Factors Related to Pleural Effusions After Fontan Procedure in the Era of Fenestration

Fedderly, Raymond T.; Whitstone, Beth N.; Frisbee, Stephanie J.; Tweddell, James S.; Litwin, S. Bert

doi:10.1161/hc37t1.094817

Cited by 60 publications

(45 citation statements)

References 11 publications

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“…It seems, however, that the hemodynamic and hydrodynamic factors are the main responsible for early and late results of the Fontan operation, high central venous pressure, absence of fenestration, significant aortopulmonary collateral circulation [15], pulmonary vascular compliance [37], low preoperative saturation and small size of the conduit [11]. Several of these variables were tested in this study, but were similar among the three groups.…”

Section: Discussionmentioning

confidence: 77%

“…However, if the CPB has proinflammatory effects, on the other hand off-pump surgery requires the surgeon to move the anastomosis of the pulmonary artery toward the left branch due to the presence of Glenn, by creating more favorable hydrodynamic conditions. The presence of infection in the postoperative period [11] and even surgery in viral season [15] have been considered as risk factors for the occurrence of pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

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Operação de Fontan: uma técnica em evolução

Fantini¹,

Gontijo²,

Martins³

et al. 2009

Rev Bras Cir Cardiovasc

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Objectives: Recent experimental flow studies based on angiography and magnetic resonance have shown that total cavopulmonary anastomosis (TCPA) is a valid concept for surgical treatment of many congenital heart defects, but there is not agreement of the best surgical arrangement. The aim of this study is to assess the immediate results with three different techniques of TCPA.Methods: Clinical study of all TCPA performed from January 2005 to July 2008; there were 40 patients, all with previous Glenn anastomosis, with mean age of 6.4 ± 3.2 years. Three different techniques were employed: Group 1 (G1) lateral tunnel, Group 2 (G2) extracardiac conduits, Group 3 (G3) intracardiac conduit directed to the left pulmonary branch. All patients had a fenestration performed and pre-and postoperative variables were assessed.Results: G1 had 11 patients, G2 10 patients and G3 19 patients. Preoperative variables were similar in the 3 groups (P>0.05). Surgical mortality was higher in Groups 1 and 2 (9.1% and 10%) compared to Group 3 (0%) but there was no statistical significance (P=0.3841). Pleural effusion was absent in Group 3 (0%), which was statistically significant in relation to the other groups (P=0.0128). The length of hospital stay was also significantly lower in G3 (8 days) in relation to G1 (18 days) and G2 (13 days) (P=0.0164). Conclusion:Intracardiac TCPA was associated with lower postoperative morbidity and is currently our preferred technique on total cavopulmonary anastomosis. Rev Bras Cir Cardiovasc 2009; 24(4): 463-469 technique in which a olytetrafluoroethylene (PTFE) conduit is placed between the inferior vena cava and pulmonary artery, through the right atrium via the foramen ovale into the left atrium roof, where it is exteriorized and sutured to the trunk or left pulmonary artery branch. This technique allowed to reach the left pulmonary artery branch with a prosthesis smaller, with fewer curves and angles, thus minimizing the presence of inflexible material in the system. The aim of this study was to review the immediate results of patients undergoing the Fontan operation at a single institution with three models of total cavopulmonary anastomosis. FANTINI, FA ET AL -Fontan operation: a technique in evolution METHODS Study designWe performed clinical trial with 40 patients with univentricular physiology undergoing the Fontan operation in Biocor Institute,

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Operação de Fontan: uma técnica em evolução

Fantini¹,

Gontijo²,

Martins³

et al. 2009

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…Identifying modifiable risk factors that are associated with PCTO and PLOS could be an important step to improve outcomes after the Fontan. Risk factors for persistent pleural drainage after the Fontan procedure have been well described in single-center studies and may include elevated mean pulmonary artery pressures (PAP), longer CPB and aortic cross-clamp times, moderate or greater atrial ventricular (AV) valve regurgitation, the presence of fenestration, ventricle morphology, and ventricular dysfunction [2][3][4][5][6][7][8][9][10][11]. Our study adds to the understanding of risk factors for persistent pleural effusions and PLOS after the ECC Fontan procedure.…”

Section: Discussionmentioning

confidence: 91%

Early Postoperative Albumin Administration Contributes to Morbidity After the Fontan Operation

et al. 2016

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The Fontan operation has low mortality, but is associated with significant postoperative morbidity, including prolonged chest tube output (PCTO), which is associated with prolonged hospital length of stay (PLOS). We sought to identify variables present early in the clinical course that could predict patients at high risk for PCTO and PLOS. Retrospective data were collected on 84 Fontan (extracardiac conduit) operations from 1/2008 to 12/2013 at a single institution. PCTO was defined as ≥8 days (>75th percentile); PLOS was defined as ≥12 days postoperatively (>75th percentile). Multivariate regression was used to determine covariates associated with PCTO and PLOS. Median age was 3.5 years (IQR 3-5); weight was 14.5 kg (IQR 13-17). There was no mortality. LOS was 9 days (IQR 3-11), and duration of chest tube drainage 6 days (IQR 5-8) at 15 ml/kg/day (IQR 9-20). In univariate analysis, only systemic right ventricle, 24-h 5 % albumin administration, 24-h fluid balance, and 12-h inotrope score were associated with PCTO. In multivariate analysis, only 5 % albumin administration in first 24 h (p < 0.001) and PCTO were independently associated with PLOS. ROC curve analysis showed patients receiving >25 ml/kg of 5 % albumin in first 24-h predicted PLOS (94 % specificity, 93 % sensitivity, AUC = 0.95, p < 0.001). Increased colloid in the first 24-h post-CPB strongly predicts PCTO and PLOS after Fontan operation, potentially providing an early identification of a cohort with unfavorable Fontan physiology. A better understanding of the role of colloid resuscitation after Fontan is necessary, and efforts to reduce perioperative colloid administration could decrease hospital morbidity.

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“…A combination of hormonal, inflammatory and hemodynamic changes contributes to this phenomenon [9][10][11], but it remains difficult to discriminate between influences related to the use of cardiopulmonary bypass and factors due to the univentricular heart physiology.…”

Section: Discussionmentioning

confidence: 99%