Lessons Learned From a Critical Analysis of the Fontan Operation Over Three Decades in a Single Institution

Imagem de Miniatura
Arquivos
art_CANEO_Lessons_Learned_From_a_Critical_Analysis_of_the_2017.PDF (369.52 KB)
Citações na Scopus
Tipo de produção
article
Data de publicação
2017
DOI
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
SAGE PUBLICATIONS INC
Autores
NEIROTTI, Rodolfo A.
SILVA, Thais M. Alexandre e
Citação
WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY, v.8, n.3, p.376-384, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. Methods: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details. End points included early and late mortality and a composite of death, heart transplantation (HTX), or Fontan takedown. Results: A total of 420 patients underwent 18 atriopulmonary connections, 82 lateral tunnels (LT), and 320 extracardiac conduit (EC) Fontan procedures. Forty-six (11%) patients died; early and late mortality were 7.9% and 3.1%, respectively. Eight (1.9%) patients underwent HTX, 11 (2.6%) underwent Fontan conversion to EC, and 1 (0.2%) takedown of EC to bidirectional Glenn shunt. Prevalence of concomitant valve surgery (P < .001) and pulmonary artery reconstruction (P < .001) differed over the eras. Preoperative valve regurgitation was associated with likelihood of early mortality (odds ratio [OR] = 3.5, P = .002). Embolic events (OR = 1.9, P = .047), preoperative valve regurgitation (OR = 2.3, P = .029), diagnosis of unbalanced atrioventricular canal defect (OR = 1.14, P = .03), and concomitant valve replacement (OR = 6.9, P = .001) during the FO were associated with increased risk of the composite end point (death, HTX, or takedown). Conclusion: Technical modifications did not result in improved results across eras, due in part to more liberal indications for surgery in the recent years. Valve regurgitation, unbalanced atrioventricular canal, embolic events, or concomitant valve replacement were associated with FO failure.
Palavras-chave
adult congenital heart disease, univentricular heart, congenital heart disease (CHD), Fontan, functionally univentricular heart
URI
https://observatorio.fm.usp.br/handle/OPI/21264
Referências
  1. Atz AM, 2015, CONGENIT HEART DIS, V10, pE30, DOI 10.1111/chd.12193
  2. Caneo LF, 2016, ARQ BRAS CARDIOL, V106, P162, DOI 10.5935/abc.20160017
  3. d'Udekem Y, 2007, CIRCULATION, V116, pI157, DOI 10.1161/CIRCULATIONAHA.106.676445
  4. Dabal RJ, 2014, J THORAC CARDIOV SUR, V148, P2517, DOI 10.1016/j.jtcvs.2014.07.075
  5. Davies R., 2015, FRONT BIOENG BIOTECH, V3, P1, DOI 10.12970/2311-1755.2015.03.01.1)
  6. De Vadder K, 2014, ACTA CARDIOL, V69, P7, DOI 10.2143/AC.69.1.3011339
  7. DELEVAL MR, 1988, J THORAC CARDIOV SUR, V96, P682
  8. FONTAN F, 1971, THORAX, V26, P240, DOI 10.1136/thx.26.3.240
  9. Garnreiter JM, 2014, CARDIOL YOUNG, V24, P813, DOI 10.1017/S104795111300108X
  10. Gewillig M, 2005, HEART, V91, P839, DOI 10.1136/hrt.2004.051789
  11. Hirsch JC, 2008, ANN SURG, V248, P402, DOI 10.1097/SLA.0b013e3181858286
  12. Imai Y, 1997, J THORAC CARDIOV SUR, V113, P262, DOI 10.1016/S0022-5223(97)70322-2
  13. Kerendi F, 2009, ANN THORAC SURG, V87, P1484, DOI 10.1016/j.athoracsur.2009.02.059
  14. Liang FY, 2013, SCI WORLD J, DOI 10.1155/2013/486815
  15. Liu VJH, 2015, ANN THORAC SURG, V99, P1632, DOI 10.1016/j.athoracsur.2015.01.035
  16. Mahle WT, 1999, J AM COLL CARDIOL, V34, P1637, DOI 10.1016/S0735-1097(99)00392-7
  17. MARCELLETTI C, 1990, J THORAC CARDIOV SUR, V100, P228
  18. Misumi Y, 2014, INTERACT CARDIOV TH, V18, P259, DOI 10.1093/icvts/ivt508
  19. Nakano T, 2007, ANN THORAC SURG, V84, P1619, DOI 10.1016/j.athoracsur.2007.05.074
  20. Nakano T, 2015, EUR J CARDIO-THORAC, V48, P825, DOI 10.1093/ejcts/ezv072
  21. O'Brien P, 2001, J Pediatr Nurs, V16, P338, DOI 10.1053/jpdn.2001.26573
  22. Ono M, 2007, J THORAC CARDIOV SUR, V134, P1199, DOI 10.1016/j.jtcvs.2007.08.002
  23. Ono M, 2016, EUR J CARDIO-THORAC, V50, P632, DOI 10.1093/ejcts/ezw091
  24. Reyes A, 1997, CIRCULATION, V96, P341
  25. Sallehuddin A, 2004, EUR J CARDIO-THORAC, V26, P54, DOI 10.1016/j.ejcts.2004.03.031
  26. Schreiber C, 2007, ANN THORAC SURG, V84, P894, DOI 10.1016/j.athoracsur.2007.04.034
  27. Stamm C, 2001, J THORAC CARDIOV SUR, V121, P28, DOI 10.1067/mtc.2001.111422
  28. Stern HJ, 2010, PEDIATR CARDIOL, V31, P1131, DOI 10.1007/s00246-010-9811-9
  29. UEMURA H, 1995, J THORAC CARDIOV SUR, V110, P405, DOI 10.1016/S0022-5223(95)70237-7
  30. Vijarnsorn C, 2014, J THORAC CARDIOV SUR, V148, P2580, DOI 10.1016/j.jtcvs.2014.08.005
  31. Wolff D, 2014, EUR J CARDIO-THORAC, V45, P602, DOI [10.1093/ejcts/ezt461, 10.1093/ejcts.ezt461]
  32. Yamagishi S, 2014, ANN THORAC SURG, V98, P641, DOI 10.1016/j.athoracsur.2014.04.086

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11