Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery

Deshaies, Catherine; Hamilton, Robert M.; Shohoudi, Azadeh; Trottier, Helen; Poirier, Nancy; Aboulhosn, Jamil; Broberg, Craig S.; Cohen, Scott B.; Cook, Stephen C.; Dore, Annie; Fernandes, Susan M.; Fournier, Anne; Kay, Joseph; Mondésert, Blandine; Mongeon, François‐Pierre; Opotowsky, Alexander R.; Proietti, Anna Bárbara de Freitas Carneiro; Ting, Jennifer; Zaidi, Ali N.; Khairy, Paul

doi:10.1016/j.jacc.2019.06.051

Cited by 46 publications

(25 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In particular, average RTs above two cardiac cycles in the coronary/systemic circulation have been linked to higher risks of thrombosis, which regions in most of our ePTFE grafts exceed 41 . Thromboembolic events are a long-term complication following the Fontan operation with the current standard of care 11 . Their cause is likely multifactorial given the associated liver disease and attendant disturbances in coagulation factors reported in Fontan patients.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

et al. 2021

View full text Add to dashboard Cite

In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.

show abstract

Section: Discussionmentioning

confidence: 99%

Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…There was hope that patients operated with the extracardiac conduit would have less arrhythmia, and globally, there seems to have been a large shift toward performing ECC over LT. 7,15,32 However, after almost 3 decades, there is little evidence of the superiority of one technique over the other in terms of long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…40 Until recently, there has been no consistently reported difference in thrombotic events between LT and ECC 1,9,41 ; however, in a recent report by Deshaies and colleagues, 15 a multivariable timeadjusted analysis of 522 patients across 12 institutions showed that ECC is associated with a lower incidence of thromboembolic events with a similar arrhythmic burden. 15 The Boston group reported a large discrepancy in postoperative warfarin use between ECC and LT patients (33% vs 4.7%), which the authors attributed to pre-Fontan thromboembolic events. 1 Although no difference in overall post-Fontan thromboembolic events between the groups, the majority of early ECC deaths were attributed to thromboembolic complications.…”

Section: Thromboembolic Eventsmentioning

confidence: 99%

The optimal Fontan operation: Lateral tunnel or extracardiac conduit?

Daley

d’Udekem

2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…B. Zyanose bei Fenestration, Vorhofthrombus, stattgehabte Thrombembolien) besteht nicht selten die Indikation zur OAK auch ohne Dokumentation atrialer Arrhythmien. Atriale Arrhythmien sind häufig (mehr als 20 % der Patienten im Zeitraum von 10 Jahren nach Fontan-Operation, mehr als 50 % der Patienten mit vorausgegangener atriopulmonaler Fontan-Prozedur [21]).…”

Section: Fontan-zirkulationunclassified

Orale Antikoagulation bei Erwachsenen mit angeborenen Herzfehlern

Rosée

Klingenheben²

2021

Aktuelle Kardiologie

View full text Add to dashboard Cite

ZusammenfassungPatienten mit angeborenen Herzfehlern weisen ein erhöhtes Risiko für das Auftreten thrombembolischer Ereignisse auf. Je nach zugrunde liegender Anatomie/operativer Korrektur ist dieses Risiko jedoch individuell sehr unterschiedlich und lässt sich weder hinsichtlich Embolierisiko noch hinsichtlich Blutungsrisiko durch die gängigen Risikoscores (z. B. CHA2DS2-VASc oder HAS-BLED) verlässlich abbilden. Neben der Frage der Indikationsstellung zur oralen Antikoagulation ist die Frage nach der Möglichkeit des Einsatzes neuer oraler Antikoagulanzien (NOAK) anstelle der Standardtherapie mit Vitamin-K-Antagonisten (VKA) eine immer drängendere, sofern kein mechanischer Klappenersatz und keine schwergradige Mitralstenose vorliegt. Bei atrialen Arrhythmien/Vorhofflimmern können nach momentaner Datenlage Patienten mit als „leicht“ klassifizierbaren Vitien mit NOAK behandelt werden, während Patienten mit mittelgradigen oder schweren/komplexen Herzfehlern eher mit VKA behandelt werden sollten.

show abstract

Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery

Cited by 46 publications

References 33 publications

Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

The optimal Fontan operation: Lateral tunnel or extracardiac conduit?

Orale Antikoagulation bei Erwachsenen mit angeborenen Herzfehlern

Contact Info

Product

Resources

About