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Extracardiac Versus Lateral Tunnel Fontan: A Meta-Analysis of Long-Term Results

Published on Mar 1, 2019in The Annals of Thoracic Surgery3.919
· DOI :10.1016/j.athoracsur.2018.08.041
Walid Ben Ali4
Estimated H-index: 4
(MHI: Montreal Heart Institute),
Ismail Bouhout9
Estimated H-index: 9
(MHI: Montreal Heart Institute)
+ 2 AuthorsNancy Poirier23
Estimated H-index: 23
(MHI: Montreal Heart Institute)
Abstract
Background There is growing awareness of the long-term impact of a Fontan circulation on the associated morbidity and mortality. Comparative data on the incidence of supraventricular arrhythmia and sinus node dysfunction following extracardiac conduit (EC) and lateral tunnel (LT) Fontans are controversial. We performed a meta-analysis pooling all available long-term results comparing the EC and LT Fontan, with a special focus on arrhythmia. Methods We performed a systematic search of PubMed, Embase, and the Cochrane Library for articles reporting long-term results of Fontan comparing the EC and the LT Fontan. Results Twelve studies were selected with 3,330 patients (1,729 EC, 1,601 LT). Freedom from tachyarrhythmia was significantly higher in the EC group (92% versus 83% at 15 years; p Conclusions The EC Fontan confers long-term survival advantage over the LT Fontan without a higher rate of reoperations. The EC Fontan preserves the sinus node function and reduces significantly the incidence of long-term postoperative arrhythmia.
  • References (29)
  • Citations (3)
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References29
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#1Emily QuintonH-Index: 1
#2Peter NightingaleH-Index: 48
Last. Joseph De BonoH-Index: 9
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#1Larissa Shamseer (Ottawa Hospital Research Institute)H-Index: 24
#2David MoherH-Index: 100
Last. Lesley A. Stewart (Ebor: University of York)H-Index: 45
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Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is...
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#1Yves d ’UdekemH-Index: 30
#2Ajay J. IyengarH-Index: 15
Last. David S. WinlawH-Index: 29
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Background—The life expectancy of patients undergoing a Fontan procedure is unknown. Methods and Results—Follow-up of all 1006 survivors of the 1089 patients who underwent a Fontan procedure in Australia and New Zealand was obtained from a binational population-based registry including all pediatric and adult cardiac centers. There were 203 atriopulmonary connections (AP; 1975–1995), 271 lateral tunnels (1988–2006), and 532 extracardiac conduits (1997–2010). The proportion with hypoplastic left ...
203 CitationsSource
#1Seshadri Balaji (OHSU: Oregon Health & Science University)H-Index: 27
#2Ankana Daga (UPenn: University of Pennsylvania)H-Index: 8
Last. Maully J. Shah (UPenn: University of Pennsylvania)H-Index: 22
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Objective The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan. Methods This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 ye...
48 CitationsSource
#1Katrien De Vadder (Katholieke Universiteit Leuven)H-Index: 1
#2Alexander Van De Bruaene (Katholieke Universiteit Leuven)H-Index: 13
Last. Werner Budts (Katholieke Universiteit Leuven)H-Index: 42
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Background The Fontan procedure has become the procedure of choice for patients with one functional ventricle. Although perioperative mortality has decreased, late failure of the Fontan circulation remains a major concern. We aimed at (i) describing Fontan patient characteristics and (ii) identifying simple risk factors for outcome.Methods Seventy-three patients (median age 23 y (IQR 19-29 y), 60.3% male) were selected from the database of congenital heart defects. Followup data were collected. ...
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#1Pranava Sinha (Children's National Medical Center)H-Index: 9
#2David Zurakowski (Boston Children's Hospital)H-Index: 100
Last. Richard A. Jonas (Children's National Medical Center)H-Index: 82
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Objective The study objective was to compare the incidence of short- and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure. Methods We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac cond...
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#1Paul Khairy (MHI: Montreal Heart Institute)H-Index: 45
#2Nancy Poirier (MHI: Montreal Heart Institute)H-Index: 23
> “In theory, theory and practice are the same. In practice, they are not.” > > —Albert Einstein There is, perhaps, no disease entity that better exemplifies the complexities, challenges, and creative innovations characteristic of the evolution in congenital heart disease care than the univentricular heart. The univentricular heart encompasses an array of uncommon and severe inborn cardiac malformations that share a similar physiology, with pulmonary and systemic venous return predominantly dire...
35 CitationsSource
#1Patricia Guyot (UoB: University of Bristol)H-Index: 3
#2Ae Ades (UoB: University of Bristol)H-Index: 61
Last. Nicky J Welton (UoB: University of Bristol)H-Index: 45
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Background The results of Randomized Controlled Trials (RCTs) on time-to-event outcomes that are usually reported are median time to events and Cox Hazard Ratio. These do not constitute the sufficient statistics required for meta-analysis or cost-effectiveness analysis, and their use in secondary analyses requires strong assumptions that may not have been adequately tested. In order to enhance the quality of secondary data analyses, we propose a method which derives from the published Kaplan Mei...
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#1Hideo OhuchiH-Index: 22
#2Koji KagisakiH-Index: 20
Last. Toshikatsu YagiharaH-Index: 35
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Background Postoperative mortality has decreased in patients undergoing the Fontan operation, and the determinants of such mortality may also have changed significantly. Methods We conducted a study intended to focus on clarifying the determinants of mortality in 405 consecutive patients who had undergone a Fontan operation (62 patients after an atriopulmonary connection, 105 after an intra-atrial rerouting, and 238 patients after an extracardiac rerouting) between 1979 and 2010. Results The ove...
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#1Jeremy P. Moore (UCLA: University of California, Los Angeles)H-Index: 9
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Abstract Background Though at lower risk, patients with prior extracardiac conduit (EC) Fontan still may require catheter ablation for supraventricular arrhythmia. Objective To determine the optimal approach to pulmonary venous access (PVA) after EC Fontan operation. Methods All electrophysiologic procedures requiring PVA over a 10-year period at the UCLA Medical Center were reviewed. PVA was grouped by transcaval (TCP) or direct conduit puncture. Procedural characteristics and outcomes were com...
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#1Viktoria Weixler (Boston Children's Hospital)H-Index: 1
#2David Zurakowski (Boston Children's Hospital)H-Index: 100
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Structured Abstract Objectives The study aim was to compare Fontan patients undergoing lateral tunnel (LT) vs. extracardiac conduit (ECC) technique. Methods Fontan patients (LT vs. ECC) from 01/2000 – 12/2017 were analyzed retrospectively. Baseline characteristics were analyzed as covariates. Primary outcomes (mortality, Fontan failure, thrombosis, pacemaker implantation) were compared using time-to-event models. Subgroup analysis including only initially-fenestrated cases and propensity score m...
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#1Simone Goa Diab (Oslo University Hospital)
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#1Catherine Deshaies (UdeM: Université de Montréal)H-Index: 1
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#1Paul Khairy (MHI: Montreal Heart Institute)H-Index: 45
Abstract The expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between two subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebste...
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