Author + information
- Alexander C. Egbe,
- Heidi Connolly,
- Carole Warnes,
- Arooj Khan and
- Sameh Said
Background: Limited data exist about the outcomes of non-cardiac procedures (NCP) in Fontan patients.
Methods: Retrospective review of NCPs in adult Fontan patients performed at Mayo Clinic, 1990-2015. To describe procedural outcomes after NCP in Fontan patients, and compare outcomes to two control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD).
We matched the procedure in the Fontan patients to similar procedures in CHD-BiV patients and NHD patients. The controls were matched by age (±5 years), gender, procedure type, and year of procedure (±5 years). Cyanosis defined as saturation <90%. Procedural hypoxia defined as saturation <80% or a drop in saturation >10% from baseline.
Results: 154 adult Fontan patients underwent 538 NCPs, age 30±8 years. The most common procedures were esophagogastroduodenoscopy 135(25%), dental extraction 50(9%), and bronchoscopy 35(7%). The following types of sedation and anesthesia were used: moderate/deep sedation in 256 (48%), general anesthesia in 51(10%), minimal sedation in 105 (20%), local anesthesia 75 (14%), and regional anesthesia in 51 (9%) procedures.
There were 93 procedural complications in 79 procedures (15%). These complications were (arrhythmia requiring intervention 9, hypotension 14, bradycardia 8, hypoxia 38, heart failure requiring intravenous diuretics 2, acute renal failure 3, bleeding requiring blood transfusion 1, unplanned procedures for placement dialysis lines 2, readmission within 72 hours, unplanned hospitalization for hypoxia 8, and unplanned transfer to intensive care unit 1). Baseline cyanosis was the only multivariable risk factor for procedural complications (HR 1.87, 95% CI 1.14-3.67, P=0.04).
Matched cohorts of 282 procedures were selected for each group. Procedural complications were more common in the Fontan group (18%) compared to the CHD-BiV group (5%) and NHD group (1.4%), P<0.001.
Conclusions: Complications after NCPs was more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low presumably because of a multi-disciplinary care approach used in this center.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:00 a.m.-11:10 a.m.
Session Title: Congenital Heart Disease: To the Third Decade and Beyond
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1131M-11
- 2017 American College of Cardiology Foundation