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Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival

Joseph T Poterucha1, Jonathan N Johnson1, Nathan W Taggart1

  • 1Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minn, USA.

Congenital Heart Disease
|May 27, 2015
PubMed

Insights

Embolizing veno-venous collaterals (VVCs) after Fontan operation did not improve outcomes and was associated with decreased survival. Careful evaluation is needed, as VVCs may provide beneficial "natural" fenestration.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Veno-venous collaterals (VVCs) can develop after Fontan operation, potentially causing systemic arterial desaturation.
  • The impact of VVC embolization on patient outcomes following Fontan surgery is not well-established.

Purpose of the Study:

  • To determine the frequency of VVCs in patients post-Fontan operation.
  • To evaluate the outcomes associated with VVC embolization compared to non-intervention.

Main Methods:

  • Retrospective analysis of clinical and hemodynamic data from patients undergoing cardiac catheterization post-Fontan operation (1995-2014).
  • Comparison of clinical, imaging, and hemodynamic data between patients with VVCs who underwent embolization versus those who did not.

Main Results:

  • VVCs were identified in 72 of 496 patients; 43% underwent embolization.
  • Embolization did not improve oxygen saturation or cardiac index and was linked to decreased 5-year survival (74% vs. 92% for non-intervention).
  • Predictors of death included embolization, atrio-pulmonary Fontan, and heterotaxy.

Conclusions:

  • Embolization of VVCs after Fontan operation is associated with reduced 5-year survival.
  • Careful consideration is advised for embolization in patients with atrio-pulmonary Fontan, heterotaxy, or elevated Fontan pressures (≥18 mmHg).
  • VVCs might serve as a beneficial "natural" fenestration in select Fontan patients.
Abstract

Keywords:
Adult Congenital Heart DiseaseEmbolizationFontanVeno-venous Collaterals

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