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Additive value of invasive haemodynamic assessment for predicting post-operative outcomes after Fontan

Published online by Cambridge University Press:  27 August 2024

Kathleen P. Wood Open the ORCID record for Kathleen P. Wood [Opens in a new window] ,
Kristin E. Bonello ,
Sarah T. Plummer Open the ORCID record for Sarah T. Plummer [Opens in a new window] ,
Reid C. Chamberlain Open the ORCID record for Reid C. Chamberlain [Opens in a new window] ,
Greg A. Fleming ,
Michael G.W. Camitta  and
Kevin D. Hill Open the ORCID record for Kevin D. Hill [Opens in a new window]
Kathleen P. Wood*
Affiliation:
Department of Pediatrics, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
Kristin E. Bonello
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
Sarah T. Plummer
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Reid C. Chamberlain
Affiliation:
Department of Pediatrics, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
Greg A. Fleming
Affiliation:
Department of Pediatrics, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
Michael G.W. Camitta
Affiliation:
Department of Pediatrics, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA
*
Corresponding author: K. P. Wood; Email: kathleen.p.wood@duke.edu
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Abstract

Routine pre-Fontan cardiac catheterization remains standard practice at most centres. However, with advances in non-invasive risk assessment, an invasive haemodynamic assessment may not be necessary for all patients.

Using retrospective data from patients undergoing Fontan palliation at our institution, we developed a multivariable model to predict the likelihood of a composite adverse post-operative outcome including prolonged length of stay ≥ 30 days, hospital readmission within 6 months, and death and/or transplant within 6 months. Our baseline model included non-invasive risk factors obtained from clinical history and echocardiogram. We then incrementally incorporated invasive haemodynamic data to determine if these variables improved risk prediction.

Our baseline model correctly predicted favourable versus adverse post-Fontan outcomes in 118/174 (68%) patients. Covariates associated with adverse outcomes included the presence of a systemic right ventricle (adjusted adds ratio [aOR] 2.9; 95% CI 1.4, 5.8; p = 0.004), earlier surgical era (aOR 3.1 for era 1 vs 2; 95% CI 1.5, 6.5; p = 0.002), and performance of concomitant surgical procedures at the time of Fontan surgery (aOR 2.5; 95% CI 1.1, 5.0; p = 0.026). Incremental addition of invasively acquired haemodynamic data did not improve model performance or percentage of outcomes predicted.

Invasively acquired haemodynamic data does not add substantially to non-invasive risk stratification in the majority of patients. Pre-Fontan catheterization may still be beneficial for angiographic evaluation of anatomy, for therapeutic intervention, and in select patients with equivocal risk stratification.

Keywords

Fontancardiac catheterizationinvasive haemodynamicsnon-invasive imagingpost-operative outcomes
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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