Practice variability and outcomes of coil embolization of aortopulmonary collaterals before fontan completion: A report from the Pediatric Heart Network Fontan Cross-Sectional Study

• Published in: The American heart journal 2011-07, Vol.162 (1), p.125-130
• Main Authors: Banka, Puja, MD, Sleeper, Lynn A., ScD, Atz, Andrew M., MD, Cowley, Collin G., MD, Gallagher, Dianne, MS, Gillespie, Matthew J., MD, Graham, Eric M., MD, Margossian, Renee, MD, McCrindle, Brian W., MD, MPH, Sang, Charlie J., MD, Williams, Ismee A., MD, MS, Newburger, Jane W., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Cardiovascular; Child; Child, Preschool; Collateral Circulation; Cross-Sectional Studies; Echocardiography; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Fontan Procedure; Gender; Heart; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Hospitalization; Hospitals; Humans; Intubation; Length of Stay; Male; Medical sciences; Mortality; Older people; Preoperative Care - methods; Pulmonary Artery; Questionnaires; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Studies; Surgery; Surgical outcomes; Thoracic Arteries; Thrombosis; Treatment Outcome; Variables; Ventricular Function, Left
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2011.03.021

Background The practice of coiling aortopulmonary collaterals (APCs) before Fontan completion is controversial, and published data are limited. We sought to compare outcomes in subjects with and without pre-Fontan coil embolization of APCs using the Pediatric Heart Network Fontan Cross-Sectional Study database which enrolled survivors of prior Fontan palliation. Methods We compared hospital length of stay after Fontan in 80 subjects who underwent APC coiling with 459 subjects who did not. Secondary outcomes included post-Fontan complications and assessment of health status and ventricular performance at cross-sectional evaluation (mean 8.6 ± 3.4 years after Fontan). Results Centers varied markedly in frequency of pre-Fontan APC coiling (range 0%-30% of subjects, P < .001). The coil group was older at Fontan ( P = .004) and more likely to have single right ventricular morphology ( P = .054) and pre-Fontan atrioventricular valve regurgitation ( P = .03). The coil group underwent Fontan surgery more recently ( P < .001), was more likely to have a prior superior cavopulmonary anastomosis ( P < .001), and more likely to undergo extracardiac Fontan connection ( P < .001) and surgical fenestration ( P < .001). In multivariable analyses, APC coiling was not associated with length of stay (hazard ratio for remaining in-hospital 0.91, 95% CI 0.70-1.18, P = .48) or postoperative complications, except more post-Fontan catheter interventions (hazard ratio 1.74, 95% CI 1.04-2.91, P = .03), primarily additional APC coils. The groups had similar outcomes at cross-sectional evaluation. Conclusion Management of APCs before Fontan shows marked practice variation. We did not find an association between pre-Fontan coiling of APCs and shorter postoperative hospital stay or with better late outcomes. Prospective studies of this practice are needed.