Key result
The intra/extracardiac fenestrated Fontan procedure resulted in a statistically significant increase in end diastolic pressure from 9.29 mmHg to 10.33 mmHg, alongside increases in pulmonary artery and left atrial pressures.
Why the study?
Does the intra/extracardiac fenestrated Fontan procedure alter hemodynamics and arrhythmia incidence in patients requiring a Fontan completion?
Observational (n=14)
No
Does the intra/extracardiac fenestrated Fontan procedure alter hemodynamics and arrhythmia incidence in patients requiring a Fontan completion?
Absolute Event Rate: 10.33% vs 9.29%
p-value: p=<0.05
The intra/extracardiac fenestrated Fontan procedure is associated with statistically significant changes in hemodynamics and a notable incidence of postoperative arrhythmias, though the clinical implications require further study.
May elevate filling pressures post-Fontan; leaves open long-term clinical impact and need for controlled trials.
Background: The primary concern of the Fontan procedure has been atrial arrhythmias, but little attention has been given to hemodynamic changes. This study’s purpose was to examine the hemodynamics and arrhythmias of the Intra/extracardiac fenestrated Fontan, and determine any advantages/disadvantages of this newer Fontan procedure. Methods: Patients undergoing the intra/ extracardiac fenestrated Fontan procedure at this institute between December 2009 and June 2017 were included in this retrospective evaluation of preoperative and postoperative hemodynamics during cardiac catheterization. End Diastolic Pressure (EDP), Pulmonary Artery Pressure (PAP), Left Atrial Pressure (LAP), and Transpulmonary Gradient (TPG) were the hemodynamic markers of interest. Occurrence of arrhythmias was also examined preoperatively, less than 2 weeks postoperatively, and greater than 2 weeks postoperatively. Morbidities and mortalities were also evaluated. Results: Fourteen patients underwent the procedure between December 2009 and June 2017. Preoperative data was available in all of these patients. Postoperative data was partially incomplete for atrial arrhythmias and hemodynamic data. EDP rose from 9.29 ± 3.50 mmHg to 10.33 ± 3.12 mmHg. PAP rose from 12.57 ± 2.50 mmHg to 14.27 mmHg. TPG dropped from 5.00 ± 2.29 mmHg to 3.25 ± 1.67 mmHg. LAP rose from 7.57 ± 2.87 mmHg to 10.30 ± 1.95 mmHg. Atrioventricular valve (AVV) regurgitation remained the same pre and postoperatively. 8 of 13 patients developed arrhythmias at less than 2 weeks postoperatively, and 5 of 12 patients developed arrhythmias at greater than 2 weeks postoperatively. There were no morbidities or mortalities. Conclusions: We found a statistically significant change in EDP, PAP, LAP, and TPG levels. It is unclear whether this is an advantage or disadvantage. The significance of these changes is unclear in this small population of patients. Further evaluation of hemodynamics, arrhythmias, morbidities and mortalities associated with the intra/extracardiac Fontan procedure is needed.
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Menon et al. (2018) conducted an observational in Functionally Univentricular Heart / Congenital Heart Disease (n=14). Intra/extracardiac fenestrated Fontan procedure vs. Preoperative baseline was evaluated on End Diastolic Pressure (EDP) (95% CI 1.04 ± 0.837, p=<0.05). The intra/extracardiac fenestrated Fontan procedure resulted in a statistically significant increase in end diastolic pressure from 9.29 mmHg to 10.33 mmHg, alongside increases in pulmonary artery and left atrial pressures.
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