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Predictors of prolonged pleural effusion after Fontan operation

Published online by Cambridge University Press:  13 March 2023

Betül Çınar*
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Sezen Ugan Atik
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Selman Gökalp
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Erman Çilsal
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Murat Şahin
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Hacer Kamalı
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
İsmihan Selen Onan
Affiliation:
Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Serhat Bahadır Genç
Affiliation:
Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Okan Yıldız
Affiliation:
Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Sertaç Haydin
Affiliation:
Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Kürşad Nuri Baydili
Affiliation:
Department of Biostatistics, University of Health Sciences, Istanbul, Turkey
Yakup Ergül
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
Alper Güzeltaş
Affiliation:
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 34303, Turkey
*
Author for correspondence: Betül ÇINAR, MD, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstasyon Mah.Turgut Özal Bulvarı No:11 Küçükçekmece, İstanbul, Turkey. Tel: +90 212 692 20 00 (4020)/ +90 554 792 30 66 (mobile); Fax: +90 212 471 94 94. E-mail: cinar_betul@hotmail.com

Abstract

Prolonged pleural effusion is a fairly common condition which has considerable impact on complicated and longer hospital stays after Fontan surgery. Identifying the patient population prone to have pleural effusions is still seeking for an answer. This study is to determine the variables that may predict prolonged pleural effusion according to the data of 69 patients who underwent Fontan operation between June 2018 and December 2020 and survived to date. Prolonged pleural effusion was defined as the need for a chest tube for more than 7 days. Two patient groups, with and without prolonged effusion, were compared in terms of pre-, peri-, and post-operative variables. The patients were subdivided into "high-risk" and "low-risk" groups based on the pre-operative catheterisation data. The most frequent main diagnosis was tricuspid atresia (n: 13, 19%). Among 69 patients, 28 (40%) had prolonged pleural effusion whereas 11 (16%) had effusions that lasted longer than 14 days. Ten patients among prolonged effusion group (35%) had pulmonary atresia coexistent with the main diagnosis. Fontan operation was performed in 6 patients (8.7%) over the age of 10, and 4 of these patients (67%) had prolonged pleural effusion. Among numerous variables, statistical significance between the two groups was achieved in pre-operative mean pulmonary artery pressure, post-operative albumin, C-reactive protein levels, length of hospital stay, duration of chest tube drainage, and amount of effusion per day. Early recognition and treatment strategies with routine medical protocol use remain to be the cornerstone for the management of post-operative prolonged pleural effusions after Fontan surgery.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Menon, S, Chennapragada, M, Ugaki, S, Sholler, GF, Ayer, J, Winlaw, DS. The lymphatic circulation in adaptations to the Fontan circulation. Pediatr Cardiol 2017; 38: 886892.CrossRefGoogle Scholar
Iyengar, AJ, Winlaw, DS, Galati, JC, et al. Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: the Australia and New Zealand Fontan Registry experience. J Thorac Cardiovasc Surg 2014; 148: 566575.CrossRefGoogle ScholarPubMed
Rogers, LS, Glatz, AC, Ravishankar, C, et al. 18 years of the fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol 2012; 60: 10181025.10.1016/j.jacc.2012.05.010CrossRefGoogle Scholar
Ergün, S, Yıldız, O, Ayyıldız, P, et al. Parameters affecting pleural drainage and management strategy after Fontan operation. J Cardiac Surg 2020; 35: 15561562.10.1111/jocs.14691CrossRefGoogle ScholarPubMed
Cava, JR, Bevandic, SM, Steltzer, MM, Tweddell, JS. A medical strategy to reduce persistent chest tube drainage after the Fontan operation. Am J Cardiol 2005; 96: 130133.10.1016/j.amjcard.2005.03.034CrossRefGoogle ScholarPubMed
Pike, NA, Okuhara, CA, Toyama, J, Gross, BP, Wells, WJ, Starnes, VA. Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol. J Thorac Cardiovasc Surg 2015; 150: 481487.CrossRefGoogle ScholarPubMed
Tran, DD, Le, TN, Vo, H-L. Predictors of prolonged pleural effusion after the extracardiac Fontan procedure: a 8-year single-center experience in resource-scare setting. Pediatr Cardiol 2021; 42: 8999.CrossRefGoogle ScholarPubMed
Rito, ML, Al-Radi, OO, Saedi, A, et al. Chylothorax and pleural effusion in contemporary extracardiac fenestrated Fontan completion. J Thorac Cardiovasc Surg 2018; 155: 20692077.CrossRefGoogle ScholarPubMed
Gupta, A, Daggett, C, Behera, S, Ferraro, M, Wells, W, Starnes, V. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg 2004; 127: 16641669.CrossRefGoogle ScholarPubMed
Kim, G, Ko, H, Byun, J-H, et al. Risk factors for prolonged pleural effusion after extracardiac Fontan operation. Pediatr Cardiol 2019; 40: 15451552.CrossRefGoogle ScholarPubMed
Ganigara, M, Prabhu, A, Varghese, R, Pavithran, S, Valliatu, J, Kumar, RNS. Extracardiac Fontan operation after late bidirectional Glenn shunt. Asian Cardiovasc Thorac Ann 2010; 18: 253259.CrossRefGoogle ScholarPubMed
Gaynor, JW, Bridges, ND, Cohen, MI, et al. Predictors of outcome after the Fontan operation: is hypoplastic left heart syndrome still a risk factor? J Thorac Cardiovasc Surg 2002; 123: 237245.CrossRefGoogle ScholarPubMed
Julsrud, PR, Weigel, TJ, Van Son, JA, et al. Influence of ventricular morphology on outcome after the Fontan procedure. Am J Cardiol 2000; 86: 319323.CrossRefGoogle ScholarPubMed
Podzolkov, VP, Chiaureli, MR, Yurlov, IA, et al. Results of Fontan operation in patients with atrioventricular valve regurgitation. Eur J Cardio-Thorac Surg 2015; 48: 308315.10.1093/ejcts/ezu489CrossRefGoogle ScholarPubMed
Sasaki, J, Dykes, JC, Sosa, LJ, et al. Risk factors for longer hospital stay following the Fontan operation. Pediatr Crit Care Med 2016; 17: 411419.CrossRefGoogle ScholarPubMed
Odenwald, T, Quail, MA, Giardini, A, et al. Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection. Heart 2012; 98: 934940.10.1136/heartjnl-2011-301599CrossRefGoogle ScholarPubMed
Lemler, MS, Scott, WA, Leonard, SR, Stromberg, D, Ramaciotti, C. Fenestration improves clinical outcome of the Fontan procedure: a prospective, randomized study. Circulation 2002; 105: 207212.10.1161/hc0202.102237CrossRefGoogle ScholarPubMed
Goldstein, SA, Beshish, AG, Bush, LB, et al. Analysis of inflammatory cytokines in postoperative Fontan pleural drainage. Pediatr Cardiol 2019; 40: 744752.CrossRefGoogle ScholarPubMed