Heart Failure in Complex Congenital Heart Disease of the Adult

Chaudhry, Anisa; Selwyn, Julia; Adams, Elizabeth E.; Bradley, Elisa A.

doi:10.1007/s11886-022-01788-0

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…The trajectory of heart failure is different in patients with FC as compared with acquired heart failure, 25 , 26 which also may impact HFH reduction. This is highlighted by 2 patients in this cohort accounting for 52% of HFHs, one of whom had significant PLE.…”

Section: Discussionmentioning

confidence: 99%

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Marshall,

Rajpal,

Mah

et al. 2023

JAHA

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Background Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. Methods and Results This single‐center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device‐related complications in patients with Fontan circulation referred for IHM placement (2015–2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow‐up Model for End‐Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21–48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device‐related procedural complications. In follow‐up (median, 35 [range, 6–83] months), 1 patient developed a pulmonary embolism (possibly device‐related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0–1.0] versus 0.6 [0–2.3]; P =0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End‐Stage Liver Disease Excluding International Normalized Ratio scores ( R 2 =0.588, P <0.001), though catheterization pressures were not ( R 2 =0.140, P =0.139). The long‐term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P =0.041), which was not reproduced with catheterization pressures (log rank P =0.764). Conclusions In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device‐related complications were low. IHM pressures may better represent real‐life conditions compared with catheterization given associations with mortality and Model for End‐Stage Liver Disease Excluding International Normalized Ratio score.

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Section: Discussionmentioning

confidence: 99%

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Marshall,

Rajpal,

Mah

et al. 2023

JAHA

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Invasive Implanted Hemodynamic Monitoring in Patients With Complex Congenital Heart Disease: State-of-the-Art Review

Marshall,

Wright,

Lampert

et al. 2024

The American Journal of Cardiology

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Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles

Marshall V,

Mah,

DeSalvo

et al. 2023

Heart

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BackgroundPulmonary hypertension (PH) is a common complication in patients with complete dextro-transposition of the great arteries (TGA) after atrial switch (D-TGA/AS) and congenitally corrected TGA (ccTGA). In this population with subaortic right ventricles (sRVs), echocardiography is a poor screening tool for PH; implantable invasive haemodynamic monitoring (IHM) could be used for this purpose, but data are limited. The aim of this study is to report on novel uses of IHM in patients with sRV.MethodsThis retrospective study describes the uses of IHM, impact of IHM on heart failure hospitalisation (HFH) and device-related complications in adults with sRV from a single centre (2015–2022).ResultsIHM was placed in 18 patients with sRV (median age 43 (range 30–54) years, 8 female, 16 with D-TGA/AS, 2 with ccTGA); 16 had moderate or severe sRV systolic dysfunction, 13 had PH on catheterisation. IHM was used for (1) Medical therapy titration, (2) Medical management after ventricular assist device in patients with transplant-limiting PH and (3) Serial monitoring of pulmonary artery pressures without repeat catheterisations to help identify the optimal time for heart transplant referral. In follow-up (median 23 months), HFHs/year were similar to the year prior to IHM (median 0 (IQR 0–1.0) before vs 0 (0–0.8) after, p=0.984). Device migration occurred in one, without long-term sequelae.ConclusionsUses of IHM in patients with sRV are described which may minimise the need for serial catheterisations in a population where PH is prevalent. HFHs were low overall but not impacted by IHM. One device-related complication occurred without long-term consequence.

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Heart Failure in Complex Congenital Heart Disease of the Adult

Cited by 3 publications

References 47 publications

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation

Invasive Implanted Hemodynamic Monitoring in Patients With Complex Congenital Heart Disease: State-of-the-Art Review

Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles

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