Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study.
Am Heart J
; 162(1): 125-30, 2011 Jul.
Article
en En
| MEDLINE
| ID: mdl-21742098
ABSTRACT
BACKGROUND:
The practice of coiling aortopulmonary collaterals (APCs) before Fontan completion is controversial, and published data are limited. We sought to compare outcomes in subjects with and without pre-Fontan coil embolization of APCs using the Pediatric Heart Network Fontan Cross-Sectional Study database which enrolled survivors of prior Fontan palliation.METHODS:
We compared hospital length of stay after Fontan in 80 subjects who underwent APC coiling with 459 subjects who did not. Secondary outcomes included post-Fontan complications and assessment of health status and ventricular performance at cross-sectional evaluation (mean 8.6 ± 3.4 years after Fontan).RESULTS:
Centers varied markedly in frequency of pre-Fontan APC coiling (range 0%-30% of subjects, P < .001). The coil group was older at Fontan (P = .004) and more likely to have single right ventricular morphology (P = .054) and pre-Fontan atrioventricular valve regurgitation (P = .03). The coil group underwent Fontan surgery more recently (P < .001), was more likely to have a prior superior cavopulmonary anastomosis (P < .001), and more likely to undergo extracardiac Fontan connection (P < .001) and surgical fenestration (P < .001). In multivariable analyses, APC coiling was not associated with length of stay (hazard ratio for remaining in-hospital 0.91, 95% CI 0.70-1.18, P = .48) or postoperative complications, except more post-Fontan catheter interventions (hazard ratio 1.74, 95% CI 1.04-2.91, P = .03), primarily additional APC coils. The groups had similar outcomes at cross-sectional evaluation.CONCLUSION:
Management of APCs before Fontan shows marked practice variation. We did not find an association between pre-Fontan coiling of APCs and shorter postoperative hospital stay or with better late outcomes. Prospective studies of this practice are needed.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Arteria Pulmonar
/
Arterias Torácicas
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Cuidados Preoperatorios
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Función Ventricular Izquierda
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Procedimiento de Fontan
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Embolización Terapéutica
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Cardiopatías Congénitas
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
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Prevalence_studies
/
Prognostic_studies
Aspecto:
Patient_preference
Límite:
Adolescent
/
Child
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Child, preschool
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Female
/
Humans
/
Male
Idioma:
En
Revista:
Am Heart J
Año:
2011
Tipo del documento:
Article
País de afiliación:
Estados Unidos