Late status of Fontan patients with persistent surgical fenestration
This study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes. Fenestrations are frequently performed during Fontan procedures, but late consequences are not well described....
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| Vydáno v: | Journal of the American College of Cardiology Ročník 57; číslo 24; s. 2437 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
14.06.2011
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| ISSN: | 1558-3597, 1558-3597 |
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| Abstract | This study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes.
Fenestrations are frequently performed during Fontan procedures, but late consequences are not well described.
Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean age 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated.
Fenestration was performed in 361 patients (67%), and frequency differed by year and center (p < 0.001 for each). After adjustment for center, age at Fontan, year of Fontan, and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At the time of cross-sectional testing 8 ± 3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention and 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared with those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p = 0.02) and had lower resting oxygen saturation (median 89% vs. 95%, p < 0.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post-Fontan stroke or thrombosis, and growth did not differ by current fenestration status.
Surgical fenestration is associated with well-demonstrated early post-operative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes. |
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| AbstractList | This study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes.OBJECTIVESThis study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes.Fenestrations are frequently performed during Fontan procedures, but late consequences are not well described.BACKGROUNDFenestrations are frequently performed during Fontan procedures, but late consequences are not well described.Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean age 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated.METHODSPatient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean age 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated.Fenestration was performed in 361 patients (67%), and frequency differed by year and center (p < 0.001 for each). After adjustment for center, age at Fontan, year of Fontan, and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At the time of cross-sectional testing 8 ± 3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention and 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared with those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p = 0.02) and had lower resting oxygen saturation (median 89% vs. 95%, p < 0.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post-Fontan stroke or thrombosis, and growth did not differ by current fenestration status.RESULTSFenestration was performed in 361 patients (67%), and frequency differed by year and center (p < 0.001 for each). After adjustment for center, age at Fontan, year of Fontan, and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At the time of cross-sectional testing 8 ± 3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention and 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared with those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p = 0.02) and had lower resting oxygen saturation (median 89% vs. 95%, p < 0.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post-Fontan stroke or thrombosis, and growth did not differ by current fenestration status.Surgical fenestration is associated with well-demonstrated early post-operative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes.CONCLUSIONSSurgical fenestration is associated with well-demonstrated early post-operative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes. This study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes. Fenestrations are frequently performed during Fontan procedures, but late consequences are not well described. Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean age 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated. Fenestration was performed in 361 patients (67%), and frequency differed by year and center (p < 0.001 for each). After adjustment for center, age at Fontan, year of Fontan, and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At the time of cross-sectional testing 8 ± 3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention and 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared with those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p = 0.02) and had lower resting oxygen saturation (median 89% vs. 95%, p < 0.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post-Fontan stroke or thrombosis, and growth did not differ by current fenestration status. Surgical fenestration is associated with well-demonstrated early post-operative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes. |
| Author | Travison, Thomas G Margossian, Renee Covitz, Wesley McCrindle, Brian W Lu, Minmin Quartermain, Michael Atz, Andrew M Breitbart, Roger E Williams, Richard V Gersony, Welton M Radojewski, Elizabeth Mahony, Lynn |
| Author_xml | – sequence: 1 givenname: Andrew M surname: Atz fullname: Atz, Andrew M email: atzam@musc.edu organization: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. atzam@musc.edu – sequence: 2 givenname: Thomas G surname: Travison fullname: Travison, Thomas G – sequence: 3 givenname: Brian W surname: McCrindle fullname: McCrindle, Brian W – sequence: 4 givenname: Lynn surname: Mahony fullname: Mahony, Lynn – sequence: 5 givenname: Michael surname: Quartermain fullname: Quartermain, Michael – sequence: 6 givenname: Richard V surname: Williams fullname: Williams, Richard V – sequence: 7 givenname: Roger E surname: Breitbart fullname: Breitbart, Roger E – sequence: 8 givenname: Minmin surname: Lu fullname: Lu, Minmin – sequence: 9 givenname: Elizabeth surname: Radojewski fullname: Radojewski, Elizabeth – sequence: 10 givenname: Renee surname: Margossian fullname: Margossian, Renee – sequence: 11 givenname: Wesley surname: Covitz fullname: Covitz, Wesley – sequence: 12 givenname: Welton M surname: Gersony fullname: Gersony, Welton M |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/21658565$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adolescent Anastomosis, Surgical - methods Cardiac Catheterization - methods Child Cohort Studies Confidence Intervals Cross-Sectional Studies Female Follow-Up Studies Fontan Procedure - adverse effects Fontan Procedure - methods Heart Atria - surgery Heart Defects, Congenital - diagnosis Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Heart Function Tests Hemodynamics - physiology Humans Intraoperative Care - methods Length of Stay Linear Models Logistic Models Male Multivariate Analysis Postoperative Care - methods Pulmonary Veins - surgery Risk Assessment Treatment Outcome |
| Title | Late status of Fontan patients with persistent surgical fenestration |
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