New STS ACSD risk models have generally excellent calibration and discrimination and are well suited for risk adjustment of STS performance metrics.

Completely new STS ACSD risk models have been developed based on contemporary patient data; their performance is superior to that of previous STS ACSD models.

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Background Late complications of the Fontan operation represent a significant management challenge. In general, failing Fontan patients have two modes of presentation: those with impaired ventricular function (IVF group) and those with preserved ventricular function but with failing Fontan physiology (protein-losing enteropathy-PLE, and plastic bronchitis-PB) (PVF group). In this study we evaluated whether failing Fontan patients referred for heart transplantation had a different outcome based on the mode of presentation. Methods We conducted a retrospective chart review of all Fontan patients evaluated for heart transplantation at a single institution from 1994–2008. Demographic, hemodynamic, and laboratory data were collected. Patients were stratified into IVF group or PVF group based on echocardiographic criteria. Descriptive statistics and Kaplan-Meier analysis were used for hypothesis testing. Results Thirty four Fontan patients were evaluated for heart transplantation. Based on echo description of systolic function, 18 were categorized as IVF and 16 patients as PVF. The IVF group had significantly lower cardiac index, SvO2, and significantly higher SVR compared to the PVF group (p<0.05). PLE or PB was present in 13/16 in the PVF group and 0/18 in the IVF group. Of the 34 patients, 20 received transplantation with similar rates amongst the IVF and PVF groups. Within one year from evaluation there were 2/18 deaths in the IVF group and 7/16 deaths in the PVF group (p=0.052) Conclusions Failing Fontans with PVF have decreased overall survival independent of whether they were transplanted. This trend indicates a need to improve the management and/or timing for transplantation amongst this population.

The current body of literature includes several methodologically sound studies that together provide consistent evidence for an association of cardiovascular events with blood apoC-III level in total plasma or in VLDL and LDL. More data are needed to determine importance of levels of apoC-III in specific lipoproteins for cardiovascular risk assessment and management and to elucidate the interaction between triglycerides and apoC-III in relation to risk of cardiovascular disease.