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Pre- and Post-operative determinants of transplantation-free survival after Fontan. The Australia and New Zealand experience.
Poh, Chin L; Cordina, Rachael L; Iyengar, Ajay J; Zannino, Diana; Grigg, Leeanne E; Wheaton, Gavin R; Bullock, Andrew; Ayer, Julian; Alphonso, Nelson; Gentles, Thomas L; Celermajer, David S; d'Udekem, Yves.
Afiliación
  • Poh CL; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
  • Cordina RL; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Victoria, Australia.
  • Iyengar AJ; Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
  • Zannino D; Sydney Medical School, University of Sydney, Sydney, Australia.
  • Grigg LE; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
  • Wheaton GR; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
  • Bullock A; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Victoria, Australia.
  • Ayer J; Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
  • Alphonso N; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
  • Gentles TL; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia.
  • Celermajer DS; Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
  • d'Udekem Y; Department of Cardiology, Perth Children's Hospital, Perth, Western Australia, Australia.
Int J Cardiol Heart Vasc ; 35: 100825, 2021 Aug.
Article en En | MEDLINE | ID: mdl-34286062
BACKGROUND: This review identifies the predictors of late mortality and heart transplantation that remain relevant in the contemporary population of patients with a Fontan circulation, focusing on the potential impact of post-Fontan morbidities on the late outlook of these patients. METHODS AND RESULTS: A total of 1561 patients who had survived the Fontan operation in Australia or New Zealand from 1975 to 2018 were included in this review. Over a median duration of 11.4 years, there was a total of 117 deaths (7%) and 32 heart transplantations (2%). Freedom from death and heart transplantation at 10, 20 and 35 years post Fontan surgery were 94% (95% CI 93-95%), 87% (95 %CI 85-90%) and 66% (95 %CI 57-78%) respectively. Being male, having an atriopulmonary Fontan, pre-Fontan atrioventricular valve intervention, or prolonged pleural effusions post Fontan were predictive of late death or heart transplantation. However, time-dependent variables such as the development of atrial arrhythmia, protein/losing enteropathy or late ventricular dysfunction were stronger predictors of the same outcome. Patients who developed a time-dependent risk factor had a freedom from death and heart transplantation rate of 54% (95 %CI 43-66) at 15 years and 44% (95 %CI 33-57) at 25 years post Fontan. However, 95% (95 %CI 91-99) of patients without any of the identified risk factors were free from death or heart transplantation rate at 25 years post Fontan. CONCLUSION: In conclusion, the occurrence of post-operative complications such as PLE, arrhythmia and ventricular dysfunction will likely precede the late demise of these patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Int J Cardiol Heart Vasc Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Irlanda
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Int J Cardiol Heart Vasc Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Irlanda