Increased Risk for Thromboembolism After Fontan Surgery: Considerations for Thromboprophylaxis

Helm, Suelyn Van Den; Sparks, Christopher Noel; Ignjatović, Vera; Monagle, Paul; Attard, Chantal

doi:10.3389/fped.2022.803408

Cited by 9 publications

(1 citation statement)

References 82 publications

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“…single ventricle disease after Fontan type operation, are at a particular high risk of thromboembolism due to endothelial dysfunction, abnormal blood flow, and hypercoagulable state resulting from the unique hemodynamic pattern and associated liver dysfunction 28 . Previous studies have reported rates of thromboembolism and stroke as high as 19%, with subclinical stroke detected through magnetic resonance imaging even more common 28,29 . The Australia national registry study showed that the free-from-thromboembolism rate 25 years after Fontan operation is 82% 30 .…”

Section: Cva and Outcome In Af With Achdmentioning

confidence: 99%

Atrial fibrillation in adult congenital heart disease in Asia

Chiu

Tseng

et al. 2023

Preprint

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Introduction With the improvement of long-term survival of patients with congenital heart disease (CHD), complications such as atrial fibrillation (AF) have become a concern. This study aimed to determine the epidemiology data and risk factors of AF in adult CHD (ACHD) patients and evaluate the impact of AF on late outcomes using a large ACHD cohort in Asia. Method This study enrolled all CHD patients older than 18 years of age diagnosed with CHD at National Taiwan University Hospital between 2007 and 2018. Data on patients' clinical characteristics, electrocardiogram, Holter reports, and follow-up information were collected. AF status was classified as sustained AF, paroxysmal AF, or intra-atrial reentry tachycardia (IART). CHD was categorized as simple, severe, or complex CHD (single ventricle). Primary endpoint was defined as cerebrovascular accidents (CVA) or death. Result The study included 4403 patients (55.9% women), with 16.4% having severe and 2.9% having complex CHD. The cumulative incidence of AF was 6.9% (54.8% paroxysmal AF, 26.9% sustained AF, and 18.4% IART), which is comparable to the Western countries. The incidence increased with age and was higher in patients with pulmonary hypertension (PH, 27%), complex CHD (12.7%), and metabolic syndrome. The mean onset age of IART, paroxysmal, and sustained AF was 35.7?15.8, 48.4?19.3, and 56.9?14.2 years, respectively. Multivariate Cox regression analysis revealed that male sex, PH, and severe and complex CHD were the most critical risk factors for AF (odds ratio 1.67, 1.91, 3.55, and 12.6, respectively). The 70-year CVA-free survival rate was 67.1% in patients with AF (vs. 80.5% in those without AF, p<0.001). However, multivariate Cox regression analysis identified male sex, PH, severe and complex CHD, and genetic syndrome as the most significant risk factors of the primary endpoint (odds ratio 1.76, 3.38, 2.62 and 19.3, and 8.91, respectively). Conclusions: This large ACHD cohort showed a high cumulative incidence of AF, similar to the Western countries, which increased with age, PH, and CHD severity. CVA-free survival was more closely associated with these factors than with AF.

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Section: Cva and Outcome In Af With Achdmentioning

confidence: 99%

Atrial fibrillation in adult congenital heart disease in Asia

Chiu

Tseng

et al. 2023

Preprint

View full text Add to dashboard Cite

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Utility of the Total Thrombus-Formation Analysis System as a Tool for Evaluating Thrombogenicity and Monitoring Antithrombotic Therapy in Pediatric Fontan Patients

et al. 2022

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Background: Despite the major clinical complication of thromboembolic events after the Fontan procedure, there is no consensus regarding the optimal antithrombotic therapy. Novel tools to assess thrombogenicity are desirable to establish optimal thromboprophylaxis in this patient population. The Total Thrombus-formation Analysis System (T-TAS) was developed for the quantitative analysis of thrombus formation using microchips with thrombogenic surfaces. This study evaluated the utility of T-TAS in the assessment of thrombogenicity in pediatric Fontan patients.Methods and results: The participants included 20 consecutive Fontan patients who underwent cardiac catheterization and 30 healthy controls. Blood samples collected without and with antithrombotic therapy (aspirin or aspirin and warfarin) were used for T-TAS to compute the area under the curve (AUC) in the atheroma (AR10-AUC30) and platelet (PL18-AUC10) chips. T-TAS values showed that patients in the Fontan group without antithrombotic therapy had lower thrombogenicity than those in the control group (PL18-AUC10, median [interquartile range] 356 [313-394] vs. 408 [392-424]; AR10-AUC30, median [interquartile range] 1270 [1178-1351] vs. 1382 [1338-1421]). Aspirin and warfarin therapies signi cantly decreased PL18-AUC10and AR10-AUC30, respectively, compared with those of patients without antithrombotic therapy (P<0.001 for each comparison). Subgroup analysis divided by low (<9 mmHg) or high (≥ 9 mmHg) central venous pressure (CVP) showed that CVP affects the reduction in AR10-AUC30with antithrombotic therapy.Conclusions: T-TAS may be a useful tool for monitoring thrombogenicity and antithrombotic therapy in Fontan patients.

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