Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery
| Autor: | Ali N. Zaidi, Blandine Mondésert, Azadeh Shohoudi, Craig S. Broberg, Nancy Poirier, Jennifer Ting, Annie Dore, Susan M. Fernandes, Robert M. Hamilton, Alexander R. Opotowsky, Paul Khairy, François-Pierre Mongeon, Scott Cohen, Catherine Deshaies, Jamil Aboulhosn, Stephen C. Cook, Anna Proietti, Joseph Kay, Anne Fournier, Helen Trottier |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty Adolescent medicine.medical_treatment Extracardiac conduit 030204 cardiovascular system & hematology Fontan Procedure Univentricular Heart Cohort Studies Fontan procedure Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Humans Medicine cardiovascular diseases 030212 general & internal medicine Young adult Child Retrospective Studies business.industry Arrhythmias Cardiac Retrospective cohort study Venous Thromboembolism Thromboembolic risk Cardiac surgery Surgery Transplantation Treatment Outcome Child Preschool cardiovascular system Female Cardiology and Cardiovascular Medicine business Follow-Up Studies Cohort study |
| Zdroj: | Journal of the American College of Cardiology. 74:1071-1081 |
| ISSN: | 0735-1097 |
| Popis: | Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts.This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk.A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complications and new-onset atrial arrhythmia were reviewed and classified by a blinded adjudicating committee. Thromboembolic risk across surgical techniques was assessed by multivariable competing-risk survival regression.Over a median follow-up of 11.6 years, 10- and 20-year freedom from Fontan conversion, transplantation, or death was 94.7% and 78.9%, respectively. New-onset atrial arrhythmias occurred in 4.4, 1.2, and 1.0 cases per 100 person-years with APC, LT, and EC, respectively. APC was associated with a 2.82-fold higher risk of developing atrial arrhythmias (p 0.001), with no difference between LT and EC (p = 0.95). A total of 71 thromboembolic events, 32 systemic and 39 venous, occurred in 12.8% of subjects, for an overall incidence of 1.1%/year. In multivariable analyses, EC was independently associated with a lower risk of systemic (hazard ratio [HR]: 0.20 vs. LT; 95% confidence interval [CI]: 0.04 to 0.97) and combined (HR: 0.34 vs. LT; 95% CI: 0.13 to 0.91) thromboembolic events. A lower incidence of combined thromboembolic events was also observed with antiplatelet agents (HR: 0.54; 95% CI: 0.32 to 0.92) but not anticoagulation (p = 0.53).The EC Fontan was independently associated with a lower thromboembolic risk after controlling for time-varying effects of atrial arrhythmias and thromboprophylaxis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|