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Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care?
Eur J Cardiothorac Surg. 2017 03 01; 51(3):483-489.EJ

Abstract

Objectives

We aimed to compare early postoperative outcome after extracardiac (EC) Fontan operation between patients with right (RV) or left (LV) systemic ventricles.

Methods

In total, 173 consecutive patients (median age 4 years, median weight 14 kg) underwent EC Fontan between 1995 and 2013. Pre- and intraoperative data as well as detailed postoperative haemodynamic variables were compared between patients with LV [ n = 109 (63%)] and RV [ n = 64 (37%)].

Results

: RV patients showed significantly lower mean arterial (median 55 vs 59 mmHg, P = 0.04), higher atrial (median 8 vs 6 mmHg, P = 0.03) and comparable pulmonary pressure (median 14 vs 14 mmHg, P = 0.7) as well as lower mean systemic perfusion pressure (median 39 vs 43 mmHg, P = 0.03) on Day 0 after EC Fontan. They suffered from longer intubation time (median 18 vs 12 h, P = 0.008), higher incidence of ascites (46% vs 28%, P = 0.04) and need for dialysis (21% vs 4%, P = 0.003). Prolonged inotropic support (25% vs 8%, P = 0.02) and pharmacological treatment to reduce pulmonary vascular resistance (71% vs 53%, P = 0.002) were more often used in RV patients and they showed more often supraventricular tachyarrhythmia (27% vs 5%, P < 0.001) and a longer intensive care unit-stay (median 4 vs 3 days, P = 0.03). However, early mortality, need for Fontan takedown, use of mechanical circulatory support, pleural effusions and hospital stay were not significantly different between both groups.

Conclusions

Patients with systemic RV demonstrate higher morbidity in the early postoperative course compared with patients with systemic LV anatomy and require intensified postoperative management to avoid postoperative Fontan failure.

Authors+Show Affiliations

Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Surgery for Congenital Heart Disease/Paediatric Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Surgery for Congenital Heart Disease/Paediatric Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28007868

Citation

Nordmeyer, Sarah, et al. "Systemic Right Ventricular Morphology in the Early Postoperative Course After Extracardiac Fontan Operation: Is There Still a Need for Special Care?" European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 51, no. 3, 2017, pp. 483-489.
Nordmeyer S, Rohder M, Nordmeyer J, et al. Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care? Eur J Cardiothorac Surg. 2017;51(3):483-489.
Nordmeyer, S., Rohder, M., Nordmeyer, J., Miera, O., Peters, B., Cho, M. Y., Photiadis, J., Berger, F., & Ovroutski, S. (2017). Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care? European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 51(3), 483-489. https://doi.org/10.1093/ejcts/ezw374
Nordmeyer S, et al. Systemic Right Ventricular Morphology in the Early Postoperative Course After Extracardiac Fontan Operation: Is There Still a Need for Special Care. Eur J Cardiothorac Surg. 2017 03 1;51(3):483-489. PubMed PMID: 28007868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care? AU - Nordmeyer,Sarah, AU - Rohder,Melanie, AU - Nordmeyer,Johannes, AU - Miera,Oliver, AU - Peters,Björn, AU - Cho,Mi-Young, AU - Photiadis,Joachim, AU - Berger,Felix, AU - Ovroutski,Stanislav, PY - 2016/07/13/received PY - 2016/10/10/accepted PY - 2016/12/23/pubmed PY - 2017/10/11/medline PY - 2016/12/24/entrez KW - Extracardiac Fontan KW - Inotropic support KW - Systemic right ventricle SP - 483 EP - 489 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 51 IS - 3 N2 - Objectives: We aimed to compare early postoperative outcome after extracardiac (EC) Fontan operation between patients with right (RV) or left (LV) systemic ventricles. Methods: In total, 173 consecutive patients (median age 4 years, median weight 14 kg) underwent EC Fontan between 1995 and 2013. Pre- and intraoperative data as well as detailed postoperative haemodynamic variables were compared between patients with LV [ n = 109 (63%)] and RV [ n = 64 (37%)]. Results: : RV patients showed significantly lower mean arterial (median 55 vs 59 mmHg, P = 0.04), higher atrial (median 8 vs 6 mmHg, P = 0.03) and comparable pulmonary pressure (median 14 vs 14 mmHg, P = 0.7) as well as lower mean systemic perfusion pressure (median 39 vs 43 mmHg, P = 0.03) on Day 0 after EC Fontan. They suffered from longer intubation time (median 18 vs 12 h, P = 0.008), higher incidence of ascites (46% vs 28%, P = 0.04) and need for dialysis (21% vs 4%, P = 0.003). Prolonged inotropic support (25% vs 8%, P = 0.02) and pharmacological treatment to reduce pulmonary vascular resistance (71% vs 53%, P = 0.002) were more often used in RV patients and they showed more often supraventricular tachyarrhythmia (27% vs 5%, P < 0.001) and a longer intensive care unit-stay (median 4 vs 3 days, P = 0.03). However, early mortality, need for Fontan takedown, use of mechanical circulatory support, pleural effusions and hospital stay were not significantly different between both groups. Conclusions: Patients with systemic RV demonstrate higher morbidity in the early postoperative course compared with patients with systemic LV anatomy and require intensified postoperative management to avoid postoperative Fontan failure. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/28007868/Systemic_right_ventricular_morphology_in_the_early_postoperative_course_after_extracardiac_Fontan_operation:_is_there_still_a_need_for_special_care L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezw374 DB - PRIME DP - Unbound Medicine ER -