Risk Factors for Prolonged Pleural Effusion After Extracardiac Fontan Operation

Kim, Geena; Ko, Hoon; Byun, Joung-Hee; Lee, Hyoung Doo; Kim, Hyungtae; Sung, Si Chan; Choi, Kyoo Wan

doi:10.1007/s00246-019-02183-3

Cited by 18 publications

(22 citation statements)

References 24 publications

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“…that found the presence of a fenestration to be associated with pleural effusions lasting <14 days. [ 30 ] However, Kim's study included all subtypes of single ventricle patients who underwent Fontan, and in fact, found HLHS to be an independent risk factor for prolonged pleural effusion. As we investigated only HLHS patients in this study, it is possible that the effect of a fenestration is less evident within this population.…”

Section: Discussionmentioning

confidence: 99%

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

et al. 2020

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Objective: To investigate patient-related factors, echocardiographic, and anatomic variables associated with immediate and long-term clinical outcomes after extracardiac Fontan procedure at our institution. Materials and Methods: Retrospective review of preoperative cardiac catheterizations and echocardiograms as well as medical records of all children with hypoplastic left heart syndrome (HLHS) who underwent Fontan between June 2002 and December 2018. Results: Seventy-seven patients with HLHS were included (age 4 years [1.5–11.7]). Seventy patients (91%) received a nonfenestrated Fontan and 57 patients (74%) underwent Fontan without cardiopulmonary bypass (CPB). Presence of a Fontan fenestration ( P = 0.69) and use of CPB ( P = 0.79) did not differ between those with <2 weeks compared to those with ≥2 weeks of chest tube drainage. There were no differences in either pre- or intra-operative hemodynamics between patients who weighed <15 kg compared to those who weighed ≥15 kg at time of surgery; incidence of death, transplant, and transplant listing were similar between weight groups. Inferior vena cava (IVC) diameter z-score did not differ among patients with and without chylous chest tube drainage ( P = 0.78), with and without development of protein losing enteropathy ( P = 0.23), or death/heart transplant/transplant listing compared to survivors without transplant ( P = 0.26). Conclusion: In HLHS patients undergoing Fontan, preoperative weight and IVC diameter appeared to have no influence on immediate postoperative outcomes. Performing the Fontan off CPB and with a fenestration also conferred no added clinical benefit. These observations should be considered when deciding optimal timing for Fontan completion.

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Section: Discussionmentioning

confidence: 99%

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

et al. 2020

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“…Salvin et al 11 reported that age, PVR, preoperative CVP, postoperative CVP, postoperative left atrial pressure, CPB duration, high‐volume resuscitation, and a high inotropic score were associated with prolonged recovery. Some studies have reported that right ventricular morphology, hypoplastic left heart syndrome, and not performing fenestration are related to prolonged drainage and prolonged LOHS 12,13 . It was thought that early extubation was associated with decreased drainage time and a shorter hospital stay 14 .…”

Section: Discussionmentioning

confidence: 99%

Parameters affecting pleural drainage and management strategy after Fontan operation

et al. 2020

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Background Prolonged pleural drainage is a common complication after undergoing the Fontan procedure. Although various protocols have been described, there is no definitive consensus for how to treat this complication. Materials and Methods Our primary aim was to determine the effect of the management strategy protocol on the duration of drainage and length of hospital stay. Our secondary aim was to determine the parameters affecting the need for prolonged drainage after the Fontan procedure. Ninety‐two consecutive patients who underwent the Fontan procedure were retrospectively analyzed. A protocol‐based postoperative management strategy was adopted in July 2018. Group 1 (n = 48) consisted of patients that underwent the procedure before the protocol was implemented. Group 2 (n = 44) consisted of patients that underwent the procedure after the protocol was implemented. Results The mean age was 5 years (interquartile range [IQR], 4.0‐6.9); the mean body weight was 17.3 kg (IQR, 15.1‐21.8). Statistically significant differences were found between the groups in terms of total drainage, duration of pleural drainage, prolonged drainage, and length of hospital stays (LOHS) (P = .05, P = .04, P = .04, P = .04, respectively). The multivariate analysis results showed that the application of the protocol was the only factor impacting prolonged drainage (OR, 2.46, 95% CI lower‐upper: 1.03‐5.86, P = .04). Conclusion Standardization and strict application of the medical treatment within a specific protocol without being affected by doctor‐, nurse‐, or patient‐based factors increases the success rate of this procedure. After implementing the changes in the medical management strategy, total drainage and duration of pleural drainage and LOHS decreased, and the costs associated with these factors also decreased.

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“…Chylothorax occurs with an incidence of 7.4% and 9-24% following surgical repair of tetralogy of Fallot and "surgical palliation" of single ventricles, respectively [21,32,33]. Chylothorax has been associated with poorer medium-term outcome and has been speculated to be a sign of lymphatic intolerance to the changed physiology [32].…”

Section: Lymphatic Effusion and Chylothoraxmentioning

confidence: 99%

Diagnosis and Management of Lymphatic Disorders in Congenital Heart Disease

2020

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Purpose of Review Lymphatic disorders have received an increasing amount of attention over the last decade. Sparked primarily by improved imaging modalities and the dawn of lymphatic interventions, understanding, diagnostics, and treatment of lymphatic complications have undergone considerable improvements. Thus, the current review aims to summarize understanding, diagnostics, and treatment of lymphatic complications in individuals with congenital heart disease. Recent Findings The altered hemodynamics of individuals with congenital heart disease has been found to profoundly affect morphology and function of the lymphatic system, rendering this population especially prone to the development of lymphatic complications such as chylous and serous effusions, protein-losing enteropathy and plastic bronchitis. Summary Although improved, a full understanding of the pathophysiology and targeted treatment for lymphatic complications is still wanting. Future research into pharmacological improvement of lymphatic function and continued implementation of lymphatic imaging and interventions may improve knowledge, treatment options, and outcome for affected individuals.

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Risk Factors for Prolonged Pleural Effusion After Extracardiac Fontan Operation

Cited by 18 publications

References 24 publications

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

Parameters affecting pleural drainage and management strategy after Fontan operation

Diagnosis and Management of Lymphatic Disorders in Congenital Heart Disease

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