Operación modificada de Fontan o variantes efectuadas en un solo tiempo quirúrgico. Determinantes de la mortalidad

Cazzaniga, M; Piñeda, Luis Fernández; Villagrá, F; León, J. Villamor; Gómez, Ricardo; Sánchez, Pedro A.; Balda, José Díez

doi:10.1016/s0300-8932(02)76619-0

Cited by 18 publications

(8 citation statements)

References 79 publications

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“…Moreover, the performance of the Fontan system itself depends on several variables such as a good systolic and diastolic function, the sinus rhythm, low pulmonary pressure and vascular resistances, and good respiratory function. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] It is also debated if the Fontan outcome is influenced by pre-Fontan haemodynamic data. 6,[13][14][15][16][17][18][19][20] In fact, even if some studies underlined that the pre-Fontan haemodynamic data do not affect short-term post-Fontan outcome, [13][14][15] the majority of the authors agree on the importance of performing a pre-Fontan haemodynamic assessment to obtain the valuable data as the need for fenestration and anticipate the need for peri-operative systemic or pulmonary 18 Bridges et al underlined that the pulmonary artery size could not be considered alone as the major determinant of Fontan outcome.…”

Section: Discussionmentioning

confidence: 99%

“…1,5 In particular, several papers underlined that higher Fontan system pressure is associated with an increased risk of failure or death. [7][8][9][10] Salvin et al report about the relation between the Fontan pressure system and the duration of effusions. 12 With all these premises, the use of a dedicated formula to predict the pressure in the Fontan system starting from pre-Fontan catheterisation data could be an additional information in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, different centres can prefer one parameter instead of another or can use different cutoffs. [1][2][3][4][5][6][7][8][9][10][11] We correlated, using ROC curves, the needs for fenestration with the predicted Fontan pressure. Statistical Analysis: Data were expressed as mean values and standard deviation or as median values and interquartile range, where appropriate.…”

Section: Methodsmentioning

confidence: 99%

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Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

et al. 2019

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Introduction:Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study.Methods and Results:Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70–37.20] months, median weight 12.00 [10.98–14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2 = 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure <17.59 mmHg, the formula identified a good short-term clinical outcome with a sensitivity of 92%.Conclusion:The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

et al. 2019

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“…Improvement of surgical techniques and the increasingly earlier age at which the TCD is completed have enabled the Fontan circulation as a real alternative for a growing number of complex congenital or acquired heart diseases in our environment. In addition, the extracardiac TCD or modified Fontan, which has replaced the classic atriopulmonary shunt, has significantly reduced complications such as arrhythmias and mortality in the most recent series [4]. The sheer size of anatomic structures in children with CHD and their longer survival have increasingly made more necessary different PI techniques that aim to keep Fontan circulation in optimum condition.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous interventions in Fontan circulation

Franco

Domingo

Val

et al. 2015

IJC Heart & Vasculature

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Introduction and objectivesDifferent percutaneous interventional procedures are needed to reach and maintain adequate anatomical and physiological conditions for the Fontan circulation. We aim to describe the experience gained at a children's hospital in such interventions, and to analyze the clinical outcomes.MethodsRetrospective study of all patients with Fontan circulation completed between 1995 and 2013. We analyzed the clinical characteristics and the different types of percutaneous interventions performed, considering three different periods of time: before Glenn surgery, between Glenn and Fontan surgeries, and after Fontan was completed. Survival and time to indication of percutaneous interventions in each period were analyzed, as well as the clinical situation at last follow-up.ResultsOf the 91 patients analyzed, 46 (50.5%) required percutaneous interventions. The most frequent procedures were pulmonary artery angioplasty and angioplasty of the Fontan conduit. Estimated survival at 10, 20 and 30 years of age was 96.2%, 94.7% and 89.4%, respectively. There were no significant differences in survival of patients undergoing percutaneous interventions or not. Overall survival and time to indication of percutaneous interventions were significantly lower in the group of patients with right morphology systemic ventricle. Patients with fenestrated Fontan required interventions more frequently. At the end of follow-up, 66 patients (72.5%) were asymptomatic, without significant differences between patients who underwent or did not undergo percutaneous interventions.ConclusionsInterventional catheterization procedures are often necessary to reach and maintain the fragile Fontan circulation, mainly in patients with right morphology systemic ventricles and fenestrated Fontan conduits.

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“…Measurements of ventricular end-diastolic pressure [6], pulmonary artery pressure [18], and pulmonary vascular resistance [15] have been used to identify and exclude patients at risk for a poor post-Fontan outcome. A prior study from our institution found that for patients undergoing a Fontan operation from 1987 through 1991, preoperative pulmonary vascular resistance was associated with early Fontan failure [26].…”

Section: Discussionmentioning

confidence: 99%

What is the Clinical Utility of Routine Cardiac Catheterization Before a Fontan Operation?

et al. 2010

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Patients with single-ventricle circulation presenting for Fontan completion routinely undergo cardiac catheterization despite ongoing debate concerning its additive value. Increasing interest in noninvasive preoperative evaluation alone led the authors to analyze the utility of routine pre-Fontan catheterization and to determine whether a subset of patients could avoid this invasive procedure. Patients younger than 5 years referred for pre-Fontan evaluation were retrospectively reviewed. Medical records and catheter angiograms were examined, and catheterizations were categorized as “additive” based on predetermined criteria. Associations between precatheterization variables, catheterization findings, and short-term postoperative outcomes were evaluated. Cardiac catheterization was clinically nonadditive for 89 of 175 patients undergoing pre-Fontan evaluation (51%). There were no robust precatheterization predictors of a nonadditive catheterization. Echocardiography did not fully demonstrate the relevant anatomy of 115 patients (66%), most frequently due to inadequate visualization of the pulmonary arteries, and 22 patients had additive catheterizations due to new diagnostic findings alone. Interventions at catheterization were frequent and deemed “important” for 64 patients (37%). Catheterization hemodynamic data were not associated with early postoperative outcomes. Minor catheterization complications occurred for 51 patients (29%) and major complications for 4 patients (2%). Although at least 50% of the patients presenting for Fontan completion may be able to avoid routine catheterization safely, an echocardiography-based imaging strategy alone is insufficient to allow proper identification of those who could be evaluated noninvasively. A more comprehensive imaging strategy not based solely on echocardiography should be considered.

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Operación modificada de Fontan o variantes efectuadas en un solo tiempo quirúrgico. Determinantes de la mortalidad

Cited by 18 publications

References 79 publications

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

Percutaneous interventions in Fontan circulation

What is the Clinical Utility of Routine Cardiac Catheterization Before a Fontan Operation?

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