149. Alarming rate of liver cirrhosis after the small conduit Extracardiac Fontan. A comparative analysis with the Lateral Tunnel.
Presented During: Congenital Rapid Fire Orals
Children's National Hospital
Washington, DC
United States - Contact Me
Eiri Kisamori is a pediatric cardiac surgery fellow at Children's National Hospital in DC.
Sunday, April 28, 2024: 11:43 AM - 11:50 AM
7 Minutes
Metro Toronto Convention Center
Room: Room 716
Description
Objective: Liver cirrhosis is a well-recognized complication following the Fontan procedure. However, the association between the prevalence of cirrhosis and the types of Fontan operations remains unclear.
Methods: We conducted a retrospective chart review of 332 patients who underwent the Fontan procedure at our institution between November 1989 and July 2021. Four patients who underwent the atriopulmonary connection Fontan were excluded from the analysis. Patients who had intracardiac-extracardiac conduit (126) were pooled with those having extracardiac conduit (ECC) (134) as the conduit went from the IVC to the pulmonary arteries. The 260 patients who underwent the ECC and the 68 who had the lateral tunnel (LT) Fontan constitute the core of the study. Diagnosis of liver cirrhosis was based on histopathology from liver biopsy or elastography.
Results: Patients who underwent the LT and the ECC Fontan shared the same characteristics. Median age at the Fontan procedure was 23.7 months (interquartile range [IQR]: 20.8-32.6) in the LT group, compared to 28.8 months (IQR: 24.6-39.5) in the ECC group (p<0.01). F
enestration rates were 96% (65) in the LT group and 84.6% (220) in the ECC group. The conduit size was reported in 258 patients: 10 mm (1); 12 mm (2); 14 mm (25);16 mm (187); 18 mm (9); 19 mm (24) and 20 mm (10). The median follow-up was 14.8 years (IQR: 12.5-16.5) in the lateral tunnel group and 7 years (IQR: 2.8-10.4) in the extracardiac conduit group. During the follow-up period, two patients (2.9%) with LT and 15 (5.8%) in the with ECC (9 patients with 16 mm or less conduit size) were diagnosed with cirrhosis. The prevalence of cirrhosis at 1, 5, 10, and 15 years was 0%, 0%, 0%, and 2.4% in the lateral tunnel group, respectively, and 0%, 0.9%, 7.6% and 26.8% in the extracardiac conduit group (p<0.01 Figure). Rates of mortality, Fontan revision, Fontan takedown, and transplant were comparable between the two groups.
Conclusions: The Extracardiac Conduit Fontan seem to be associated with faster development of cirrhosis, especially in patients implanted with small conduits.
Authors
Eiri Kisamori (1), Alyssia Venna (1), Rahul Rajeev (1), Manan Desai (1), Aybala Tongut (1), Rittal Mehta (1), Sarah Clauss (1), Can Yerebakan (1), Yves d’Udekem (1)
Institutions
(1) Children's National Hospital, Washington, DC
Methods: We conducted a retrospective chart review of 332 patients who underwent the Fontan procedure at our institution between November 1989 and July 2021. Four patients who underwent the atriopulmonary connection Fontan were excluded from the analysis. Patients who had intracardiac-extracardiac conduit (126) were pooled with those having extracardiac conduit (ECC) (134) as the conduit went from the IVC to the pulmonary arteries. The 260 patients who underwent the ECC and the 68 who had the lateral tunnel (LT) Fontan constitute the core of the study. Diagnosis of liver cirrhosis was based on histopathology from liver biopsy or elastography.
Results: Patients who underwent the LT and the ECC Fontan shared the same characteristics. Median age at the Fontan procedure was 23.7 months (interquartile range [IQR]: 20.8-32.6) in the LT group, compared to 28.8 months (IQR: 24.6-39.5) in the ECC group (p<0.01). F
enestration rates were 96% (65) in the LT group and 84.6% (220) in the ECC group. The conduit size was reported in 258 patients: 10 mm (1); 12 mm (2); 14 mm (25);16 mm (187); 18 mm (9); 19 mm (24) and 20 mm (10). The median follow-up was 14.8 years (IQR: 12.5-16.5) in the lateral tunnel group and 7 years (IQR: 2.8-10.4) in the extracardiac conduit group. During the follow-up period, two patients (2.9%) with LT and 15 (5.8%) in the with ECC (9 patients with 16 mm or less conduit size) were diagnosed with cirrhosis. The prevalence of cirrhosis at 1, 5, 10, and 15 years was 0%, 0%, 0%, and 2.4% in the lateral tunnel group, respectively, and 0%, 0.9%, 7.6% and 26.8% in the extracardiac conduit group (p<0.01 Figure). Rates of mortality, Fontan revision, Fontan takedown, and transplant were comparable between the two groups.
Conclusions: The Extracardiac Conduit Fontan seem to be associated with faster development of cirrhosis, especially in patients implanted with small conduits.
Authors
Eiri Kisamori (1), Alyssia Venna (1), Rahul Rajeev (1), Manan Desai (1), Aybala Tongut (1), Rittal Mehta (1), Sarah Clauss (1), Can Yerebakan (1), Yves d’Udekem (1)
Institutions
(1) Children's National Hospital, Washington, DC
Presentation Duration
You will have a 4 minute presentation followed by 3 minutes of discussion from the audience. All presenters must adhere to the presentation and discussion times provided. The AATS will begin to play music once your speaking time is exceeded.