Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures

Alexander Egbe, Arooj R. Khan, Naser M. Ammash, David W. Barbara, William C. Oliver, Sameh M. Said, Emmanuel Akintoye, Carole A. Warnes, Heidi M. Connolly

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). Methods To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline. Results There were 538 NCPs in 154 Fontan patients (mean age, 30 years) performed in 1990-2015. Sedation and anaesthesia types were monitored anaesthesia care (256,48%), general anaesthesia (51,9%), minimal sedation (105,20%), local anaesthesia (75,14%) and regional anaesthesia (51,9%). Ninety-three complications occurred in 79 procedures (15%) and included arrhythmia requiring intervention (9), hypotension (14), bradycardia (8), hypoxia (38), heart failure requiring intravenous diuretics (2), acute kidney injury (3), bleeding requiring blood transfusion (1), unplanned procedures for dialysis catheter placement (2), readmission (2), unplanned hospitalisation for hypoxia (8) and unplanned transfer to intensive care unit (1). Baseline cyanosis was the only multivariable risk factor for complications (HR, 1.87 (95% CI 1.14 to 3.67), p=0.04). Procedural complications were more common in the Fontan group (18%) than in the CHD-BiV (5%) and NHD groups (1.4%) (p=0.001). Conclusions Complications after NCPs were more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low and may be related to the multidisciplinary care approach used for Fontan patients at our centre.

Original languageEnglish (US)
Pages (from-to)1813-1820
Number of pages8
JournalHeart
Volume103
Issue number22
DOIs
StatePublished - Nov 1 2017

Fingerprint

Cyanosis
Heart Diseases
Fontan Procedure
Anesthesia
Conduction Anesthesia
Local Anesthesia
Bradycardia
Diuretics
Acute Kidney Injury
Blood Transfusion
Hypotension
General Anesthesia
Intensive Care Units
Cardiac Arrhythmias
Dialysis
Hospitalization
Research Design
Catheters
Heart Failure
Hemorrhage

Keywords

  • congenital heart disease
  • mortality
  • noncardiac surgery
  • procedural complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Egbe, A., Khan, A. R., Ammash, N. M., Barbara, D. W., Oliver, W. C., Said, S. M., ... Connolly, H. M. (2017). Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures. Heart, 103(22), 1813-1820. https://doi.org/10.1136/heartjnl-2016-311039

Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures. / Egbe, Alexander; Khan, Arooj R.; Ammash, Naser M.; Barbara, David W.; Oliver, William C.; Said, Sameh M.; Akintoye, Emmanuel; Warnes, Carole A.; Connolly, Heidi M.

In: Heart, Vol. 103, No. 22, 01.11.2017, p. 1813-1820.

Research output: Contribution to journalArticle

Egbe, A, Khan, AR, Ammash, NM, Barbara, DW, Oliver, WC, Said, SM, Akintoye, E, Warnes, CA & Connolly, HM 2017, 'Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures', Heart, vol. 103, no. 22, pp. 1813-1820. https://doi.org/10.1136/heartjnl-2016-311039
Egbe, Alexander ; Khan, Arooj R. ; Ammash, Naser M. ; Barbara, David W. ; Oliver, William C. ; Said, Sameh M. ; Akintoye, Emmanuel ; Warnes, Carole A. ; Connolly, Heidi M. / Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures. In: Heart. 2017 ; Vol. 103, No. 22. pp. 1813-1820.
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abstract = "Objective Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). Methods To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90{\%} and procedural hypoxia as saturation <80{\%} or a decrease in saturation >10{\%} from baseline. Results There were 538 NCPs in 154 Fontan patients (mean age, 30 years) performed in 1990-2015. Sedation and anaesthesia types were monitored anaesthesia care (256,48{\%}), general anaesthesia (51,9{\%}), minimal sedation (105,20{\%}), local anaesthesia (75,14{\%}) and regional anaesthesia (51,9{\%}). Ninety-three complications occurred in 79 procedures (15{\%}) and included arrhythmia requiring intervention (9), hypotension (14), bradycardia (8), hypoxia (38), heart failure requiring intravenous diuretics (2), acute kidney injury (3), bleeding requiring blood transfusion (1), unplanned procedures for dialysis catheter placement (2), readmission (2), unplanned hospitalisation for hypoxia (8) and unplanned transfer to intensive care unit (1). Baseline cyanosis was the only multivariable risk factor for complications (HR, 1.87 (95{\%} CI 1.14 to 3.67), p=0.04). Procedural complications were more common in the Fontan group (18{\%}) than in the CHD-BiV (5{\%}) and NHD groups (1.4{\%}) (p=0.001). Conclusions Complications after NCPs were more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low and may be related to the multidisciplinary care approach used for Fontan patients at our centre.",
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AU - Khan, Arooj R.

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AU - Barbara, David W.

AU - Oliver, William C.

AU - Said, Sameh M.

AU - Akintoye, Emmanuel

AU - Warnes, Carole A.

AU - Connolly, Heidi M.

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N2 - Objective Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). Methods To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline. Results There were 538 NCPs in 154 Fontan patients (mean age, 30 years) performed in 1990-2015. Sedation and anaesthesia types were monitored anaesthesia care (256,48%), general anaesthesia (51,9%), minimal sedation (105,20%), local anaesthesia (75,14%) and regional anaesthesia (51,9%). Ninety-three complications occurred in 79 procedures (15%) and included arrhythmia requiring intervention (9), hypotension (14), bradycardia (8), hypoxia (38), heart failure requiring intravenous diuretics (2), acute kidney injury (3), bleeding requiring blood transfusion (1), unplanned procedures for dialysis catheter placement (2), readmission (2), unplanned hospitalisation for hypoxia (8) and unplanned transfer to intensive care unit (1). Baseline cyanosis was the only multivariable risk factor for complications (HR, 1.87 (95% CI 1.14 to 3.67), p=0.04). Procedural complications were more common in the Fontan group (18%) than in the CHD-BiV (5%) and NHD groups (1.4%) (p=0.001). Conclusions Complications after NCPs were more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low and may be related to the multidisciplinary care approach used for Fontan patients at our centre.

AB - Objective Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). Methods To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline. Results There were 538 NCPs in 154 Fontan patients (mean age, 30 years) performed in 1990-2015. Sedation and anaesthesia types were monitored anaesthesia care (256,48%), general anaesthesia (51,9%), minimal sedation (105,20%), local anaesthesia (75,14%) and regional anaesthesia (51,9%). Ninety-three complications occurred in 79 procedures (15%) and included arrhythmia requiring intervention (9), hypotension (14), bradycardia (8), hypoxia (38), heart failure requiring intravenous diuretics (2), acute kidney injury (3), bleeding requiring blood transfusion (1), unplanned procedures for dialysis catheter placement (2), readmission (2), unplanned hospitalisation for hypoxia (8) and unplanned transfer to intensive care unit (1). Baseline cyanosis was the only multivariable risk factor for complications (HR, 1.87 (95% CI 1.14 to 3.67), p=0.04). Procedural complications were more common in the Fontan group (18%) than in the CHD-BiV (5%) and NHD groups (1.4%) (p=0.001). Conclusions Complications after NCPs were more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low and may be related to the multidisciplinary care approach used for Fontan patients at our centre.

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KW - mortality

KW - noncardiac surgery

KW - procedural complications

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