Repository logo
 
Publication

Surgical Options After Fontan Failure

2016-07-15Journal article Open access
Simple item page
dc.contributor.authorvan Melle, JP
dc.contributor.authorWolff, D
dc.contributor.authorHörer, J
dc.contributor.authorBelli, E
dc.contributor.authorMeyns, B
dc.contributor.authorPadalino, M
dc.contributor.authorLindberg, H
dc.contributor.authorJacobs, J
dc.contributor.authorMattila, I
dc.contributor.authorBerggren, H
dc.contributor.authorBerger, R
dc.contributor.authorPrêtre, R
dc.contributor.authorHazekamp, M
dc.contributor.authorHelvind, M
dc.contributor.authorNosál, M
dc.contributor.authorTlaskal, T
dc.contributor.authorRubay, J
dc.contributor.authorLazarov, S
dc.contributor.authorKadner, A
dc.contributor.authorHraska, V
dc.contributor.authorFragata, J
dc.contributor.authorPozzi, M
dc.contributor.authorSarris, G
dc.contributor.authorMichielon, G
dc.contributor.authordi Carlo, D
dc.contributor.authorEbels, T
dc.date.accessioned2016-08-12T11:38:11Z
dc.date.available2016-08-12T11:38:11Z
dc.date.issued2016-07-15
dc.description.abstractOBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04). CONCLUSIONS: Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.pt_PT
dc.identifier.citationHeart. 2016 Jul 15;102(14):1127-33pt_PT
dc.identifier.doi10.1136/heartjnl-2015-309235pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2552
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJ Publishing Grouppt_PT
dc.subjectHSM CCTpt_PT
dc.subjectFontan Procedure/adverse effectspt_PT
dc.subjectEuropept_PT
dc.subjectFontan Procedure/mortalitypt_PT
dc.subjectHeart Defects, Congenital/diagnosis
dc.subjectHeart Defects, Congenital/mortality
dc.subjectHeart Defects, Congenital/surgery
dc.subjectHeart Transplantation/adverse effects
dc.subjectHeart Transplantation/mortality
dc.subjectKaplan-Meier Estimate
dc.subjectPostoperative Complications/diagnosis
dc.subjectPostoperative Complications/mortality
dc.subjectPostoperative Complications/physiopathology
dc.subjectPostoperative Complications/surgery
dc.subjectProportional Hazards Models
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectTime Factors
dc.subjectTreatment Failure
dc.titleSurgical Options After Fontan Failurept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1133pt_PT
oaire.citation.issue14pt_PT
oaire.citation.startPage1127pt_PT
oaire.citation.titleHeartpt_PT
oaire.citation.volume102pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Heart 2016.pdf
Size:
469.34 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

CCT - Artigos