Long-Term Outcomes After Extracardiac Fontan Takedown to an Intermediate Palliative Circulation

Trezzi, Matteo; Cetrano, Enrico; Giannico, Salvatore; Iorio, Fiore S.; Albanese, Sonia B.; Carotti, Adriano

doi:10.1016/j.athoracsur.2017.05.068

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…Moreover, the performance of the Fontan system itself depends on several variables such as a good systolic and diastolic function, the sinus rhythm, low pulmonary pressure and vascular resistances, and good respiratory function. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] It is also debated if the Fontan outcome is influenced by pre-Fontan haemodynamic data. 6,[13][14][15][16][17][18][19][20] In fact, even if some studies underlined that the pre-Fontan haemodynamic data do not affect short-term post-Fontan outcome, [13][14][15] the majority of the authors agree on the importance of performing a pre-Fontan haemodynamic assessment to obtain the valuable data as the need for fenestration and anticipate the need for peri-operative systemic or pulmonary 18 Bridges et al underlined that the pulmonary artery size could not be considered alone as the major determinant of Fontan outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, these cutoffs are not universally established. [1][2][3][4][5][6][7][8][9][10][11] Therefore, a formula that can support the decision on fenestration could be useful. However, our results showed that the formula had a poor capability in identifying patients' need for fenestration.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, different centres can prefer one parameter instead of another or can use different cutoffs. [1][2][3][4][5][6][7][8][9][10][11] We correlated, using ROC curves, the needs for fenestration with the predicted Fontan pressure. Statistical Analysis: Data were expressed as mean values and standard deviation or as median values and interquartile range, where appropriate.…”

Section: Methodsmentioning

confidence: 99%

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Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

et al. 2019

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Introduction:Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study.Methods and Results:Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70–37.20] months, median weight 12.00 [10.98–14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2 = 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure <17.59 mmHg, the formula identified a good short-term clinical outcome with a sensitivity of 92%.Conclusion:The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

et al. 2019

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“…[48][49][50][51] Other strategies to address acute Fontan failure include listing for transplantation, 52 mechanical circulatory support, 53 or take down to a SCPC physiology. 54 A recent series identified 18 patients who underwent Fontan takedown to a SCPC; 2 during the Fontan procedure and 16 within the first 2 months. Seventeen patients survived the takedown.…”

Section: Failure To Progress To the Fontan Or Failure Of Fontan Pallimentioning

confidence: 99%

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

Choi

DiNardo

Brown

2020

Semin Cardiothorac Vasc Anesth

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The superior cavopulmonary connection (SCPC) or “bidirectional Glenn” is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.

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“…Of four patients surviving takedown, three (75%) underwent redo Fontan. Trezzi et al 3 in their series of 431 extracardiac Fontan (ECF) had 18 (4.2%) patients requiring takedown within two months, with 1 mortality. Redo Fontan candidacy probability was 35% for the 17 surviving takedown patients.…”

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confidence: 99%

Modified Technique for Takedown of a Failing Fontan, With Option for Future Interventional Completion

Prabhu

Karl

2021

World J Pediatr Congenit Heart Surg

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Long-Term Outcomes After Extracardiac Fontan Takedown to an Intermediate Palliative Circulation

Cited by 7 publications

References 31 publications

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

Modified Technique for Takedown of a Failing Fontan, With Option for Future Interventional Completion

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