Kei Inai1, Ryo Inuzuka2, Hiroshi Ono3, Masaki Nii4, Shinichi Ohtsuki5, Yoshihiko Kurita5, Atsuhito Takeda6, Keiichi Hirono7, Kohta Takei8, Satoshi Yasukouchi8, Tadahiro Yoshikawa9, Yoshiyuki Furutani1, Eriko Shimada1, Tokuko Shinohara1, Tomohiro Shinozaki10, Yutaka Matsuyama11, Hideaki Senzaki12, Toshio Nakanishi1,13. 1. Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku, Tokyo 162-8666, Japan. 2. Department of Pediatrics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan. 3. Department of Cardiology, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya-ku, Tokyo 153-0074, Japan. 4. Department of Pediatric Cardiology, Shizuoka Children's Hospital, 860 Urushiyama, Shizuoka City 420-8660, Japan. 5. Department of Pediatric Cardiology, Okayama University, 2-5-1 Kita-ku, Okayama City 700-0914, Japan. 6. Department of Pediatrics, Hokkaido University, Kita 14, Nishi 5, Kita-ku, Sapporo 060-8648, Japan. 7. Department of Pediatrics, University of Toyama, 2630 Sugitani, Toyama City 930-0194, Japan. 8. Department of Pediatric Cardiology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano 399-8205, Japan. 9. Department of Pediatric Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-machi, Fuchu-shi, Tokyo 183-0003, Japan. 10. Faculty of Engineering, Department of Information and Computer Technology, Tokyo University of Science, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan. 11. Department of Biostatistics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan. 12. Department of Pediatrics, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan. 13. Sakakibara Heart Institute Clinics, Tokyo, Japan.
Abstract
AIMS: The criteria for 'good' Fontan haemodynamics have been poorly defined in relation to long-term outcomes. The aim of this study was to identify the risk factors for mortality among haemodynamic parameters obtained early after the Fontan operation. METHODS AND RESULTS: Clinical data of all perioperative survivors of the Fontan operation performed before 2011, from nine institutions, were collected through a retrospective chart review. In total, 1260 patients were included. The median age at the time of Fontan operation was 3.6 years. Post-operative cardiac catheterization was conducted in 1117 patients at a median period of 1.0 years after the operation. During the median follow-up period of 10.2 years, 107 patients died. The mortality rates at 10, 20, and 25 years after the operation were 5%, 12%, and 22%, respectively. On multivariable analysis, older age at the time of the operation {≥15 years, hazard ratio (HR) [95% confidence interval (CI)]: 3.2 (1.7-5.9)} and haemodynamic parameters obtained at post-operative catheterization, such as low ejection fraction [<30%, HR (95% CI): 7.5 (3.2-18)], low systemic oxygen saturation [<80%, HR (95% CI): 3.8 (1.6-9.1)], high central venous pressure [≥16 mmHg, HR (95% CI): 2.3 (1.3-3.9)], and low mean systemic arterial pressure [<60 mmHg, HR (95% CI): 3.0 (1.4-6.2)] were identified as independent predictors of mortality. The predictive model based on these parameters had a c-index of 0.75 at 10 years. CONCLUSIONS: Haemodynamic parameters obtained at a median period of 1.0 years, post-operatively, can accurately identify patients with a high mortality risk, who may need intensive management to improve long-term outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The criteria for 'good' Fontan haemodynamics have been poorly defined in relation to long-term outcomes. The aim of this study was to identify the risk factors for mortality among haemodynamic parameters obtained early after the Fontan operation. METHODS AND RESULTS: Clinical data of all perioperative survivors of the Fontan operation performed before 2011, from nine institutions, were collected through a retrospective chart review. In total, 1260 patients were included. The median age at the time of Fontan operation was 3.6 years. Post-operative cardiac catheterization was conducted in 1117 patients at a median period of 1.0 years after the operation. During the median follow-up period of 10.2 years, 107 patients died. The mortality rates at 10, 20, and 25 years after the operation were 5%, 12%, and 22%, respectively. On multivariable analysis, older age at the time of the operation {≥15 years, hazard ratio (HR) [95% confidence interval (CI)]: 3.2 (1.7-5.9)} and haemodynamic parameters obtained at post-operative catheterization, such as low ejection fraction [<30%, HR (95% CI): 7.5 (3.2-18)], low systemic oxygen saturation [<80%, HR (95% CI): 3.8 (1.6-9.1)], high central venous pressure [≥16 mmHg, HR (95% CI): 2.3 (1.3-3.9)], and low mean systemic arterial pressure [<60 mmHg, HR (95% CI): 3.0 (1.4-6.2)] were identified as independent predictors of mortality. The predictive model based on these parameters had a c-index of 0.75 at 10 years. CONCLUSIONS: Haemodynamic parameters obtained at a median period of 1.0 years, post-operatively, can accurately identify patients with a high mortality risk, who may need intensive management to improve long-term outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Ja-Kyoung Yoon; Gi Beom Kim; Mi Kyoung Song; Sang Yun Lee; Seong Ho Kim; So Ick Jang; Woong Han Kim; Chang-Ha Lee; Kyung Jin Ahn; Eun Jung Bae Journal: Korean Circ J Date: 2022-03-16 Impact factor: 3.101