Thromboembolic Complications After Fontan Operations

Abstract

Thromboembolic complications occur frequently after the Fontan operation and its modifications and are a cause of significant morbidity. The time of presentation varies greatly. The rate of thrombosis appears to be similar in all modifications of the Fontan operation.

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

“…The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses (Tables 1 and 2). 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84 Of the 16 RCTs identified,1...…”

“…Finally, we noted that many studies have a relatively short follow‐up period in detecting VTE. With those studies with an extended follow‐up period beyond the acute hospital stay,23, 44, 45, 46, 49, 59, 71 symptomatic VTE continued to occur. Hence, future cohort studies and RCTs on VTE after cardiac surgery should consider VTE events well beyond the immediate postoperative period.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…Jahangiri et al 183 found a 1.7% incidence (1 in 57 cases) of stroke among patients surviving Fontan procedures, and the stroke occurred in a patient who was being treated with warfarin at a therapeutic level at the time of the stroke. Rosenthal et al 184 reported cerebral thromboembolic events in 4.2% (3 of 70 patients) in another retrospective single-center cohort study of patients surviving Fontan procedures and followed up for a median of 5 years postoperatively. In a more recently published study, Barker et al 185 retrospectively reviewed 402 children who underwent Fontan procedures between 1975 and 1998 for single-ventricle defects and were followed up for a median of 3.5 years postoperatively.…”

“…When reported, there appears to be a higher risk within the perioperative period up to 3 to 12 months after Fontan, followed by a lower and constant level of risk, which then increases at 5 to 10 years after Fontan. 184,266,267 There may be some utility to matching the need for and degree of anticoagulation therapy to the magnitude of risk with the recognition that the risk may change over time. Patients who have had previous thrombosis or related events are at high risk for recurrence.…”

The Risk of Thromboembolic Complications in Fontan Patients with Atrial Flutter/Fibrillation Treated with Electrical Cardioversion

“…The prevalence of thrombosis after Fontan palliation is reportedly 1-33%, with a high, immediate risk of thrombosis after surgery and an increased risk for Fontan patients surviving into adulthood (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The anticoagulation regimens for these patients vary (3,11).…”