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Cardiovascular complications in patients with total cavopulmonary connection: A nationwide cohort study
Michelle D Schmiegelow1, Lars Idorn2, Gunnar Gislason3
1Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; Department of Internal Medicine, Holbaek Sygehus, Holbaek, Denmark.
Insights
Patients undergoing total cavopulmonary connection (TCPC) face significantly higher risks of death, heart transplantation, and cardiovascular events like arrhythmias and stroke. These risks persist throughout intermediate-term follow-up after the procedure.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Long-term outcomes after total cavopulmonary connection (TCPC) in patients with functional univentricular hearts are not well-established at a population level.
- Understanding post-TCPC cardiovascular event incidence is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence of cardiovascular events after the completion of total cavopulmonary connection (TCPC).
Main Methods:
- A population-based cohort of 178 patients with completed TCPC circulation was identified.
- A comparison cohort of 35,600 general population controls was frequency-matched by sex and birth date.
- Cardiovascular event risks were assessed using cumulative incidence and adjusted Poisson regression models.
Main Results:
- Over a median 12.5-year follow-up, 5.6% of TCPC patients died and 4.5% underwent heart transplantation.
- TCPC patients experienced significantly higher rates of arrhythmia (15.7%) and stroke (3.4%) compared to controls (>50-fold higher).
- 21.4% of TCPC patients initiated diuretic and RAS-inhibitor therapy, compared to 0.04% in controls.
Conclusions:
- Patients with TCPC circulation face a high risk of cardiovascular events during intermediate-term follow-up.
- These findings highlight the need for vigilant monitoring and management of cardiovascular health in post-TCPC patients.
Background:
Long-term outcomes are not well established at the population level after completion of the total cavopulmonary connection (TCPC) among patients with functional univentricular hearts.
Purpose:
To evaluate the incidence of cardiovascular events after TCPC completion.
Methods:
From a validated population-based cohort, we identified 178 patients with TCPC circulation completed after January 1, 1995. We established a comparison cohort by frequency-matching patients 1:200 on sex, and month and year of birth to the general Danish population (n = 35,600 population controls). We started follow-up at date of TCPC completion for cases and, for controls, at the index date of their matched case. The risks of cardiovascular events were assessed using cumulative incidence rates and Poisson regression models adjusted for age, sex, and calendar year.
Results:
The median age at TCPC completion was 3.3 years (interquartile range 2.6 to 5.3 years). Over a median follow-up of 12.5 years, 10 (5.6%) TCPC patients died and 7 (4.5%) had a heart transplantation compared with a 0.2% mortality in the matched population. In TCPC patients, 15.7% had an arrhythmia (11.8% supraventricular tachycardia), 3.4% had a stroke (all ischemic), and 21.4% of TCPC patients initiated a combination of a diuretic and a renin-angiotensin system (RAS)-inhibitor. These rates were >50-fold higher than in the comparison cohort: 0.2% arrhythmia, 0.06% stroke, and 0.04% starting a diuretic and a RAS-inhibitor.
Conclusions:
Patients with TCPC circulation face a high risk of cardiovascular events during intermediate term follow-up.
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