helen</creator><creator>Poirier, Nancy</creator><creator>Aboulhosn, Jamil</creator><creator>Broberg, Craig S.</creator><creator>Cohen, Scott</creator><creator>Cook, Stephen</creator><creator>Dore, Annie</creator><creator>Fernandes, Susan M.</creator><creator>Fournier, Anne</creator><creator>Kay, Joseph</creator><creator>Mondésert, Blandine</creator><creator>Mongeon, François-Pierre</creator><creator>Opotowsky, Alexander R.</creator><creator>Proietti, Anna</creator><creator>Ting, Jennifer</creator><creator>Zaidi, Ali</creator><creator>Khairy, Paul</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>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20190827</creationdate><title>Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery</title><author>Deshaies, Catherine ; Hamilton, Robert M. ; Shohoudi, Azadeh ; Trottier, Helen ; Poirier, Nancy ; Aboulhosn, Jamil ; Broberg, Craig S. ; Cohen, Scott ; Cook, Stephen ; Dore, Annie ; Fernandes, Susan M. ; Fournier, Anne ; Kay, Joseph ; Mondésert, Blandine ; Mongeon, François-Pierre ; Opotowsky, Alexander R. ; Proietti, Anna ; Ting, Jennifer ; Zaidi, Ali ; Khairy, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-a9778fcd9be736f68fe7e56929129bf8aba8bce8208a5eb3c2d493b62820e9653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anticoagulants</topic><topic>Arrhythmia</topic><topic>Arrhythmias, Cardiac - diagnosis</topic><topic>Arrhythmias, Cardiac - epidemiology</topic><topic>Arrhythmias, Cardiac - surgery</topic><topic>atrial arrhythmia</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Complications</topic><topic>Confidence intervals</topic><topic>Congenital diseases</topic><topic>Data collection</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fontan procedure</topic><topic>Fontan Procedure - adverse effects</topic><topic>Fontan Procedure - trends</topic><topic>Heart Defects, Congenital - diagnosis</topic><topic>Heart Defects, Congenital - epidemiology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart failure</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Incidence</topic><topic>Male</topic><topic>Morbidity</topic><topic>Palliation</topic><topic>Patients</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Pulmonary arteries</topic><topic>Quality control</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Risk management</topic><topic>single ventricle</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Thromboembolism</topic><topic>thromboprophylaxis univentricular heart</topic><topic>Transplantation</topic><topic>Treatment Outcome</topic><topic>Univentricular Heart - diagnosis</topic><topic>Univentricular Heart - epidemiology</topic><topic>Univentricular Heart - surgery</topic><topic>Venous Thromboembolism - diagnosis</topic><topic>Venous Thromboembolism - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deshaies, Catherine</creatorcontrib><creatorcontrib>Hamilton, Robert M.</creatorcontrib><creatorcontrib>Shohoudi, Azadeh</creatorcontrib><creatorcontrib>Trottier, Helen</creatorcontrib><creatorcontrib>Poirier, Nancy</creatorcontrib><creatorcontrib>Aboulhosn, Jamil</creatorcontrib><creatorcontrib>Broberg, Craig S.</creatorcontrib><creatorcontrib>Cohen, Scott</creatorcontrib><creatorcontrib>Cook, Stephen</creatorcontrib><creatorcontrib>Dore, Annie</creatorcontrib><creatorcontrib>Fernandes, Susan M.</creatorcontrib><creatorcontrib>Fournier, Anne</creatorcontrib><creatorcontrib>Kay, Joseph</creatorcontrib><creatorcontrib>Mondésert, Blandine</creatorcontrib><creatorcontrib>Mongeon, François-Pierre</creatorcontrib><creatorcontrib>Opotowsky, Alexander R.</creatorcontrib><creatorcontrib>Proietti, Anna</creatorcontrib><creatorcontrib>Ting, Jennifer</creatorcontrib><creatorcontrib>Zaidi, Ali</creatorcontrib><creatorcontrib>Khairy, Paul</creatorcontrib><creatorcontrib>Alliance for Adult Research in Congenital Cardiology (AARCC)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deshaies, Catherine</au><au>Hamilton, Robert M.</au><au>Shohoudi, Azadeh</au><au>Trottier, Helen</au><au>Poirier, Nancy</au><au>Aboulhosn, Jamil</au><au>Broberg, Craig S.</au><au>Cohen, Scott</au><au>Cook, Stephen</au><au>Dore, Annie</au><au>Fernandes, Susan M.</au><au>Fournier, Anne</au><au>Kay, Joseph</au><au>Mondésert, Blandine</au><au>Mongeon, François-Pierre</au><au>Opotowsky, Alexander R.</au><au>Proietti, Anna</au><au>Ting, Jennifer</au><au>Zaidi, Ali</au><au>Khairy, Paul</au><aucorp>Alliance for Adult Research in Congenital Cardiology (AARCC)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2019-08-27</date><risdate>2019</risdate><volume>74</volume><issue>8</issue><spage>1071</spage><epage>1081</epage><pages>1071-1081</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.
