S M Bradley1, M M McCall, J J Sistino, W A Radtke. 1. Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425, USA. bradlesm@musc.edu
Abstract
BACKGROUND: The effects of aortopulmonary collaterals (APCs) on the outcome of a Fontan procedure are unclear. We undertook this study to define the incidence and extent of APC flow, identify risk factors for APC flow, and determine if APC flow has a measurable effect on the outcome of a Fontan procedure. METHODS: The APC flow was directly measured in 32 patients undergoing Fontan procedures from July 1997 to September 2000. The APC flow was measured in the operating room during total cardiopulmonary bypass, and was expressed as a percentage of total bypass pump flow. RESULTS: The APC flow ranged from 9% to 49% of total pump flow (median, 18%). Higher preoperative systemic oxygen saturation, pulmonary artery oxygen saturation, pulmonary to systemic flow ratio, and angiographic APC grade correlated with higher APC flow. There were no operative deaths; there was one Fontan takedown (APC flow = 14%). The APC flow had no significant effects on postoperative Fontan pressure, common atrial pressure, transpulmonary gradient, duration of effusions, or resource utilization after the Fontan procedures. CONCLUSIONS: In patients undergoing a Fontan procedure, APC flow is omnipresent, although its extent varies widely. Increased APC flow has no significant effect on the outcome of a Fontan procedure. This conclusion applies to patients who are well prepared for a Fontan procedure, but may not extend to patients at higher risk.
BACKGROUND: The effects of aortopulmonary collaterals (APCs) on the outcome of a Fontan procedure are unclear. We undertook this study to define the incidence and extent of APC flow, identify risk factors for APC flow, and determine if APC flow has a measurable effect on the outcome of a Fontan procedure. METHODS: The APC flow was directly measured in 32 patients undergoing Fontan procedures from July 1997 to September 2000. The APC flow was measured in the operating room during total cardiopulmonary bypass, and was expressed as a percentage of total bypass pump flow. RESULTS: The APC flow ranged from 9% to 49% of total pump flow (median, 18%). Higher preoperative systemic oxygen saturation, pulmonary artery oxygen saturation, pulmonary to systemic flow ratio, and angiographic APC grade correlated with higher APC flow. There were no operative deaths; there was one Fontan takedown (APC flow = 14%). The APC flow had no significant effects on postoperative Fontan pressure, common atrial pressure, transpulmonary gradient, duration of effusions, or resource utilization after the Fontan procedures. CONCLUSIONS: In patients undergoing a Fontan procedure, APC flow is omnipresent, although its extent varies widely. Increased APC flow has no significant effect on the outcome of a Fontan procedure. This conclusion applies to patients who are well prepared for a Fontan procedure, but may not extend to patients at higher risk.
Authors: Puja Banka; Doff B McElhinney; Emile A Bacha; John E Mayer; Kimberlee Gauvreau; Tal Geva; David W Brown Journal: Pediatr Cardiol Date: 2010-05-26 Impact factor: 1.655
Authors: Kevin K Whitehead; Matthew A Harris; Andrew C Glatz; Matthew J Gillespie; Michael V DiMaria; Neil E Harrison; Yoav Dori; Marc S Keller; Jonathan J Rome; Mark A Fogel Journal: Am J Cardiol Date: 2015-03-24 Impact factor: 2.778
Authors: Mark A Fogel; Christine Li; Felice Wilson; Tom Pawlowski; Susan C Nicolson; Lisa M Montenegro; Laura Diaz Berenstein; Thomas L Spray; J William Gaynor; Stephanie Fuller; Marc S Keller; Matthew A Harris; Kevin K Whitehead; Robert Clancy; Okan Elci; Jim Bethel; Arastoo Vossough; Daniel J Licht Journal: Heart Date: 2015-06-05 Impact factor: 5.994
Authors: Puja Banka; Lynn A Sleeper; Andrew M Atz; Collin G Cowley; Dianne Gallagher; Matthew J Gillespie; Eric M Graham; Renee Margossian; Brian W McCrindle; Charlie J Sang; Ismee A Williams; Jane W Newburger Journal: Am Heart J Date: 2011-07 Impact factor: 4.749
Authors: Jeffrey A Feinstein; D Woodrow Benson; Anne M Dubin; Meryl S Cohen; Dawn M Maxey; William T Mahle; Elfriede Pahl; Juan Villafañe; Ami B Bhatt; Lynn F Peng; Beth Ann Johnson; Alison L Marsden; Curt J Daniels; Nancy A Rudd; Christopher A Caldarone; Kathleen A Mussatto; David L Morales; D Dunbar Ivy; J William Gaynor; James S Tweddell; Barbara J Deal; Anke K Furck; Geoffrey L Rosenthal; Richard G Ohye; Nancy S Ghanayem; John P Cheatham; Wayne Tworetzky; Gerard R Martin Journal: J Am Coll Cardiol Date: 2012-01-03 Impact factor: 24.094
Authors: Andrew C Glatz; Jonathan J Rome; Adam J Small; Matthew J Gillespie; Yoav Dori; Matthew A Harris; Marc S Keller; Mark A Fogel; Kevin K Whitehead Journal: Circ Cardiovasc Imaging Date: 2012-01-06 Impact factor: 7.792
Authors: Tristan D Margetson; Justin Sleasman; Sami Kollmann; Patrick J McCarthy; Ozzie Jahadi; Don Sheff; Paul Shuttleworth; Richard D Mainwaring; Frank L Hanley Journal: J Extra Corpor Technol Date: 2019-09