What surgical improvements are needed to prove that anatomic repair is superior to physiologic repair in the majority of patients with corrected transposition of the great arteries?

Hraška, Viktor; Mitchell, Michael E.; Woods, Ronald K.; Frommelt, Michele A.

doi:10.1016/j.jtcvs.2016.10.111

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…Therefore, projections both forwards and backwards in time were based on assumptions and potential fluctuations in trends may not have been adequately captured. There could be fluctuation in the incidence of pregnancy terminations, for example, and improvements in the biventricular repair technique [ 32 – 35 ] may lead to some decline in the number of Fontan surgeries conducted in future. However, we have assumed a steady rate of Fontan and these potential trends would therefore not be captured.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Persons Living with Fontan in 2020 and Projections for 2030: Development of an Epidemiology Model Providing Multinational Estimates

Plappert¹,

Edwards

Senatore

et al. 2021

Adv Ther

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Introduction: Fontan surgery is a palliative procedure performed in children with a functionally univentricular heart. Improvements in surgical technique over the past 30 years have increased life expectancy in this rare population. However, the epidemiology of persons living with Fontan is poorly understood. This study aimed to estimate the 2020 and 2030 prevalence of persons living with a Fontan circulation in 11 countries across the US, Europe, Australia and New Zealand, by procedure type: [atriopulmonary connection (AP), lateral tunnel total cavopulmonary connection (LT-TCPC) or extracardiac total cavopulmonary connection (EC-TCPC)]; and age group:[children (\12 years), adolescents (12-17 years), and adults (C 18 years old)] by building an epidemiologic model. Methods: The annual number of Fontan surgeries by country in 2010-2020 were extracted from hospital or claims databases, via procedure codes. The epidemiology of persons living with Fontan was modelled by applying these surgery frequencies to mid-year populations from 1972 to 2020 and overlaying an uptake curve. A literature search identified: 30-day mortality rates, long-term survival, and median age at surgery. Averages of these estimates were inputted into the model to project prevalence in 2030. Results:The number of persons living with Fontan in 2020 across the 11 countries was estimated to be 47,881 [66 people per million (ppm)], rising to 59,777 (79 ppm) by 2030. In 2020, this population was 55% adults, 17% adolescents and 28% children shifting to 64%, 13% and 23%, respectively, in 2030. Among all persons living with Fontan, 74%/18%/9% are estimated to have EC-TCPC/LT-TCPC/AP, respectively, in 2020, and 83%/14%/4% in 2030. Conclusions: According to this epidemiology model, the Fontan population is growing, partly driven by increased survival rates with the more recent LT-TCPC and EC-TCPC procedures (compared with AP). The 2020/2030 prevalence of persons living with Fontan is 66/79 ppm.

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Section: Discussionmentioning

confidence: 99%

The Epidemiology of Persons Living with Fontan in 2020 and Projections for 2030: Development of an Epidemiology Model Providing Multinational Estimates

Plappert¹,

Edwards

Senatore

et al. 2021

Adv Ther

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“…Hraska and colleagues 3,4 have recently suggested several surgical improvements for biventricular repair, including the modified Senning operation, training the left ventricle, avoiding heart block, modifying the Rastelli procedure to avoid intraventricular tunnel obstruction, and aortic translocation procedures.…”

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confidence: 99%

Commentary: Choosing complex biventricular repair versus Fontan—the unmet needs

Huang

2019

The Journal of Thoracic and Cardiovascular Surgery

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The multicenter study in Australia of Sun and colleagues, 1 reported in this issue of the Journal, enrolled 129 patients with D-transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction (D-TGA/VSD/LVOTO; n ¼ 85) or L-transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction (L-TGA/VSD/LVOTO; n ¼ 44) who underwent 29 Fontan procedures and 100 biventricular repair operations in a 26-year cohort. Both pathways were associated with excellent mortality and functional outcomes. The main finding is that biventricular repair required more reinterventions than Fontan procedures. The results of Fontan procedures for those patients whose anatomy is not amenable to biventricular repair, is not, at least in short term, inferior to those of biventricular repair. This study included patients with both D-and L-TGA/ VSD/LVOTO, and it also included many types of biventricular repair procedures, including anatomic repair and physiologic repair, with or without atrial switch, in the group compared with the Fontan group. The patients were simply

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“…In this issue of the Journal, Hra ska and colleagues, 27 my friends and colleagues from the Medical College of Wisconsin, have provided a comment on the article by Alomair and colleagues 26 from the University of Toronto. Certainly, Hra ska and colleagues 27 are experts in the management of this challenging group of patients and have advocated for AR. They have offered some well-thought out suggestions that they believe will improve the outcome of AR.…”

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confidence: 99%

“…Although patch augmentation of the SVC-RV junction might limit the potential for obstruction, other groups have reported very good results without this addition. Hra ska and colleagues 27 have suggested an improved method for LV retraining. Although this well-reasoned strategy, which combines both pressure and volume loading seems to make sense, there are as yet inadequate data to recommend any specific LVretraining strategy.…”

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confidence: 99%

“…Although heart block among patients with normal ventricular looping is rarely associated with LV dysfunction, the association between heart block and LV dysfunction among patients with ccTGA is a troubling reality. Hra ska and colleagues 27 are correct that every effort should be made to avoid surgical heart block. While the role of biventricular pacing for congenital heart disease in general and for ccTGA in particular, has not been compelety defined the addition of biventricular pacing for patients with ccTGA and heart block would seem to add little additional risk and should be considered.…”

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confidence: 99%

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What do we really know about the management of patients with congenitally corrected transposition of the great arteries?

Tweddell

2017

The Journal of Thoracic and Cardiovascular Surgery

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What surgical improvements are needed to prove that anatomic repair is superior to physiologic repair in the majority of patients with corrected transposition of the great arteries?

Abstract: It is our obligation to refine our surgical approaches to demonstrate the superiority of using the morphologic left ventricle as the systemic pumping chamber in ccTGA.

Cited by 6 publications

References 24 publications

The Epidemiology of Persons Living with Fontan in 2020 and Projections for 2030: Development of an Epidemiology Model Providing Multinational Estimates

The Epidemiology of Persons Living with Fontan in 2020 and Projections for 2030: Development of an Epidemiology Model Providing Multinational Estimates

Commentary: Choosing complex biventricular repair versus Fontan—the unmet needs

What do we really know about the management of patients with congenitally corrected transposition of the great arteries?

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