Risk Factors for Failed Fontan Procedure After Stage 2 Palliation

Ono, Masamichi; Burri, Melchior; Mayr, Benedikt; Anderl, Lisa; Strbad, Martina; Cleuziou, Julie; Hager, Alfred; Hörer, Jürgen; Lange, Rüdiger

doi:10.1016/j.athoracsur.2020.06.030

Cited by 19 publications

(14 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study of 683 adult Fontan patients published in 2018 from the Australian and New Zealand Fontan Registry found that, by age 40, mortality reached 20%, only 53% of patients were free of heart failure symptoms, and only 41% were free of serious adverse events [1]. Similar data has been widely reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Approximately half of the instances of mortality and significant morbidity can be attributed to the failure of the unique Fontan circulatory system.…”

Section: Introductionmentioning

confidence: 78%

“…This approach revealed the model sensitivity to these parameters as well as a trend in IVC pressure reduction. When comparing ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 for constant 𝐷 𝑖𝑗𝑠 (cases [3,6,9], [4,7,10] or [5,8,11]), it can be seen that as ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 decreases (7cm to 3cm) IVC pressure increases. Conversely, comparison for varying 𝐷 𝑖𝑗𝑠 for constant ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 (cases [3,4,5], [6,7,8], or [9,10,11]) shows that for decreasing 𝐷 𝑖𝑗𝑠 (5mm to 3mm) IVC pressure decreases.…”

Section: Design Space Explorationmentioning

confidence: 99%

“…When comparing ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 for constant 𝐷 𝑖𝑗𝑠 (cases [3,6,9], [4,7,10] or [5,8,11]), it can be seen that as ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 decreases (7cm to 3cm) IVC pressure increases. Conversely, comparison for varying 𝐷 𝑖𝑗𝑠 for constant ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 (cases [3,4,5], [6,7,8], or [9,10,11]) shows that for decreasing 𝐷 𝑖𝑗𝑠 (5mm to 3mm) IVC pressure decreases. Given the values in Table 2, it can be determined that IVC pressure variation due to 𝐷 𝑖𝑗𝑠 reduction ranges between 3.1-3.8% whereas for a decrease in ∆ 𝐼𝐽𝑆−𝑇𝐶𝑃𝐶 , IVC pressure changes 0.24-0.97%.…”

Section: Design Space Explorationmentioning

confidence: 99%

See 2 more Smart Citations

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Prather

Das²,

Farias

et al. 2021

Preprint

View full text Add to dashboard Cite

Rationale: Approximately 1/2500 babies are born with only one functioning ventricle and the Fontan is the third and, ideally final staged palliative operation for these patients. This altered circulation is prone to failure with survival rates below 50% into adulthood in some series. Chronically elevated inferior vena cava (IVC) pressure is implicated as one cause of the mortality and morbidity in this population.Objective: An injection jet shunt (IJS) drawing blood-flow directly from the aortic arch to significantly lower IVC pressure is proposed.Methods and Results: A computer-generated 3D model of a 2–4 year old patient with a fenestrated Fontan and a cardiac output of 2.3L/min was generated. The detailed 3D pulsatile hemodynamics are resolved in a zero-dimensional lumped parameter network tightly-coupled to a 3D computational fluid dynamics model accounting for non-Newtonian blood rheology and resolving turbulence using large eddy simulation. IVC pressure and systemic oxygen saturation were tracked for various IJS-assisted Fontan configurations, altering design parameters such as shunt and fenestration diameters and locations.A baseline “failing” Fontan with 4mm fenestration was tuned to elevated IVC pressure (\(+17.8mmHg\)). Enlargement of the fenestration to 8mm resulted in a 3mmHg IVC pressure drop but an unacceptable reduction in systemic oxygen saturation below 80%. Addition of an IJS with a 2mm nozzle and minor volume load to the ventricle improved the IVC pressure drop to 3.2mmHg while increasing systemic oxygen saturation above 80%.Conclusions: The salutary effects of the IJS to effectively lower IVC pressure while retaining acceptable levels of oxygen saturation are successfully demonstrated.

