Univentricular hearts not undergoing Fontan: the type of palliation matters.

Fecha de publicación: 01/01/2024 Fecha Ahead of Print: 09/03/2023

Autores de IIS La Fe

Joaquín Rueda Soriano

Autor

Participantes ajenos a IIS La Fe

Gordon, Blanca
Fuentes, Francisco Buendia
Colunga, Pablo Meras
Gallego, Pastora
Gonzalez Garcia, Ana Elvira
Arevalo, Raquel Prieto
De La Cal, Teresa Segura
Rodriguez-Puras, Maria J
Montserrat, Silvia
Cebada, Fernando Sarnago
Garcia, Andres Alonso
Oliver, Jose M
Subira, Laura Dos

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

Abstract

INTRODUCTION AND OBJECTIVES: There is scarce information on patients with single ventricle physiology (SVP) and restricted pulmonary flow not undergoing Fontan circulation. This study aimed to compare survival and cardiovascular events in these patients according to the type of palliation. METHODS: SVP patient data were obtained from the databases of the adult congenital heart disease units of 7 centers. Patients completing Fontan circulation or developing Eisenmenger syndrome were excluded. Three groups were created according to the source of pulmonary flow: G1 (restrictive pulmonary forward flow), G2 (cavopulmonary shunt), and G3 (aortopulmonary shunts±cavopulmonary shunt). The primary endpoint was death. RESULTS: We identified 120 patients. Mean age at the first visit was 32.2 years. Mean follow-up was 7.1 years. Fifty-five patients (45.8%) were assigned to G1, 30 (25%) to G2, and 35 (29.2%) to G3. Patients in G3 had worse renal function, functional class, and ejection fraction at the first visit and a more marked ejection fraction decline during follow-up, especially when compared with G1. Twenty-four patients (20%) died, 38 (31.7%) were admitted for heart failure, and 21 (17.5%) had atrial flutter/fibrillation during follow-up. These events were more frequent in G3 and significant differences were found compared with G1 in terms of death (HR, 2.9; 95%CI, 1.14-7.37; P=.026) and atrial flutter/fibrillation (HR, 2.9; 95%CI, 1.11-7.68; P=.037). CONCLUSIONS: The type of palliation in patients with SVP and restricted pulmonary flow not undergoing Fontan palliation identifies distinct profiles. Patients palliated with aortopulmonary shunts have an overall worse prognosis with higher morbidity and mortality.

Datos de la publicación

ISSN/ISSNe:: 1885-5857, 1885-5857
Tipo:: Article
Páginas:: 6-16
DOI:: 10.1016/j.rec.2023.03.001
PubMed:: 36898520
Factor de Impacto:: 0,385 SCImago ℠
Cuartil:: Q3 SCImago ℠

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Métricas

Filiaciones

Gordon, Blanca:: Unidad Integrada de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Departamento de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain

Departamento de Cardiología, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
Gallego, Pastora:: Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain

Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Instituto de BioMedicina de Sevilla (IBIS), Seville, Spain

European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
Gonzalez Garcia, Ana Elvira:: Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain
Rodriguez-Puras, Maria J:: Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain

Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Instituto de BioMedicina de Sevilla (IBIS), Seville, Spain
Montserrat, Silvia:: Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain

Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital Clinic Barcelona, Institut Clinic Cardiovascular (ICCV), Universidad de Barcelona, Instituto de Investigaciones BiomédicasAugust Pi i Sunyer (IDIBAPS), Barcelona, Spain
Oliver, Jose M:: Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain

Unidad de Cardiopatías Congénitas del Adulto, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain