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Long-term outcome and anaesthetic management for non-cardiac surgery after Fontan palliation: a single-centre retrospective analysis

Published online by Cambridge University Press:  23 September 2014

Thomas Palumbo
Affiliation:
Department of Anesthesiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Thierry Sluysmans
Affiliation:
Department of Pediatric Cardiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Jean E. Rubay
Affiliation:
Department of Cardiac Surgery; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Alain J. Poncelet
Affiliation:
Department of Cardiac Surgery; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Mona Momeni*
Affiliation:
Department of Anesthesiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
*
Correspondence to: M. Momeni, MD, PhD, Department of Anesthesiology, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10/1821, 1200 Brussels, Belgium. Tel: +322 764 7029; Fax: +322 764 3699; E-mail: [email protected]

Abstract

Objectives: The improved management of Fontan patients has resulted in good outcome. As such, these patients may necessitate care for non-cardiac surgery. We sought to determine the long-term outcome of our Fontan series palliated with the most recent surgical techniques. Our second objective was to report the incidence and the perioperative course after non-cardiac procedures. We reviewed the records of all patients with either a lateral tunnel or an extracardiac conduit Fontan between 1996 and 2008. Follow-up was recorded until June, 2013, including records regarding non-cardiac interventions. Results: Overall, 58 patients were included. Of them, one patient underwent a takedown of his Fontan, and five patients died in the immediate postoperative course. The cumulative survival of the remaining 52 patients was 81%. There was no significant difference in survival between right and left ventricle morphologies (p=0.56), nor between both types of Fontan (p=0.9). Chronic arrhythmias (25%), fatigue/dyspnoea (40%), thrombotic complications (19%), and embolic events (10%) were among the most recurrent comorbidities. In total, 45 non-cardiac interventions were performed on 26 patients, with three bleeding complications and one death. Conclusions: This study shows excellent long-term survival after both lateral tunnel and extracardiac conduit Fontan. The incidence of cardiovascular morbidity remains high, however. We also report a high number of non-cardiac interventions. Thorough understanding of the Fontan physiology is mandatory when non-cardiac anaesthesiologists are in charge of these patients.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

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References

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240248.CrossRefGoogle ScholarPubMed
2. Mitchell, ME, Ittenbach, RF, Gaynor, JW, Wernovsky, G, Nicolson, S, Spray, TL. Intermediate outcomes after the Fontan procedure in the current era. J Thorac Cardiovasc Surg 2006; 131: 172180.CrossRefGoogle ScholarPubMed
3. Hosein, R, Clarke, A, McGuirk, S, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The “Two Commandments”? Eur J Cardiothorac Surg 2007; 31: 344353.Google Scholar
4. d’Udekem, Y, Iyengar, AJ, Cochrane, AD, et al. The Fontan procedure: contemporary techniques have improved long-term outcomes. Circulation 2007; 116 (Suppl 11): 157164.CrossRefGoogle ScholarPubMed
5. Stewart, RD, Pasquali, SK, Jacobs, JP, et al. Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection. Ann Thorac Surg 2012; 93: 12541261.Google Scholar
6. Kumar, SP, Rubinstein, CS, Simsic, JM, Taylor, AB, Saul, JP, Bradley, SM. Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. Ann Thorac Surg 2003; 76: 13891397.Google Scholar
7. Azakie, A, McCrindle, BW, Van Arsdell, G, et al. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 2001; 122: 12191228.CrossRefGoogle Scholar
8. Siebenmann, R, von Segesser, L, Schneider, K, Schneider, J, Senning, A, Turina, M. Late failure of systemic ventricle after atrial correction for transposition of great arteries. Eur J Cardiothorac Surg 1989; 3: 119123.CrossRefGoogle ScholarPubMed
9. Termignon, JL, Leca, F, Vouhé, PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg 1996; 62: 199206.Google Scholar
10. Tweddell, JS, Nersesian, M, Mussatto, KA, et al. Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 2009; 88: 12911299.Google Scholar
11. McGuirk, SP, Winlaw, DS, Langley, SM, et al. The impact of ventricular morphology on midterm outcome following completion total cavopulmonary connection. Eur J Cardiothorac Surg 2003; 24: 3746.Google Scholar
12. d’Udekem, Y, Xu, MY, Galati, JC, et al. Predictors of survival after single-ventricle palliation: the impact of right ventricle dominance. J Am Coll Cardiol 2012; 59: 11781185.CrossRefGoogle ScholarPubMed
13. Gaynor, JW, Bridges, ND, Cohen, MI, et al. Predictors of outcome after the Fontan palliation: is hypoplastic left heart syndrome still a risk factor? J Thorac Cardiovsc Surg 2002; 123: 237245.Google Scholar
14. Anderson, PA, Sleeper, LA, Mahony, L, et al. Contemporary outcomes after the Fontan procedure. a pediatric heart network multicenter study. J Am Coll Cardiol 2008; 52: 8598.CrossRefGoogle ScholarPubMed
15. Grewal, J, Al Hussein, M, Feldstein, J, et al. Evaluation of silent thrombus after the Fontan operation. Congenit Heart Dis 2013; 8: 4047.CrossRefGoogle ScholarPubMed
16. Monagle, P, Chan, AK, Goldenberg, NA, et al. American College of Chest Physicians. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians. evidence − based clinical practice guidelines. Chest 2012; 141: e737Se801S.Google Scholar
17. Morrone, C, Galasso, G, Piccolo, R, et al. Antiplatelet versus anticoagulation therapy after extracardiac conduit Fontan: a systematic review and meta-analysis. Pediatr Cardiol 2011; 32: 3239.CrossRefGoogle Scholar
18. Monagle, P, Cochrane, A, Roberts, R, et al. A multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children. J Am Coll Cardiol 2011; 58: 645651.Google Scholar
19. Lemler, MS, Scott, WA, Leonard, SR, Stromberg, D, Ramaciotti, C. Fenestration improves clinical outcome of the fontan procedure: a prospective, randomized study. Circulation 2002; 105: 207212.Google Scholar
20. Rabbitts, JA, Groenewald, CB, Mauermann, WJ, et al. Outcomes of general anesthesia for noncardiac surgery in a series of patients with Fontan palliation. Paediatr Anaesth 2013; 23: 180187.Google Scholar