show abstract

Section: Introductionmentioning

confidence: 78%

Section: Design Space Explorationmentioning

confidence: 99%

Section: Design Space Explorationmentioning

confidence: 99%

See 1 more Smart Citation

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Prather

Das²,

Farias

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Patients with unbalanced AVSD and the common AV valve are known to have various degrees of AV valve structural abnormalities, which often hinders successful single-ventricle palliation and maintenance of the Fontan circulation in the long term. 2 The study provides unique new data on this matter. Firstly, the study includes very long-term follow-up of AV valve function in patients with unbalanced AVSD.…”

mentioning

confidence: 95%

“…Atrioventricular (AV) valve insufficiency in patients with a functional single ventricle causes significant chronic volume overload to the systemic ventricle, which negatively influences all stages of single-ventricle physiology, resulting in high mortality and failing Fontan circulation. 1,2 The multicenter study conducted by Arrigoni and colleagues 3 sheds a light on the long-term influence of AV valve insufficiency on patients with unbalanced AV septal defect (AVSD). Patients with unbalanced AVSD and the common AV valve are known to have various degrees of AV valve structural abnormalities, which often hinders successful single-ventricle palliation and maintenance of the Fontan circulation in the long term.…”

mentioning

confidence: 99%

Commentary: Atrioventricular valve insufficiency: Achilles' heel in single-ventricle physiology

Honjo¹,

Kadowaki²

2022

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Relationship of Aortopulmonary Collaterals and Pulmonary Artery Development During Staged Single Ventricle Reconstruction

Staehler,

Schaeffer,

Georgiev

et al. 2024

Pediatr Cardiol

View full text Add to dashboard Cite

To evaluate the relationship of aortopulmonary collaterals and the development of central pulmonary arteries during staged palliation. A total of 287 patients, who underwent staged palliation with bidirectional cavopulmonary shunt and total cavopulmonary connection between 2008 and 2019, had available angiography. Pulmonary artery index was calculated using pulmonary angiography as described by Nakata and colleagues. Aortopulmonary collaterals were observed in 47 (16%) patients at stage II palliation, in 131 (46%) at total cavopulmonary connection, and afterwards in 49 (7%). The interventional closure of aortopulmonary collaterals was performed before stage II in 12 (4%) patients, before Fontan completion in 38 (13%), and afterwards in 39 (14%). Presence of aortopulmonary collaterals before stage II was not associated with the pulmonary artery index (129 vs. 150 mm2/m2, p = 0.176) at stage II. In contrast, aortopulmonary collaterals before the Fontan completion were associated with lower pulmonary artery index (154 vs. 172 mm2/m2, p = 0.005), and right pulmonary artery index (99 vs. 106 mm2/m2, p = 0.006). Patients who underwent interventional closure of aortopulmonary collaterals before total cavopulmonary connection had lower pulmonary artery index (141 vs. 169 mm2/m2, p < 0.001), lower right pulmonary artery index (93 vs. 106 mm2/m2, p = 0.007), and left pulmonary artery index (54 vs. 60 mm2/m2, p = 0.013) at Fontan completion. The presence of aortopulmonary collaterals did not influence pulmonary artery size by the time of stage II. However, presence of aortopulmonary collaterals was associated with under-developed pulmonary arteries at Fontan completion, especially in patients who needed interventional closure of aortopulmonary collaterals.

show abstract

Risk Factors for Failed Fontan Procedure After Stage 2 Palliation

Cited by 19 publications

References 23 publications

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Parametric Investigation of an Injection-Jet Self-Powered Fontan Circulation

Commentary: Atrioventricular valve insufficiency: Achilles' heel in single-ventricle physiology

Relationship of Aortopulmonary Collaterals and Pulmonary Artery Development During Staged Single Ventricle Reconstruction

Contact Info

Product

Resources

About