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Impact of Ventricular Morphology on Clinical Outcome after the Fontan Palliation
WonKyung Pyo, EunSeok Choi, TaeJin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Whether the right ventricle structure is less equipped to support systemic circulation is still a controversial issue. We examined the effect of dominant ventricle morphology on Fontan palliation outcomes.
Methods : Medical records of 389 (female: male=156: 233) patients undergoing Fontan palliation in a single center between May 1993, and May 2017 were reviewed retrospectively. Patients were categorized into three groups based on dominant ventricle morphology; left dominant ventricle (LV group; n=158), right dominant ventricle (RV group; n=144) and balanced or indeterminate ventricles (n=87) which were excluded in this study. Impact of ventricular morphology on clinical outcomes following the Fontan palliation was examined.
Results : At a median follow-up time of 107.8 months, 20 patients had died. Survival of study population was 97.3±0.9%, 92.5±1.7% and 90.5±2.4% at 1, 10 and 20 years, respectively. No statistically significant difference was noted on failure-free survival (death, Fontan take-down and heart transplantation); 93.7±2.2% and 89.6±3.1% in each LV and RV group (p=0.318). Freedom from death or ventricular dysfunction were comparable in two groups; 88.8±3.4% and 80.6±4.6% in each LV and RV group (p=0.069). Freedom from death or significant atrioventricular valve regurgitation was 91.1±3.2% in LV group and 82.2±4.5% in RV group (p=0.076). Cumulative incidence rates were estimated by the Kaplan-Meir method and compared by the log-rank test.
Conclusion : Right ventricle dominance is not a risk factor for mortality, ventricular dysfunction or significant atrioventricular valve regurgitation after Fontan palliation. However, careful follow-up is required to confirm the findings of this study.
Methods : Medical records of 389 (female: male=156: 233) patients undergoing Fontan palliation in a single center between May 1993, and May 2017 were reviewed retrospectively. Patients were categorized into three groups based on dominant ventricle morphology; left dominant ventricle (LV group; n=158), right dominant ventricle (RV group; n=144) and balanced or indeterminate ventricles (n=87) which were excluded in this study. Impact of ventricular morphology on clinical outcomes following the Fontan palliation was examined.
Results : At a median follow-up time of 107.8 months, 20 patients had died. Survival of study population was 97.3±0.9%, 92.5±1.7% and 90.5±2.4% at 1, 10 and 20 years, respectively. No statistically significant difference was noted on failure-free survival (death, Fontan take-down and heart transplantation); 93.7±2.2% and 89.6±3.1% in each LV and RV group (p=0.318). Freedom from death or ventricular dysfunction were comparable in two groups; 88.8±3.4% and 80.6±4.6% in each LV and RV group (p=0.069). Freedom from death or significant atrioventricular valve regurgitation was 91.1±3.2% in LV group and 82.2±4.5% in RV group (p=0.076). Cumulative incidence rates were estimated by the Kaplan-Meir method and compared by the log-rank test.
Conclusion : Right ventricle dominance is not a risk factor for mortality, ventricular dysfunction or significant atrioventricular valve regurgitation after Fontan palliation. However, careful follow-up is required to confirm the findings of this study.
책임저자: TaeJin Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: WonKyung Pyo, E-mail : buguimoran@gmail.com