This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.
A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complications and new-onset atrial arrhythmia were reviewed and classified by a blinded adjudicating committee. Thromboembolic risk across surgical techniques was assessed by multivariable competing-risk survival regression.
Over a median follow-up of 11.6 years, 10- and 20-year freedom from Fontan conversion, transplantation, or death was 94.7% and 78.9%, respectively. New-onset atrial arrhythmias occurred in 4.4, 1.2, and 1.0 cases per 100 person-years with APC, LT, and EC, respectively. APC was associated with a 2.82-fold higher risk of developing atrial arrhythmias (p < 0.001), with no difference between LT and EC (p = 0.95). A total of 71 thromboembolic events, 32 systemic and 39 venous, occurred in 12.8% of subjects, for an overall incidence of 1.1%/year. In multivariable analyses, EC was independently associated with a lower risk of systemic (hazard ratio [HR]: 0.20 vs. LT; 95% confidence interval [CI]: 0.04 to 0.97) and combined (HR: 0.34 vs. LT; 95% CI: 0.13 to 0.91) thromboembolic events. A lower incidence of combined thromboembolic events was also observed with antiplatelet agents (HR: 0.54; 95% CI: 0.32 to 0.92) but not anticoagulation (p = 0.53).
The EC Fontan was independently associated with a lower thromboembolic risk after controlling for time-varying effects of atrial arrhythmias and thromboprophylaxis.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31439217</pmid><doi>10.1016/j.jacc.2019.06.051</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2019-08, Vol.74 (8), p.1071-1081 |
| issn | 0735-1097 1558-3597 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2336984771 |
| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Anticoagulants Arrhythmia Arrhythmias, Cardiac - diagnosis Arrhythmias, Cardiac - epidemiology Arrhythmias, Cardiac - surgery atrial arrhythmia Cardiac arrhythmia Cardiology Child Child, Preschool Cohort Studies Complications Confidence intervals Congenital diseases Data collection Female Follow-Up Studies Fontan procedure Fontan Procedure - adverse effects Fontan Procedure - trends Heart Defects, Congenital - diagnosis Heart Defects, Congenital - epidemiology Heart Defects, Congenital - surgery Heart failure Heart surgery Humans Hypertension Incidence Male Morbidity Palliation Patients Postoperative Complications - diagnosis Postoperative Complications - epidemiology Pulmonary arteries Quality control Retrospective Studies Risk Factors Risk management single ventricle Statistical analysis Surgery Thromboembolism thromboprophylaxis univentricular heart Transplantation Treatment Outcome Univentricular Heart - diagnosis Univentricular Heart - epidemiology Univentricular Heart - surgery Venous Thromboembolism - diagnosis Venous Thromboembolism - epidemiology Young Adult |
| title | Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T21%3A45%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Thromboembolic%20Risk%20After%20Atriopulmonary,%20Lateral%20Tunnel,%20and%20Extracardiac%20Conduit%C2%A0Fontan%C2%A0Surgery&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Deshaies,%20Catherine&rft.aucorp=Alliance%20for%20Adult%20Research%20in%20Congenital%20Cardiology%20(AARCC)&rft.date=2019-08-27&rft.volume=74&rft.issue=8&rft.spage=1071&rft.epage=1081&rft.pages=1071-1081&rft.issn=0735-1097&rft.eissn=1558-3597&rft_id=info:doi/10.1016/j.jacc.2019.06.051&rft_dat=%3Cproquest_cross%3E2275909848%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2275909848&rft_id=info:pmid/31439217&rft_els_id=S0735109719357651&rfr_iscdi=true |