Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay

FIGURE 1. Forest Plots of Factors Associated With Fontan Fenestration Forest plots generated by multivariable logistic regression for factors associated with Fontan fenestration. Additional factors included in the model but not shown are age at Fontan, sex, race, pulmonary vascular resistance index, and cardiac index. Due to co-linearity, separate models were created for mean pulmonary artery pressure, ventricular end diastolic pressure, and pulmonary vascular resistance index. The OR (◆) and 95% CIs (lines) are depicted with center and Fontan type (lateral tunnel) associated with fenestration. EDP = end diastolic pressure; LV = left ventricle; PA = pulmonary artery; PVRi = pulmonary vascular resistance index; RV = right ventricle.

FIGURE 2. Comparison of LOS Across mPAPs by Fenestration Restrictive cubic spline model demonstrating the postoperative LOS across the range of pre-Fontan mPAPs for those having a fenestration placed (orange) and those not having a fenestration placed (blue) with 95% CI displayed. LOS was shorter throughout the range of mPAPs with fenestration, but the greatest divergence was seen when mPAP was ≥13 mm Hg. LOS = length of stay; mPAP = mean pulmonary artery pressure.

FIGURE 3. LOS by Fenestration Group Stratified by mPAP Box and whisker plots demonstrating the post-Fontan LOS in days (log scale) for those with (orange) and without (blue) a fenestration placed at the time of Fontan (A) when mPAP was <13 mm Hg and (B) when mPAP was ≥13 mm Hg. Boxes represent the interquartile range and whiskers highest/lowest observation within fence (the interquartile ±1.5*IQR). Symbols (triangle and circle) inside the boxes represent the mean. Median LOS in fenestrated patients was not significantly lower than in nonfenestrated patients (8 vs 9 days, P = 0.25) (A) when mPAP was <13 mm Hg. When mPAP was ≥13 mm Hg median LOS was significantly shorter in fenestrated patients (9 vs 12 days, P = 0.01). LOS = length of stay; mPAP = mean pulmonary artery pressure.

CENTRAL ILLUSTRATION. Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay Among 704 patients undergoing the Fontan procedure, 66.7% were fenestrated and 33.7% were nonfenestrated Fontan procedures. Only center and Fontan type (lateral tunnel vs extracardiac conduit) were associated with fenestration, while hemodynamic measurements at cardiac catheterization <1 year prior to Fontan were not associated with fenestration. Postoperative LOS was shorter with fenestration across the range of mPAPs, but those with a pre-Fontan mPAP ≥13 mm Hg showed the most benefit with fenestration (median LOS 9 vs 12 days, P = 0.01). EDP = end-diastolic pressure; LOS = length of stay; mPAP = mean pulmonary artery pressure; PVRi = pulmonary vascular resistance index.