Surgical options after Fontan failure
Jazyk angličtina Země Velká Británie, Anglie Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie
Odkazy
PubMed
27076374
DOI
10.1136/heartjnl-2015-309235
PII: heartjnl-2015-309235
Knihovny.cz E-zdroje
- MeSH
- časové faktory MeSH
- dítě MeSH
- dospělí MeSH
- Fontanova operace škodlivé účinky mortalita MeSH
- Kaplanův-Meierův odhad MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pooperační komplikace diagnóza mortalita patofyziologie chirurgie MeSH
- předškolní dítě MeSH
- proporcionální rizikové modely MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- terapie neúspěšná MeSH
- transplantace srdce * škodlivé účinky mortalita MeSH
- vrozené srdeční vady diagnóza mortalita chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Evropa MeSH
OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04). CONCLUSIONS: Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.
Children's Heart Centre The Queen Silvia Children's Hospital Gothenburg Sweden
Clinic for Cardiovascular Surgery University Hospital Zurich Zurich Switzerland
Department of Cardiac Surgery Catholic University Leuven Leuven Belgium
Department of Cardio Thoracic Surgery University Hospital of Copenhagen Copenhagen Denmark
Department of Cardiothoracic Surgery Hospital de Santa Marta Lisbon Portugal
Department of Congenital and Paediatric Cardiac Surgery and Cardiology Riuniti Hospital Ancona Italy
Department of Congenital Heart Disease Centre Chirurgical Marie Lannelongue Paris France
Division of Cardiac Surgery Cliniques Universitaires Saint Luc Brussels Belgium
German Pediatric Heart Centre Asklepios Clinic Sankt Augustin Sankt Augustin Germany
Hospital for Children and Adolescents University of Helsinki Helsinki Finland
National Heart Hospital Sofia Sofia Bulgaria
Technical University German Heart Center Munich Munich Germany
