Chris Schilling1, Kim Dalziel1, Russell Nunn2, Karin Du Plessis3, William Y Shi4, David Celermajer5, David Winlaw6, Robert G Weintraub7, Leanne E Grigg8, Dorothy J Radford9, Andrew Bullock10, Thomas L Gentles11, Gavin R Wheaton12, Tim Hornung11, Robert N Justo13, Yves d'Udekem14. 1. Centre for Health Policy, The University of Melbourne, 207 Bouverie St Carlton, Victoria 3051, Australia. 2. Department of Cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia. 3. Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. 4. Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 5. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Department of Medicine, The University of Sydney, New South Wales, Australia. 6. Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. 7. Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia. 8. Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. 9. Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Medicine, University of Queensland, Brisbane, Australia. 10. Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. 11. Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand. 12. Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia. 13. Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Queensland, Australia. 14. Department of Cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: yves.dudekem@rch.org.au.
Abstract
BACKGROUND: The number and age demographic of the future Fontan population is unknown. METHODS: Population projections were calculated probabilistically using microsimulation. Mortality hazard rates for each Fontan recipient were calculated from survivorship of 1353 Fontan recipients in the Australia and New Zealand Fontan Registry, based on Fontan type, age at Fontan, gender and morphology. Projected rates of new Fontan procedures were generated from historical rates of Fontan procedures per population births. RESULTS: At the end of 2014, the living Fontan population of Australia and New Zealand was 1265 people from an Australian and New Zealand regional population of 28 million (4.5 per 100,000 population). Of those, 165 (13%) received an atrio-pulmonary (AP) procedure, 262 (21%) a lateral tunnel (LT) procedure and 838 (66%) an extra-cardiac conduit (ECC) procedure. This population is expected to grow to 1917 (95% CI: 1846: 1986) by 2025 (5.8 per 100,000 population), with 149 (8%) AP procedures, 254 (13%) LT procedures, and 1514 (79%) ECC procedures. By 2045, the living Fontan population is expected to reach 2986 (95% CI: 2877: 3085; 7.2 per 100,000 population). The average age of the Fontan population is expected to increase from 18years in 2014 to 23years (95% CI: 22-23) by 2025, and 31years (95% CI: 30-31) by 2045. CONCLUSION: The Australian and New Zealand population of patients alive after a Fontan procedure will double over the next 20years increasing the demand for heart-failure services and cardiac transplantation. Greater consideration for the needs of this mostly adult Fontan population will be necessary.
BACKGROUND: The number and age demographic of the future Fontan population is unknown. METHODS: Population projections were calculated probabilistically using microsimulation. Mortality hazard rates for each Fontan recipient were calculated from survivorship of 1353 Fontan recipients in the Australia and New Zealand Fontan Registry, based on Fontan type, age at Fontan, gender and morphology. Projected rates of new Fontan procedures were generated from historical rates of Fontan procedures per population births. RESULTS: At the end of 2014, the living Fontan population of Australia and New Zealand was 1265 people from an Australian and New Zealand regional population of 28 million (4.5 per 100,000 population). Of those, 165 (13%) received an atrio-pulmonary (AP) procedure, 262 (21%) a lateral tunnel (LT) procedure and 838 (66%) an extra-cardiac conduit (ECC) procedure. This population is expected to grow to 1917 (95% CI: 1846: 1986) by 2025 (5.8 per 100,000 population), with 149 (8%) AP procedures, 254 (13%) LT procedures, and 1514 (79%) ECC procedures. By 2045, the living Fontan population is expected to reach 2986 (95% CI: 2877: 3085; 7.2 per 100,000 population). The average age of the Fontan population is expected to increase from 18years in 2014 to 23years (95% CI: 22-23) by 2025, and 31years (95% CI: 30-31) by 2045. CONCLUSION: The Australian and New Zealand population of patients alive after a Fontan procedure will double over the next 20years increasing the demand for heart-failure services and cardiac transplantation. Greater consideration for the needs of this mostly adult Fontan population will be necessary.
Authors: Andrew M Atz; Victor Zak; Lynn Mahony; Karen Uzark; Nicholas D'agincourt; David J Goldberg; Richard V Williams; Roger E Breitbart; Steven D Colan; Kristin M Burns; Renee Margossian; Heather T Henderson; Rosalind Korsin; Bradley S Marino; Kaitlyn Daniels; Brian W McCrindle Journal: J Am Coll Cardiol Date: 2017-06-06 Impact factor: 24.094
Authors: Nigel E Drury; Victoria M Stoll; Chris J Bond; Akshay J Patel; Suzie Hutchinson; Paul F Clift Journal: Cardiol Young Date: 2018-12-21 Impact factor: 1.093