Predictors of protein losing enteropathy after Fontan completion: An 8-year retrospective study at Sheikh Khalifa Medical City.

Autor: AbdelMassih AF; Pediatric Cardiology unit, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.; Pediatric Cardiology Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Kiraly L; Pediatric Cardiac Surgery at Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital., Badaoui HE; Pediatric Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE., Khan M; Pediatric Cardiology Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Hetharsi B; Pediatric Cardiac Intensive Care Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Till JN; Pediatric Cardiac Intensive Care Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Omelchenko AY; Pediatric Cardiac surgery Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Salah AZ; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Jburi FTA; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Alkhouli L; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Taher M; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Alhosani N; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Youssef O; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Iqbal S; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Allami Z; Pediatrics' Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Jha NK; Pediatric Cardiac surgery Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Hamad EM; Pediatric Cardiac Intensive Care Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Omar Y; Pediatric Cardiology unit, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt., Khan A; Pediatric Echocardiography, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Azeez Z; Pediatric Cardiology Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Attia M; Cardiology department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Mina M; Pediatrics' department, Danat Al Emarat Hospital for Women & Children, Abu Dhabi, UAE., Ali AA; Pediatric Cardiac Intensive Care Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE., Afifi YK; Yas Clinic Group, Abu Dhabi, UAE., Shershaby ME; Pediatric Cardiology unit, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt., Musleh A; Pediatric Cardiology Division, Cardiac Sciences' department, Sheikh Khalifa Medical City, Abu Dhabi, UAE.
Jazyk: angličtina
Zdroj: Global cardiology science & practice [Glob Cardiol Sci Pract] 2023 Aug 01; Vol. 2023 (3), pp. e202317. Date of Electronic Publication: 2023 Aug 01 (Print Publication: 2023).
DOI: 10.21542/gcsp.2023.17
Abstrakt: Background: The Fontan procedure is the final stage of a three-stage palliation process in patients born with a univentricular heart as part of hypoplastic left heart syndrome (HLHS) or other pathologies with a univentricular heart. As essential as this procedure has proven to be for such cases, the Fontan physiology diminishes cardiac output and expands systemic venous pressure, which then leads to venous congestion that can be complicated by protein-losing enteropathy (PLE). This retrospective study aimed to identify the predictors of such complications in all patients who underwent completion of the Fontan procedure at our center (Sheikh Khalifa Medical City/SKMC) in the past eight years.
Methods: This study examined the medical records of patients who underwent completion of Fontan repair at our center since the inauguration of the cardiac surgery program of SKMC in the United Arab Emirates (UAE) - 01 Jan 2012 to 31 Dec 2020. Exclusion criteria included the absence of any of the undermentioned data in patient files. Patients were divided into two groups: those who developed PLE and those who did not. For each group, the following data were collected: demographics data (current age and age at completion of Fontan), clinical and laboratory data (oxygen saturation, serum albumin), echocardiographic data (classification of original cardiac diagnosis, degree of atrio-ventricular valve regurgitation, ventricular functions), hemodynamic data (mean pressures of superior vena cava and pulmonary arteries before Fontan completion), operative data (type of initial palliation, type of Fontan, presence of fenestrations and its size) and the need for any cardiac intervention prior to Fontan completion, such as atrio-ventricular valve repair, peripheral pulmonary stenting and arch balloon dilatation.
Results: Of the 48 included patients,13 (25%) developed PLE. Multivariate regression analysis proved that the best predictors of PLE were superior vena cava mean pressure ( P  = 0.012) and the degree of atrio-ventricular valve regurgitation ( P  = 0.013). An oxygen saturation <83% prior to Fontan completion was 92% sensitive in predicting PLE after Fontan completion.
Conclusion: This is a single-center study of the predictors of PLE after Fontan procedure and, as expected from similar studies, SVC pressure higher than 11 mmHg and moderate-to-severe atrio-ventricular valve regurgitation were predictors of Fontan failure. The higher prevalence of PLE in our cohort, as well as lower cut-offs of SVC pressure that can predict complications, may be related to the predominance of hypoplastic left heart in the operated patients, which has been the main referral center for cardiac surgeries in UAE in the last decade.
(Copyright ©2023 The Author(s).)
Databáze: MEDLINE
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