Medium-term outcomes of Kawashima and completion Fontan palliation in single-ventricle heart disease with heterotaxy and interrupted inferior vena Cava

Shelby Kutty, Michele A. Frommelt, David Alan Danford, James S. Tweddell

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Abstract

Background We investigated medium-term outcomes in single-ventricle heart disease palliated with a Kawashima procedure (KP) compared with matched patients who had a standard Fontan procedure (FP). Methods Clinical characteristics, oxygen saturation as measured by pulse oximetry (Spo2) trends, and survival in 18 KP cases were compared with 36 matched controls who underwent a standard FP. Records of surgical procedures, catheterizations, noninvasive imaging, and clinical follow-up were reviewed. Results The median duration of follow-up after KP was 6.7 years. The mean Spo2 (%) in the KP group over the follow-up period before completion Fontan was 85.1 ± 6, and differed significantly from the control FP group (90.7 ± 5.1, p < 0.001). Thirteen of the 18 KP patients underwent completion Fontan at a median age of 3.3 years (1.1 to 8.6) and median interval of 2.61 years (0.61 to 7.35) after KP. Mean Spo2 after completion Fontan following KP was 88.7 ± 7.6%. The Spo2 in Fontan after KP was not as high as after control FP. Low Spo2 with upward trend was noted throughout the postoperative follow-up. The overall survival in the KP group after Fontan estimated by the Kaplan-Meier method was 87% at 5 years and at 7 years. Conclusions The KP and subsequent Fontan completion results in acceptable medium-term survival, and remains the approach of choice for single-ventricle heart disease with interrupted inferior vena cava. The KP has to be undertaken with expectation for somewhat lower early Spo2 relative to standard Fontan patients, but in anticipation that Spo2 is likely to rise gradually with time.

Original languageEnglish (US)
Pages (from-to)1609-1613
Number of pages5
JournalAnnals of Thoracic Surgery
Volume90
Issue number5
DOIs
StatePublished - Jan 1 2010

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Inferior Vena Cava
Heart Diseases
Fontan Procedure
Survival
Oximetry
Catheterization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Medium-term outcomes of Kawashima and completion Fontan palliation in single-ventricle heart disease with heterotaxy and interrupted inferior vena Cava. / Kutty, Shelby; Frommelt, Michele A.; Danford, David Alan; Tweddell, James S.

In: Annals of Thoracic Surgery, Vol. 90, No. 5, 01.01.2010, p. 1609-1613.

Research output: Contribution to journalArticle

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abstract = "Background We investigated medium-term outcomes in single-ventricle heart disease palliated with a Kawashima procedure (KP) compared with matched patients who had a standard Fontan procedure (FP). Methods Clinical characteristics, oxygen saturation as measured by pulse oximetry (Spo2) trends, and survival in 18 KP cases were compared with 36 matched controls who underwent a standard FP. Records of surgical procedures, catheterizations, noninvasive imaging, and clinical follow-up were reviewed. Results The median duration of follow-up after KP was 6.7 years. The mean Spo2 ({\%}) in the KP group over the follow-up period before completion Fontan was 85.1 ± 6, and differed significantly from the control FP group (90.7 ± 5.1, p < 0.001). Thirteen of the 18 KP patients underwent completion Fontan at a median age of 3.3 years (1.1 to 8.6) and median interval of 2.61 years (0.61 to 7.35) after KP. Mean Spo2 after completion Fontan following KP was 88.7 ± 7.6{\%}. The Spo2 in Fontan after KP was not as high as after control FP. Low Spo2 with upward trend was noted throughout the postoperative follow-up. The overall survival in the KP group after Fontan estimated by the Kaplan-Meier method was 87{\%} at 5 years and at 7 years. Conclusions The KP and subsequent Fontan completion results in acceptable medium-term survival, and remains the approach of choice for single-ventricle heart disease with interrupted inferior vena cava. The KP has to be undertaken with expectation for somewhat lower early Spo2 relative to standard Fontan patients, but in anticipation that Spo2 is likely to rise gradually with time.",
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N2 - Background We investigated medium-term outcomes in single-ventricle heart disease palliated with a Kawashima procedure (KP) compared with matched patients who had a standard Fontan procedure (FP). Methods Clinical characteristics, oxygen saturation as measured by pulse oximetry (Spo2) trends, and survival in 18 KP cases were compared with 36 matched controls who underwent a standard FP. Records of surgical procedures, catheterizations, noninvasive imaging, and clinical follow-up were reviewed. Results The median duration of follow-up after KP was 6.7 years. The mean Spo2 (%) in the KP group over the follow-up period before completion Fontan was 85.1 ± 6, and differed significantly from the control FP group (90.7 ± 5.1, p < 0.001). Thirteen of the 18 KP patients underwent completion Fontan at a median age of 3.3 years (1.1 to 8.6) and median interval of 2.61 years (0.61 to 7.35) after KP. Mean Spo2 after completion Fontan following KP was 88.7 ± 7.6%. The Spo2 in Fontan after KP was not as high as after control FP. Low Spo2 with upward trend was noted throughout the postoperative follow-up. The overall survival in the KP group after Fontan estimated by the Kaplan-Meier method was 87% at 5 years and at 7 years. Conclusions The KP and subsequent Fontan completion results in acceptable medium-term survival, and remains the approach of choice for single-ventricle heart disease with interrupted inferior vena cava. The KP has to be undertaken with expectation for somewhat lower early Spo2 relative to standard Fontan patients, but in anticipation that Spo2 is likely to rise gradually with time.

AB - Background We investigated medium-term outcomes in single-ventricle heart disease palliated with a Kawashima procedure (KP) compared with matched patients who had a standard Fontan procedure (FP). Methods Clinical characteristics, oxygen saturation as measured by pulse oximetry (Spo2) trends, and survival in 18 KP cases were compared with 36 matched controls who underwent a standard FP. Records of surgical procedures, catheterizations, noninvasive imaging, and clinical follow-up were reviewed. Results The median duration of follow-up after KP was 6.7 years. The mean Spo2 (%) in the KP group over the follow-up period before completion Fontan was 85.1 ± 6, and differed significantly from the control FP group (90.7 ± 5.1, p < 0.001). Thirteen of the 18 KP patients underwent completion Fontan at a median age of 3.3 years (1.1 to 8.6) and median interval of 2.61 years (0.61 to 7.35) after KP. Mean Spo2 after completion Fontan following KP was 88.7 ± 7.6%. The Spo2 in Fontan after KP was not as high as after control FP. Low Spo2 with upward trend was noted throughout the postoperative follow-up. The overall survival in the KP group after Fontan estimated by the Kaplan-Meier method was 87% at 5 years and at 7 years. Conclusions The KP and subsequent Fontan completion results in acceptable medium-term survival, and remains the approach of choice for single-ventricle heart disease with interrupted inferior vena cava. The KP has to be undertaken with expectation for somewhat lower early Spo2 relative to standard Fontan patients, but in anticipation that Spo2 is likely to rise gradually with time.

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