Reintervention for arch obstruction after stage 1 reconstruction does not adversely affect survival or outcome at Fontan completion

Jean A. Ballweg, Troy E. Dominguez, Sarah Tabbutt, Jonathan J. Rome, J. William Gaynor, Susan C. Nicolson, Thomas L. Spray, Chitra Ravishankar

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objective: To determine the effect of reintervention for coarctation after stage 1 reconstruction for hypoplastic left heart syndrome and variants on survival, suitability for Fontan, and morbidity at Fontan. Methods: A retrospective review of echocardiograms, catheterizations, hospital records of patients who underwent stage 1 reconstruction from January 2002 to May 2005, with a cross-sectional analysis of hospital survivors, was performed. Kaplan-Meier curves were derived for patients alive more than 30 days after stage 1 reconstruction. Results: A total of 176 patients underwent stage 1 reconstruction. Forty-three patients (23%) underwent balloon angioplasty (n = 43) or surgical intervention (n = 4) for re-coarctation. Median time to intervention was 123 (1-316) days. Seven of 43 patients (16%) underwent more than 1 balloon angioplasty. Thirty-nine patients underwent intervention before stage 2 reconstruction, and 4 patients had intervention between stage 2 reconstruction and Fontan. Kaplan-Meier curves showed no difference in freedom from death or transplant between patients who did and did not undergo intervention for re-coarctation. Fontan completion was performed in 107 patients. By echocardiogram, the prevalence of moderate to severe ventricular dysfunction between groups was similar at Fontan; however, significant atrioventricular valve regurgitation was more common in patients who required intervention (28/33 vs 40/65, P = .02). Overall Fontan mortality was 2% and not different between groups. Length of stay was not different between patients with and without re-coarctation. Conclusions: Reintervention for coarctation after stage 1 reconstruction is common. Hemodynamic differences between groups did not affect Fontan completion, mortality, or hospital length of stay. Follow-up is necessary to determine the impact of re-coarctation on longer-term mortality and morbidity.

Original languageEnglish (US)
Pages (from-to)545-549
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number3
DOIs
StatePublished - Sep 2010

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Reintervention for arch obstruction after stage 1 reconstruction does not adversely affect survival or outcome at Fontan completion'. Together they form a unique fingerprint.

  • Cite this