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Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation.
J Thorac Cardiovasc Surg. 2013 Mar; 145(3):678-82.JT

Abstract

OBJECTIVE

The study objective was to compare the incidence of short- and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure.

METHODS

We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac conduit, and lateral tunnel. Rhythm was classified as normal or abnormal. A rhythm dysfunction grading was devised and used to identify worsening of rhythm for patients with abnormal rhythm preoperatively. Multivariable logistic regression was used to determine predictors of abnormal rhythm. To eliminate confounding effects of transient immediate postoperative arrhythmias, data were analyzed for abnormal rhythm within the first 2 weeks and for more than 2 weeks after surgery.

RESULTS

Of the 134 patients (n = 50 with intra/extracardiac conduit with limited atriotomy, n = 19 with standard extracardiac conduit, n = 65 with lateral tunnel) (median follow-up, 36 months; interquartile range, 22-50 months; 2 operative deaths and 6 late deaths), rhythm data for more than 2 weeks postoperatively were available in 88 (40 with lateral tunnel, 14 with standard extracardiac conduit, 34 with intra/extracardiac conduit with limited atriotomy). These patients constituted the study groups. Patients in the lateral tunnel group were relatively younger at the time of the Fontan operation (P < .001) and had a longer follow-up (P < .001). Multivariable logistic regression confirmed that greater than moderate atrioventricular valve regurgitation was the only independent predictor of abnormal rhythm during the first 2 postoperative weeks. Older age at Fontan (odds ratio, 1.20; 95% confidence interval, 1.05-1.38; P = .012) and higher preoperative mean pulmonary artery pressure (odds ratio, 1.2; 95% confidence interval, 1.03-1.44; P = .026) were predictors of abnormal rhythm more than 2 weeks postoperatively. Intra/extracardiac conduit with limited atriotomy Fontan modification was associated with a significantly lower incidence of abnormal rhythm after 2 weeks postoperatively compared with lateral tunnel modification (odds ratio, 0.28; 95% confidence interval, 0.10-0.84; P = .015).

CONCLUSIONS

Intra/extracardiac conduit with limited atriotomy Fontan modification has a significantly lower risk of abnormal rhythm postoperatively in the short and intermediate term when compared with the lateral tunnel.

Authors+Show Affiliations

Cardiovascular Surgery, Children's National Medical Center, Washington, DC 20010, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22578898

Citation

Sinha, Pranava, et al. "Intra/extracardiac Fenestrated Modification Leads to Lower Incidence of Arrhythmias After the Fontan Operation." The Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 3, 2013, pp. 678-82.
Sinha P, Zurakowski D, He D, et al. Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation. J Thorac Cardiovasc Surg. 2013;145(3):678-82.
Sinha, P., Zurakowski, D., He, D., Yerebakan, C., Freedenberg, V., Moak, J. P., & Jonas, R. A. (2013). Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation. The Journal of Thoracic and Cardiovascular Surgery, 145(3), 678-82. https://doi.org/10.1016/j.jtcvs.2012.03.080
Sinha P, et al. Intra/extracardiac Fenestrated Modification Leads to Lower Incidence of Arrhythmias After the Fontan Operation. J Thorac Cardiovasc Surg. 2013;145(3):678-82. PubMed PMID: 22578898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation. AU - Sinha,Pranava, AU - Zurakowski,David, AU - He,Dingchao, AU - Yerebakan,Can, AU - Freedenberg,Vicki, AU - Moak,Jeffrey P, AU - Jonas,Richard A, Y1 - 2012/05/09/ PY - 2011/09/28/received PY - 2012/03/20/revised PY - 2012/03/28/accepted PY - 2012/5/15/entrez PY - 2012/5/15/pubmed PY - 2013/5/17/medline SP - 678 EP - 82 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 145 IS - 3 N2 - OBJECTIVE: The study objective was to compare the incidence of short- and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure. METHODS: We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac conduit, and lateral tunnel. Rhythm was classified as normal or abnormal. A rhythm dysfunction grading was devised and used to identify worsening of rhythm for patients with abnormal rhythm preoperatively. Multivariable logistic regression was used to determine predictors of abnormal rhythm. To eliminate confounding effects of transient immediate postoperative arrhythmias, data were analyzed for abnormal rhythm within the first 2 weeks and for more than 2 weeks after surgery. RESULTS: Of the 134 patients (n = 50 with intra/extracardiac conduit with limited atriotomy, n = 19 with standard extracardiac conduit, n = 65 with lateral tunnel) (median follow-up, 36 months; interquartile range, 22-50 months; 2 operative deaths and 6 late deaths), rhythm data for more than 2 weeks postoperatively were available in 88 (40 with lateral tunnel, 14 with standard extracardiac conduit, 34 with intra/extracardiac conduit with limited atriotomy). These patients constituted the study groups. Patients in the lateral tunnel group were relatively younger at the time of the Fontan operation (P < .001) and had a longer follow-up (P < .001). Multivariable logistic regression confirmed that greater than moderate atrioventricular valve regurgitation was the only independent predictor of abnormal rhythm during the first 2 postoperative weeks. Older age at Fontan (odds ratio, 1.20; 95% confidence interval, 1.05-1.38; P = .012) and higher preoperative mean pulmonary artery pressure (odds ratio, 1.2; 95% confidence interval, 1.03-1.44; P = .026) were predictors of abnormal rhythm more than 2 weeks postoperatively. Intra/extracardiac conduit with limited atriotomy Fontan modification was associated with a significantly lower incidence of abnormal rhythm after 2 weeks postoperatively compared with lateral tunnel modification (odds ratio, 0.28; 95% confidence interval, 0.10-0.84; P = .015). CONCLUSIONS: Intra/extracardiac conduit with limited atriotomy Fontan modification has a significantly lower risk of abnormal rhythm postoperatively in the short and intermediate term when compared with the lateral tunnel. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/22578898/Intra/extracardiac_fenestrated_modification_leads_to_lower_incidence_of_arrhythmias_after_the_Fontan_operation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(12)00469-2 DB - PRIME DP - Unbound Medicine ER -