Impact of aortopulmonary and venovenous collaterals on the onset of plastic bronchitis after the Fontan procedure.

Osawa, Takuya; Schaeffer, Thibault; Schmiel, Mervin; Hoa Nguyen Cong, Michelle Bao; Niedermaier, Carolin; Heinisch, Paul Philipp; Piber, Nicole; Georgiev, Stanimir; Hager, Alfred; Ewert, Peter; Hörer, Jürgen; Ono, Masamichi

doi:10.1016/j.jtcvs.2024.09.049

Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)

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Titel:: Impact of aortopulmonary and venovenous collaterals on the onset of plastic bronchitis after the Fontan procedure.
Dokumenttyp:: Journal Article
Autor(en):: Osawa, Takuya; Schaeffer, Thibault; Schmiel, Mervin; Hoa Nguyen Cong, Michelle Bao; Niedermaier, Carolin; Heinisch, Paul Philipp; Piber, Nicole; Georgiev, Stanimir; Hager, Alfred; Ewert, Peter; Hörer, Jürgen; Ono, Masamichi
Abstract:: OBJECTIVE: To clarify the association of the aortopulmonary collaterals (APCs)/venovenous collateral (VVCs) in patients with plastic bronchitis (PB) after the Fontan procedure. METHODS: All patients who underwent total cavopulmonary connection from 1994 to 2022 were reviewed. APCs/VVCs were detected using angiography. The impact of APC/VVCs, as well as other variables on the onset of plastic bronchitis, was evaluated. RESULTS: A total of 635 patients were included. Plastic bronchitis was observed in 15 (2.4%) patients, and the median duration between total cavopulmonary connection and the onset of plastic bronchitis was 1.1 years. Freedom from PB at 5 and 10 years was 97.5% and 96.5%, respectively. As for the association of PB and APCs/VVCs, patients with PB had an increased incidence of post-total cavopulmonary connection APCs (60% vs 14%, P < .001) and VVCs (53% vs 14%, P < .001). Freedom from PB was the lowest in the patients who were associated with both APCs and VVCs after total cavopulmonary connection. APCs after total cavopulmonary connection (P = .002; hazard ratio, 5.729), VVCs after total cavopulmonary connection (P = .016; hazard ratio, 3.527), and chylothorax (P = .019; hazard ratio, 3.662) were identified as independently associated factors with the onset of PB. CONCLUSIONS: The occurrence of post-Fontan APCs and VVCs was significantly associated with the development of PB. Treatment or mitigation of collaterals may represent an opportunity to prevent the development of PB, a remaining source of post-Fontan excess morbidity and mortality.
Zeitschriftentitel:: J Thorac Cardiovasc Surg
Jahr:: 2025
Band / Volume:: 169
Heft / Issue:: 4
Seitenangaben Beitrag:: 1070-1079.e3
Volltext / DOI:: doi:10.1016/j.jtcvs.2024.09.049
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/39384081
Print-ISSN:: 0022-5223
TUM Einrichtung:: 592; Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (DHM) (Prof. Hörer); Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)
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