Long-term outcomes after first-onset arrhythmia in Fontan physiology

Carins, Thomas; Shi, William Y.; Iyengar, Ajay J.; Nisbet, Ashley; Forsdick, Victoria; Zannino, Diana; Gentles, Thomas L.; Radford, Dorothy J.; Justo, Robert; Celermajer, David S.; Bullock, Andrew; Winlaw, David S.; Wheaton, Gavin; Grigg, Leeanne; d’Udekem, Yves

doi:10.1016/j.jtcvs.2016.07.073

Cited by 59 publications

(31 citation statements)

References 15 publications

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“…HLHS patients are estimated to require more resources on average as expected, and so are male children which is in line with the pediatric healthcare literature on gender 15 and previous Fontan studies. 16 …”

Section: Discussionmentioning

confidence: 99%

“…These conditions are not currently recognized as one of the most common noncardiac inpatient needs for this population, although a few previous studies [15][16][17][18] have reported worse dental caries experience and comorbidities in digestive system for children with heart disease. However, it is unclear from this study whether these admissions simply reflect more inpatient needs for this population on commonly seen conditions due to anesthesia concerns or that these children indeed had worse dental and digestive outcomes.…”

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confidence: 98%

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Hospital Inpatient Costs for Single Ventricle Patients Surviving the Fontan Procedure

Huang

Schilling

Dalziel

et al. 2017

The American Journal of Cardiology

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We estimated the inpatient resource use for a Fontan patient from birth to adulthood and explored factors that might induce cost differences (2014 US dollar). Inpatient costing records from four hospitals with greatest numbers of Fontan patients in Australia and New Zealand were linked with the Fontan registry database. Inpatient records between July 1995 and September 2014 for 420 Fontan patients were linked, and the most frequent primary diagnoses were hypoplastic left heart syndrome (HLHS) (20.7%), tricuspid atresia (19.7%), and double inlet left ventricle (17.1%). The mean hospital cost for a Fontan patient from birth to 18 years of age was estimated to be $390,601 (95% confidence interval [CI] $264,703 to $516,499), corresponding to 164 (95% CI 98 to 231) inpatient days. The cost incurred from birth through to Fontan completion (the staged procedures period) was $219,482 (95% CI $202,410 to $236,553) and the cost thereafter over 15 years was $146,820 (95% CI $44,409 to $249,231), corresponding to 82 (95% CI 72 to 92) and 65 (95% CI 18 to 112) inpatient days respectively. Costs were higher in male and HLHS patients in the staged procedures period (P<0.001). Having fenestration was associated with higher costs in the staged procedures period (P<0.001) and lower cost post Fontan over 15 years (P=0.66). In conclusion, patients with single-ventricle congenital heart disease continue to demand considerable inpatient resources after the staged procedures period. Over 40% of the pediatric hospital costs for Fontan patients were estimated to occur after the last planned surgery.Key Words: Fontan patients, hospital cost, congenital heart disease, health serviceThe Fontan procedure is the final in a series of staged palliations for single-ventricle congenital heart disease, affecting approximately 1 in 2000 live births. 1, 2 As the outcomes of the staged procedures improve, an increasing number of children with complex heart conditions have survived into adulthood. [2][3][4][5] More patients are now undergoing staged procedures 6-8 but the trend in long-term inpatient cost and care needs for this population are unclear. Using hospital billing data associated with encounters, Keren et al. (2012) have shown that the cumulative costs of the 10 most expensive pediatric conditions in the US accounted for approximately one third of the standardized costs for all pediatric visits to hospital, and single-ventricle congenital heart defects such as hypoplastic left heart syndrome (HLHS) ranked 7 th on the list. 9 Previous studies also documented the costs of a single staged procedure 10, 11 , the costs of non-cardiac admissions to pediatric hospitals 12 , and the costs of admissions in adults for this patient group. 13 Nevertheless, the literature is limited by its focus on single encounters and knowledge regarding the long-term trend in hospital costs for single-ventricle patients is lacking. The purpose of this study was to assess the trend in longterm hospital costs for single-ventricle patients surviving the F...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Hospital Inpatient Costs for Single Ventricle Patients Surviving the Fontan Procedure

Huang

Schilling

Dalziel

et al. 2017

The American Journal of Cardiology

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“…Two-thirds of pacing for bradycardia is for sinus node dysfunction [213,214], as junctional rhythm is poorly tolerated and chronotropic incompetence significantly reduces exercise tolerance. The sinus node may have been damaged at the time of the prior superior vena cava-pulmonary artery anastomosis and is more common after the atriopulmonary Fontan procedure [215].…”

Section: Pacingmentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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“…Delayed fenestration closure has become an integral part of Fontan surgery in many centres 8 9. The arrhythmic load of this population increases as they age and it is no surprise that a total of 122 patients needed a pacemaker implantation and 47 an ablation procedure 10 11. Ablation procedures have been shown to be successful in this population, but often requires multiple reinterventions 11 12.…”

Section: Discussionmentioning

confidence: 99%

Reintervention and survival in 1428 patients in the Australian and New Zealand Fontan Registry

Daley

Plessis

Zannino

et al. 2019

Heart

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ObjectivePatients undergoing single-ventricle palliation have experienced significant improvement in survival in the recent era. However, a substantial proportion of these patients undergo reoperations. We performed a review of the Australia and New Zealand (ANZ) Fontan Registry to determine the overall reintervention and reoperative burden in these patients.MethodsA retrospective longitudinal cohort study was performed using data from patients who underwent a Fontan operation between 1975 and 2016 from the ANZ Fontan Registry. The data obtained included Fontan operation, reinterventions and most recent follow-up status. We examined the type and timing of reinterventions and survival.ResultsOf the 1428 patients identified, 435 (30%) underwent at least one reintervention after the Fontan operation: 110 patients underwent early reintervention and 413 underwent late reinterventions. Excluding Fontan conversion and transplantation, 220 patients underwent at least one interventional procedure and 209 patients underwent at least one reoperation. Fenestration closure and pacemaker-related procedures were the most common catheter and surgical interventions, respectively. The cumulative incidence of reintervention following Fontan was 23%, 37% and 55% at 10, 20 and 30 years, respectively. Survival and freedom from failure were worse in patients requiring later reintervention after Fontan surgery (51% vs 83% and 42% vs 69%, respectively at 30 years, p<0.001). This difference persisted after excluding pacemaker-related procedures (p<0.001). Operative mortality for non-pacemaker late reoperations after Fontan was 6%.ConclusionsA substantial proportion of Fontan patients require further intervention to maintain effective single-ventricle circulation. Patients undergoing reoperation after Fontan have higher rates of mortality and failure, despite intervention.

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Long-term outcomes after first-onset arrhythmia in Fontan physiology

Abstract: The development of an arrhythmia is associated with a heightened risk of subsequent failure of the Fontan circulation.

Cited by 59 publications

References 15 publications

Hospital Inpatient Costs for Single Ventricle Patients Surviving the Fontan Procedure

Hospital Inpatient Costs for Single Ventricle Patients Surviving the Fontan Procedure

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Reintervention and survival in 1428 patients in the Australian and New Zealand Fontan Registry

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