Colchicine in post-operative Fontan patients

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Clinical Pharmacology

Background:

• Prolonged effusions and high pro-inflammatory cytokines are common morbidities post-Fontan procedure.
• Colchicine, an anti-inflammatory agent, has shown efficacy in reducing post-cardiac surgery effusions in adults.
• This study investigated colchicine's effect on cytokine levels and effusion duration in pediatric Fontan patients.

Purpose of the Study:

• To evaluate the efficacy of colchicine in reducing pro-inflammatory cytokines and chest tube drainage duration post-Fontan procedure.
• To assess the impact of colchicine on length of hospital stay in Fontan patients.

Main Methods:

• A pilot clinical trial involving nine pediatric patients undergoing the Fontan procedure.
• Patients received daily colchicine starting post-operative day 2, with chest tube fluid analyzed for 17 cytokines.
• Comparison was made to a historical control cohort (n=25).

Main Results:

• Patients completing the colchicine protocol showed significantly shorter chest tube drainage (6 vs. 10 days, p=0.007) and length of stay (7 vs. 9 days, p=0.005).
• Pro-inflammatory cytokine levels trended lower in the colchicine group.
• No significant difference was observed in the intention-to-treat group.

Conclusions:

• Colchicine administration in pediatric Fontan patients completing the protocol resulted in shortened chest tube drainage and hospital stay.
• Reduced pro-inflammatory cytokines may be the underlying mechanism.
• Further investigation in larger trials is warranted.