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Long-term survival after the Fontan operation: Twenty years of experience at a single center.
Downing, Tacy E; Allen, Kiona Y; Glatz, Andrew C; Rogers, Lindsay S; Ravishankar, Chitra; Rychik, Jack; Faerber, Jennifer A; Fuller, Stephanie; Montenegro, Lisa M; Steven, James M; Spray, Thomas L; Nicolson, Susan C; Gaynor, J William; Goldberg, David J.
Afiliación
  • Downing TE; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Allen KY; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Glatz AC; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Rogers LS; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Ravishankar C; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Rychik J; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Faerber JA; Department of Pediatrics, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Fuller S; Department of Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Montenegro LM; Department of Anesthesiology and Critical Care, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Steven JM; Department of Anesthesiology and Critical Care, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Spray TL; Department of Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Nicolson SC; Department of Anesthesiology and Critical Care, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Gaynor JW; Department of Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Goldberg DJ; Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: goldbergda@email.chop.edu.
J Thorac Cardiovasc Surg ; 154(1): 243-253.e2, 2017 07.
Article en En | MEDLINE | ID: mdl-28341469
OBJECTIVE: Existing studies of patients palliated with the Fontan operation are limited by heterogeneous patient populations and incomplete follow-up. This study aimed to describe long-term post-Fontan survival in a modern patient cohort. METHODS: All 773 patients who underwent a first Fontan operation at our institution between 1992 and 2009 were reviewed. The primary outcome was the composite endpoint of Fontan takedown, heart transplantation, or death before 2013. RESULTS: Follow-up rate was 99.2%. Survival with intact Fontan circulation was 94% at 1 year (95% confidence interval [95% CI], 92%-95%), 90% at 10 years (95% CI, 88%-92%), 85% at 15 years (95% CI, 82%-88%), and 74% at 20 years (95% CI, 67%-80%). Distinct risk factors were identified for early (≤1 year) and late composite outcomes. Independent risk factors for early outcome included prolonged pleural drainage (hazard ratio [HR], 4.4; P < .001), intensive care unit stay >1 week (HR, 2.4; P < .001), Fontan before 1997 (HR, 3.3; P < .001), preoperative atrioventricular valve regurgitation (HR, 2.0; P < .001), and longer crossclamp time (HR, 1.3 per 10 minutes; P < .001). Late outcome was predicted by atrioventricular valve regurgitation prior to Fontan (HR, 2.0; P ≤ .001), and post-Fontan ICU stay >1 week (HR, 2.4; P < .001). CONCLUSIONS: Long-term mortality after Fontan operation remains substantial. Risk factors for death or loss of Fontan circulation differ between the early and late postoperative periods. Long-term survival has not improved appreciably over the last decade, suggesting that alternatives to the Fontan are warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos