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- Document type:
- Journal Article
- Author(s):
- Kido, Takashi; Stern, Christoph; Heinisch, Paul Philipp; Burri, Melchior; Vodiskar, Janez; Strbad, Martina; Cleuziou, Julie; Ruf, Bettina; Ewert, Peter; Hager, Alfred; Hörer, Jürgen; Ono, Masamichi
- Title:
- The impact of pulmonary artery size on midterm outcomes after nonfenestrated Fontan operation.
- Abstract:
- OBJECTIVE: We sought to identify the impact of pulmonary artery size on outcomes after nonfenestrated total cavopulmonary connection. In a subgroup of patients with right-sided bidirectional cavopulmonary shunt, the impact of each branch pulmonary artery size was individually determined. METHODS: The medical records of all patients who underwent nonfenestrated total cavopulmonary connection between 2009 and 2021 were reviewed. The pulmonary artery index was calculated using angiography before the operation. RESULTS: A total of 247 patients were included in this study. A right-sided bidirectional cavopulmonary shunt was performed in 217 patients (88%). Median pulmonary artery index was 162 (133-207) mm2/m2 before total cavopulmonary connection. Chylothorax occurred in 55 patients (22%). Pulmonary artery index was an independent factor for chylothorax (odds ratio, 0.98, 95% confidence interval, 0.97-0.99, P < .001) with a cutoff value of 170 mm2/m2. In a subgroup of patients with right-sided bidirectional cavopulmonary shunt, the left pulmonary artery index was identified as an independent risk factor for longer stay in the intensive care unit (coefficient B -0.02, 95% confidence interval, -0.04 to -0.002, P = .034) and for adverse events (hazard ratio, 0.98, 95% confidence interval, 0.96-0.99, P = .011) with a cutoff value of 56 mm2/m2. CONCLUSIONS: The pulmonary artery index is significantly associated with the occurrence of chylothorax after nonfenestrated total cavopulmonary connection with a cutoff value of 170 mm2/m2. In patients with right-sided bidirectional cavopulmonary shunt, left pulmonary artery index has a significant predictive value for longer stay in the intensive care unit and adverse events with a cutoff value of 56 mm2/m2.
- Journal title abbreviation:
- J Thorac Cardiovasc Surg
- Year:
- 2023
- Journal volume:
- 165
- Journal issue:
- 5
- Pages contribution:
- 1651-1660.e2
- Fulltext / DOI:
- doi:10.1016/j.jtcvs.2022.08.025
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/36220701
- Print-ISSN:
- 0022-5223
- TUM Institution:
- Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (Prof. Hörer); Klinik für Herz- und Gefäßchirurgie (Prof. Lange)
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