Factors related to pleural effusions after Fontan procedure in the era of fenestration

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R T Fedderly1, B N Whitstone, S J Frisbee

  • 1Department of Pediatrics, Division of Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, USA. fedderly@mcw.edu

Circulation
|September 25, 2001
PubMed

Insights

Performing the Fontan operation during the respiratory viral season is linked to increased pleural effusions and longer hospital stays in pediatric patients. Early age also correlates with greater chest tube output after this cardiac surgery.

Area of Science:

  • Pediatric Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Significant pleural effusions post-Fontan operation can prolong hospitalization and increase infection risk.
  • Pleural effusions may necessitate additional procedures like pleurodesis.
  • Understanding factors influencing pleural effusions is crucial for optimizing Fontan outcomes.

Purpose of the Study:

  • To identify risk factors associated with significant pleural effusions after the Fontan procedure.
  • To evaluate the impact of the respiratory viral season and patient age on postoperative outcomes.
  • To analyze the relationship between various surgical and physiological parameters and pleural effusions.

Main Methods:

  • Retrospective analysis of 94 pediatric patients who underwent the fenestrated Fontan procedure.
  • Evaluation of factors including age, ventricular morphology, fenestration status, Fontan type, chest tube output (CTO5, CTO10, CTO20), pleurodesis, length of stay (LOS), operation during respiratory viral season (ReVS+), and pre-Fontan pressures (PAP, PVR).
  • Statistical analysis using univariate and ordinary least squares regression models.

Main Results:

  • Operations during the respiratory viral season (ReVS+) were associated with prolonged LOS, increased chest tube output, and higher rates of pleurodesis.
  • Younger age (<4 years) correlated with increased chest tube output (CTO20).
  • Age and ReVS+ were significant predictors for chest tube output and length of hospital stay in regression analysis.

Conclusions:

  • The Fontan procedure performed during the respiratory viral season is a significant risk factor for prolonged pleural effusions and extended hospitalizations.
  • Younger patient age is also a contributing factor to increased postoperative fluid drainage.
  • Optimizing surgical timing and considering patient age may help mitigate postoperative complications.
Abstract

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