Practice variability and outcomes of coil embolization of aortopulmonary collaterals before fontan completion: A report from the Pediatric Heart Network Fontan Cross-Sectional Study - 06/08/11
, Lynn A. Sleeper, ScD b, i, Andrew M. Atz, MD c, i, Collin G. Cowley, MD d, i, Dianne Gallagher, MS b, i, Matthew J. Gillespie, MD e, i, Eric M. Graham, MD c, i, Renee Margossian, MD a, i, Brian W. McCrindle, MD, MPH f, i, Charlie J. Sang, MD g, i, Ismee A. Williams, MD, MS h, i, Jane W. Newburger, MD, MPH a, iRésumé |
Background |
The practice of coiling aortopulmonary collaterals (APCs) before Fontan completion is controversial, and published data are limited. We sought to compare outcomes in subjects with and without pre-Fontan coil embolization of APCs using the Pediatric Heart Network Fontan Cross-Sectional Study database which enrolled survivors of prior Fontan palliation.
Methods |
We compared hospital length of stay after Fontan in 80 subjects who underwent APC coiling with 459 subjects who did not. Secondary outcomes included post-Fontan complications and assessment of health status and ventricular performance at cross-sectional evaluation (mean 8.6 ± 3.4 years after Fontan).
Results |
Centers varied markedly in frequency of pre-Fontan APC coiling (range 0%-30% of subjects, P < .001). The coil group was older at Fontan (P = .004) and more likely to have single right ventricular morphology (P = .054) and pre-Fontan atrioventricular valve regurgitation (P = .03). The coil group underwent Fontan surgery more recently (P < .001), was more likely to have a prior superior cavopulmonary anastomosis (P < .001), and more likely to undergo extracardiac Fontan connection (P < .001) and surgical fenestration (P < .001). In multivariable analyses, APC coiling was not associated with length of stay (hazard ratio for remaining in-hospital 0.91, 95% CI 0.70-1.18, P = .48) or postoperative complications, except more post-Fontan catheter interventions (hazard ratio 1.74, 95% CI 1.04-2.91, P = .03), primarily additional APC coils. The groups had similar outcomes at cross-sectional evaluation.
Conclusion |
Management of APCs before Fontan shows marked practice variation. We did not find an association between pre-Fontan coiling of APCs and shorter postoperative hospital stay or with better late outcomes. Prospective studies of this practice are needed.
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| Funding sources: This publication was made possible by grant numbers HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, and HL068288 from the National Heart Lung and Blood Institute. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI or NIH. |
Vol 162 - N° 1
P. 125-130 - juillet 2011 Retour au numéro
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