Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T06:52:54.292Z Has data issue: false hasContentIssue false
  • English
  • Français

Fontan completion during winter season is not associated with higher mortality or morbidity in the early post-operative period

Published online by Cambridge University Press:  13 April 2020

Sarah Nordmeyer Open the ORCID record for Sarah Nordmeyer [Opens in a new window] ,
Sabeth Krettek ,
Johannes Nordmeyer ,
Marie Schafstedde ,
Konstantin Rehm ,
Joachim Photiadis ,
Felix Berger  and
Stanislav Ovroutski
Sarah Nordmeyer*
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Sabeth Krettek
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Johannes Nordmeyer
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Marie Schafstedde
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Konstantin Rehm
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Joachim Photiadis
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Surgery – Pediatric Heart Surgery, Berlin, Germany
Felix Berger
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
Stanislav Ovroutski
Affiliation:
German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Berlin, Germany
*
Address for correspondence: S. Nordmeyer, MD, German Heart Center Berlin, Department of Congenital Heart Disease – Pediatric Cardiology, Augustenburger Platz 1, 13353Berlin, Germany. Tel: +49 30 4593 2800; Fax: +49 30 4593 2900. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

The aim of our study was to compare post-operative outcome after total cavopulmonary connection between patients operated during winter and summer season.

Methods:

We retrospectively studied 211 patients who underwent extracardiac total cavopulmonary connection completion at our institution between 1995 and 2015 (median age 4 (1–42) years). Seventy (33%) patients were operated during winter (November to March) and 141 (67%) patients during summer season (April to October).

Results:

Patients operated during winter and summer season showed no difference in early mortality (7% versus 5%, p = 0.52) and severe morbidity like need for early Fontan takedown (1% versus 1%, p = 0.99) and need for mechanical circulatory support (9% versus 4%, p = 0.12). The post-operative course and haemodynamic outcome were comparable between both groups of patients (ICU (4 versus 3 days, p = 0.44) and hospital stay (15 versus 14 days, p = 0.28), prolonged pleural effusions (36% versus 31%, p = 0.51), need for dialysis (16% versus 11%, p = 0.37), ascites (37% versus 33%, p = 0.52), supraventricular tachyarrhythmia (16% versus 13%, p = 0.56) and chylothorax (26% versus 16%, p = 0.12), change of antibiotic treatment (47% versus 36%, p = 0.06), prolonged inotropic support (24% versus 14%, p = 0.05), intubation time (15 versus 12 hours, p = 0.33), and incidence of fast-track extubation (11% versus 22%, p = 0.06).

Conclusion:

Outcomes after total cavopulmonary connection completion during winter and summer season were comparably related to mortality, severe morbidity, or longer hospital stay in the early post-operative period. These results suggest that total cavopulmonary connection completion during winter season is as safe as during summer season.

Keywords

Total cavopulmonary connectionwinter seasonearly post-operative outcome
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 629 - 632
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fedderly, RT, Whitstone, BN, Frisbee, SJ, Tweddell, JS, Litwin, SB.Factors related to pleural effusions after Fontan procedure in the era of fenestration. Circulation 2001; 104: I148–I151.CrossRefGoogle ScholarPubMed
Nicolas, RT, Hills, C, Moller, JH, Huddleston, CB, Johnson, MC.Early outcome after Glenn shunt and Fontan palliation and the impact of operation during viral respiratory season: analysis of a 19-year multi-institutional experience. Ann Thorac Surg 2005; 79: 613–617.CrossRefGoogle ScholarPubMed
Spaeder, MC, Carson, KA, Vricella, LA, Alejo, DE, Holmes, KW.Impact of the viral respiratory season on postoperative outcomes in children undergoing cardiac surgery. Pediatr Cardiol 2011; 32(6): 801–806.10.1007/s00246-011-9985-9CrossRefGoogle ScholarPubMed
Salam, S, Dominguez, T, Tsang, V, Giardini, A.Longer hospital stay after Fontan completion in the November to March period. Eur J Cardiothorac Surg 2015; 47(2): 262–268.10.1093/ejcts/ezu134CrossRefGoogle ScholarPubMed
Fontan, F, Baudet, E.Surgical repair of tricuspid atresia. Thorax 1971; 26(3): 240–248.10.1136/thx.26.3.240CrossRefGoogle ScholarPubMed
Alexi-Meskishvili, V, Ovroutski, S, Dahnert, I, Lange, PE, Hetzer, R.Early experience with extracardiac Fontan operation. Ann Thorac Surg 2001; 71(1): 71–76.10.1016/S0003-4975(00)02069-5CrossRefGoogle ScholarPubMed
Gaynor, JW, Bridges, ND, Cohen, MI, et al.Predictors of outcome after the Fontan operation: is hypoplastic left heart syndrome still a risk factor? J Thorac Cardiovasc Surg 2002; 123(2): 237–245.10.1067/mtc.2002.119337CrossRefGoogle ScholarPubMed
Pizarro, C, Mroczek, T, Gidding, SS, Murphy, JD, Norwood, WI.Fontan completion in infants. Ann Thorac Surg 2006; 81(6): 2243–2248.10.1016/j.athoracsur.2006.01.016CrossRefGoogle ScholarPubMed
Rogers, LS, Glatz, AC, Ravishankar, C, et al.18 years of the Fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol 2012; 60(11): 1018–1025.10.1016/j.jacc.2012.05.010CrossRefGoogle Scholar
Ovroutski, S, Sohn, C, Barikbin, P, et al.Analysis of the risk factors for early failure after extracardiac Fontan operation. Ann Thorac Surg 2013; 95(4): 1409–1416.10.1016/j.athoracsur.2012.12.042CrossRefGoogle ScholarPubMed
Salvin, JW, Scheurer, MA, Laussen, PC, et al.Factors associated with prolonged recovery after the fontan operation. Circulation 2008; 118(14): S171–S176.10.1161/CIRCULATIONAHA.107.750596CrossRefGoogle ScholarPubMed
Tweddell, JS, Nersesian, M, Mussatto, KA, et al.Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 2009; 88(4): 1291–1299.10.1016/j.athoracsur.2009.05.076CrossRefGoogle ScholarPubMed
Sreeram, N, Watson, JG, Hunter, S.Cardiovascular effects of acute bronchiolitis. Acta Paediatr Scand 1991; 80(1): 133–136.CrossRefGoogle ScholarPubMed
Marcelletti, C, Corno, A, Giannico, S, Marino, B.Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg 1990; 100(2): 228–232.10.1016/S0022-5223(19)35562-XCrossRefGoogle ScholarPubMed
Laschinger, JC, Ringel, RE, Brenner, JI, McLaughlin, JS.The extracardiac total cavopulmonary connection for definitive conversion to the Fontan circulation: summary of early experience and results. J Card Surg 1993; 8(5): 524–533.10.1111/j.1540-8191.1993.tb00407.xCrossRefGoogle ScholarPubMed
Alexi-Meskishvili, V, Ovroutski, S, Ewert, P, et al.Optimal conduit size for extracardiac Fontan operation. Eur J Cardiothorac Surg 2000; 18(6): 690–695.10.1016/S1010-7940(00)00593-5CrossRefGoogle ScholarPubMed
Nordmeyer, S, Rohder, M, Nordmeyer, J, et al.Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care? Eur J Cardiothorac Surg 2017; 51(3): 483–489.Google Scholar