Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-20T04:54:19.948Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Thierry Sluysmans ,
Jean E. Rubay ,
Alain J. Poncelet  and
Mona Momeni
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: mona.momeni@uclouvain.be
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Fontanlong-term outcomenon-cardiac intervention
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015 , pp. 1148 - 1154
Copyright
© Cambridge University Press 2014 

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

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.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: 172–180.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: 344–353.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): 157–164.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: 1254–1261.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: 1389–1397.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: 1219–1228.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: 119–123.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: 199–206.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: 1291–1299.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: 37–46.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: 1178–1185.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: 237–245.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: 85–98.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: 40–47.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: e737S–e801S.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: 32–39.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: 645–651.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: 207–212.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: 180–187.Google Scholar