LONG TERM OUTCOMES OF ADULTS WITH SINGLE VENTRICLE PHYSIOLOGY NOT UNDERGOING FONTAN REPAIR: A MULTICENTRE EXPERIENCE.

Fecha de publicación: 09/06/2021 Fecha Ahead of Print: 01/07/2022

Autores de IIS La Fe

Francisco Buendía Fuentes

Autor

Participantes ajenos a IIS La Fe

Gordon-Ramirez, Blanca
Subira, Laura Dos
Meras, Pablo
Gallego, Pastora
Gonzalez, Ana
Prieto-Arevalo, Raquel
Segura, Teresa
Rodriguez-Puras, Maria J.
Montserrat, Silvia
Sarnago-Cebada, Fernando
Alonso-Garcia, Andres
Oliver, Jose M.
Rueda-Soriano, Joaquin

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

Abstract

Background: To describe long-term survival and cardiovascular events in adult patients with single ventricle physiology (SVP) without Fontan palliation, focusing on predictors of mortality and comparing groups according to their cardiovascular physiology. Methods: Multicentre observational and retrospective study including adult patients with SVP without Fontan palliation since their first adult clinic visit. The cohort was subdivided into 3 groups: Eisenmenger, restricted pulmonary flow, and aortopulmonary shunt. Death was considered as the main end point. Other clinical outcomes occurring during follow-up were considered as secondary end points. Results: A total of 146 patients, mean age 32.5 +/- 11.1 years, were analysed. Over a mean follow-up of 7.3 +/- 4.1 years, 33 patients (22.6%) died. Survival was 86% and 74% at 5 and 10 years, respectively. Right ventricular morphology was not associated with higher mortality. Four variables at baseline were related to a higher mortality: at least moderate atrioventricular valve regurgitation, platelet count < 150 x 10(3)/mm(3), GFR < 60 mL/min/1.73 m(2), and QRS > 120 ms). A total of 34.2% of patients were admitted to the hospital due to heart failure, and 7.5% received a heart transplant. Other cardiovascular outcomes were also frequent: atrial arrhythmias in 19.2%, stroke in 15.1%, and pacemaker/implantable cardioverter-defibrillator in 6.2%/ 2.7%. Conclusions: Adult patients with SVP who had not undergone Fontan exhibit a high mortality rate and frequent major cardiovascular events. At least moderate atrioventricular valve regurgitation, thrombocytopenia, renal dysfunction, and QRS duration > 120 ms at baseline visit allow identification of a cohort of patients at higher risk of mortality.

Datos de la publicación

ISSN/ISSNe:: 0828-282X, 1916-7075
Tipo:: Article
Páginas:: 1111-1120
DOI:: 10.1016/j.cjca.2021.06.001
Factor de Impacto:: 1,328 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Buendia-Fuentes, Francisco:: Instituto de Investigación. 1Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Centro de Investigación Biomédica en Red Cardiovascular, Valencia, Spain.
Gordon-Ramirez, Blanca:: 2Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Subira, Laura Dos:: 3Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular, Barcelona, Spain.
Meras, Pablo:: 4Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
Gallego, Pastora:: 5Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla, Centro de Investigación Biomédica en Red Cardiovascular, Sevilla, Spain.
Gonzalez, Ana:: 4Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
Prieto-Arevalo, Raquel:: 6Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Centro de Investigación Biomédica en Red Cardiovascular, Madrid, Spain.
Segura, Teresa:: 7Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 Octubre, Madrid, Spain.
Rodriguez-Puras, Maria J.:: 5Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla, Centro de Investigación Biomédica en Red Cardiovascular, Sevilla, Spain.
Montserrat, Silvia:: 8Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Clinic Barcelona, Institut Clinic Cardiovascular, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Centro de Investigación Biomédica en Red Cardiovascular, Barcelona, Spain.
Sarnago-Cebada, Fernando:: 7Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 Octubre, Madrid, Spain.
Alonso-Garcia, Andres:: 6Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Centro de Investigación Biomédica en Red Cardiovascular, Madrid, Spain.
Oliver, Jose M.:: 6Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Centro de Investigación Biomédica en Red Cardiovascular, Madrid, Spain.
Rueda-Soriano, Joaquin:: Instituto de Investigación. 1Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Centro de Investigación Biomédica en Red Cardiovascular, Valencia, Spain.