Factors associated with mortality or transplantation versus Fontan completion after cavopulmonary shunt for patients with tricuspid atresia.

Autor:	Callahan CP; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario Canada., Jegatheeswaran A; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario Canada., Barron DJ; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario Canada., Husain SA; Division of Pediatric Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah., Eghtesady P; Department of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St Louis, Mo., Welke KF; Division of Pediatric Cardiac Surgery, Levine Children's Hospital, Charlotte, NC., Caldarone CA; Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex., Overman DM; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, and Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, Minn., Kirklin JK; Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Ala., Jacobs ML; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md., Lambert LM; Division of Pediatric Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah., DeCampli WM; Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla., McCrindle BW; Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario Canada. Electronic address: Brian.mccrindle@sickkids.ca.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2022 Feb; Vol. 163 (2), pp. 399-409.e6. Date of Electronic Publication: 2021 Apr 30.
DOI:	10.1016/j.jtcvs.2021.04.061
Abstrakt:	Objective: Tricuspid atresia with normally related great vessels (TA) is considered the optimal substrate for the Fontan pathway. The factors associated with death or transplantation after cavopulmonary shunt (CPS) are underappreciated. We aimed to determine factors associated with CPS-Fontan interstage death/transplantation versus transition to Fontan in TA. Methods: A total of 417 infants younger than 3 months of age with TA were enrolled (January 1999 to February 2020) from 40 institutions into the Congenital Heart Surgeons' Society TA cohort. Parametric competing risk methodology was used to determine factors associated with the competing end points of death/transplantation without Fontan completion, and transition to Fontan. Results: CPS was performed in 382 patients with TA; of those, 5% died or underwent transplantation without transition to Fontan and 91% transitioned to Fontan by 5 years after CPS. Prenatal diagnosis (hazard ratio [HR], 0.74; P < .001) and pulmonary artery band (PAB) at CPS (HR, 0.50; P < .001) were negatively associated with Fontan completion. Preoperative moderate or greater mitral valve regurgitation (HR, 3.0; P < .001), concomitant mitral valve repair (HR, 11.0; P < .001), PAB at CPS (HR, 3.0; P < .001), postoperative superior vena cava interventions (HR, 9.0; P < .001), and CPS takedown (HR, 40.0; P < .001) were associated with death/transplantation. Conclusions: The mortality rate after CPS in patients with TA is notable. Those with preoperative mitral valve regurgitation remain a high-risk group. PAB at the time of CPS being associated with both increased risk of death and decreased Fontan completion may represent a deleterious effect of antegrade pulmonary blood flow in the CPS circulation. (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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