Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival

Joseph T. Poterucha, Jonathan N. Johnson, Nathan W. Taggart, Allison K. Cabalka, Donald J. Hagler, David J. Driscoll, Frank Cetta

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. Design: We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Results: Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43%). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21%) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18mmHg. Five-year survival of patients with VVCs undergoing embolization was 74% compared with 92% in those patients who did not undergo embolization (P < 01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95% confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95% CI, 1.4-15], P = 01), and heterotaxy (HR = 3.7 [95% CI, 1.0-15], P = .05). Conclusion: We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18mmHg. These patients may benefit from the "natural" fenestration that VVCs provide.

Original languageEnglish (US)
Pages (from-to)E230-E236
JournalCongenital Heart Disease
Volume10
Issue number5
DOIs
StatePublished - Sep 1 2015

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Fontan Procedure
Survival
Confidence Intervals
Catheterization
Hemodynamics
Pressure
Lung
Cardiac Catheterization

Keywords

  • Adult Congenital Heart Disease
  • Embolization
  • Fontan
  • Veno-venous Collaterals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Poterucha, J. T., Johnson, J. N., Taggart, N. W., Cabalka, A. K., Hagler, D. J., Driscoll, D. J., & Cetta, F. (2015). Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival. Congenital Heart Disease, 10(5), E230-E236. https://doi.org/10.1111/chd.12276

Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival. / Poterucha, Joseph T.; Johnson, Jonathan N.; Taggart, Nathan W.; Cabalka, Allison K.; Hagler, Donald J.; Driscoll, David J.; Cetta, Frank.

In: Congenital Heart Disease, Vol. 10, No. 5, 01.09.2015, p. E230-E236.

Research output: Contribution to journalArticle

Poterucha, JT, Johnson, JN, Taggart, NW, Cabalka, AK, Hagler, DJ, Driscoll, DJ & Cetta, F 2015, 'Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival', Congenital Heart Disease, vol. 10, no. 5, pp. E230-E236. https://doi.org/10.1111/chd.12276
Poterucha JT, Johnson JN, Taggart NW, Cabalka AK, Hagler DJ, Driscoll DJ et al. Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival. Congenital Heart Disease. 2015 Sep 1;10(5):E230-E236. https://doi.org/10.1111/chd.12276
Poterucha, Joseph T. ; Johnson, Jonathan N. ; Taggart, Nathan W. ; Cabalka, Allison K. ; Hagler, Donald J. ; Driscoll, David J. ; Cetta, Frank. / Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival. In: Congenital Heart Disease. 2015 ; Vol. 10, No. 5. pp. E230-E236.
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abstract = "Objective: After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. Design: We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Results: Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43{\%}). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21{\%}) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18mmHg. Five-year survival of patients with VVCs undergoing embolization was 74{\%} compared with 92{\%} in those patients who did not undergo embolization (P < 01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95{\%} confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95{\%} CI, 1.4-15], P = 01), and heterotaxy (HR = 3.7 [95{\%} CI, 1.0-15], P = .05). Conclusion: We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18mmHg. These patients may benefit from the {"}natural{"} fenestration that VVCs provide.",
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AU - Johnson, Jonathan N.

AU - Taggart, Nathan W.

AU - Cabalka, Allison K.

AU - Hagler, Donald J.

AU - Driscoll, David J.

AU - Cetta, Frank

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N2 - Objective: After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. Design: We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Results: Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43%). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21%) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18mmHg. Five-year survival of patients with VVCs undergoing embolization was 74% compared with 92% in those patients who did not undergo embolization (P < 01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95% confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95% CI, 1.4-15], P = 01), and heterotaxy (HR = 3.7 [95% CI, 1.0-15], P = .05). Conclusion: We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18mmHg. These patients may benefit from the "natural" fenestration that VVCs provide.

AB - Objective: After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. Design: We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Results: Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43%). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21%) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18mmHg. Five-year survival of patients with VVCs undergoing embolization was 74% compared with 92% in those patients who did not undergo embolization (P < 01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95% confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95% CI, 1.4-15], P = 01), and heterotaxy (HR = 3.7 [95% CI, 1.0-15], P = .05). Conclusion: We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18mmHg. These patients may benefit from the "natural" fenestration that VVCs provide.

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KW - Embolization

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KW - Veno-venous Collaterals

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