Benefits of Coiling Aorto-Pulmonary Collaterals in Children with Complex Congenital Heart Diseases
Ashley Molloy1, Neil Tailor1, Katherine Hunter1
1Division of Pediatric Cardiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Avenue, Memphis, TN, 38103, USA.
Insights
Coiling aortopulmonary collaterals (APCs) before Fontan completion and heart transplantation significantly reduces chest tube output and hospital stay. This intervention also improves 1-year survival rates for patients with failed Fontan procedures.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Aortopulmonary collaterals (APCs) are common in patients with single ventricle physiology and can complicate Fontan completion and heart transplantation.
- The benefits of pre-procedural APC coiling in these high-risk pediatric populations remain incompletely understood.
- Optimizing outcomes for Fontan patients, particularly those requiring subsequent heart transplantation, is a critical area of cardiovascular research.
Purpose of the Study:
- To investigate the impact of pre-Fontan completion and pre-heart transplantation APC coiling on clinical outcomes.
- To compare outcomes between patients who underwent APC coiling and those who did not.
- To evaluate the effect of APC coiling on post-transplant survival in children with failed Fontan circulation.
Main Methods:
- A retrospective comparative study analyzing data from two distinct eras and patient cohorts.
- Comparison of outcomes (chest tube output, duration, hospital length of stay) between Fontan patients with and without prior APC coiling.
- Evaluation of 1-year post-heart transplant survival rates in patients with failed Fontan, comparing cohorts with and without APC coiling.
Main Results:
- Fontan patients who underwent APC coiling demonstrated significantly lower chest tube output (22.6 vs. 41.8 mL/kg), shorter chest tube duration (5.1 vs. 10.3 days), and reduced hospital length of stay (9.9 vs. 27.4 days).
- Pre-transplant APC coiling in patients with failed Fontan was associated with improved 1-year survival rates (85% with coiling vs. 66% without in St. Louis; 92% in Memphis with aggressive coiling).
- Statistical significance was observed for all primary outcome measures, highlighting the positive impact of APC coiling.
Conclusions:
- Coiling of aortopulmonary collaterals before Fontan completion is associated with decreased postoperative complications, including reduced chest tube drainage and shorter hospitalizations.
- Aggressive pre-transplant APC coiling appears to improve 1-year survival rates in pediatric patients with failed Fontan circulation.
- These findings support the routine consideration of APC coiling as an adjunct therapy in the management of complex single ventricle physiology.
Abstract:
This study investigates the benefits of coiling aortopulmonary collaterals (APCs) before Fontan completion and prior to heart transplantation due to failed Fontan. The advantages of APC coiling in these situations remain unclear. Outcomes were compared between those undergoing the Fontan operation between June 2013 and December 2015, who did not undergo coiling of APCs, and those between January 2016 and May 2022, when aggressive coiling of APCs was performed. The 1-year post-transplant survival was compared for patients from Memphis, TN, where aggressive APC coiling was performed before transplantation, to a previously published report from St. Louis, MO, where APCs were actively coiled and an earlier era when they were not. The 44 Fontan patients with prior APC coiling were compared to 22 patients matched for age, diagnosis, and hemodynamics. The chest tube output (22.6 ± 6.1 vs. 41.8 ± 8.2 mL/kg; P < 0.001), the chest tube duration (5.1 ± 1.1 vs. 10.3 ± 4.5 days; P < 0.001), and the hospital length of stay (9.9 ± 1.7 vs. 27.4 ± 6.2 days; P < 0.001) were significantly lower for those who had APC coiling compared to those who did not. In St. Louis, MO, when APCs were not coiled before transplantation (N = 27), the 1-year survival rate was 66%, which improved to 85% (N = 20) in the era of APC coiling. In the Memphis experience (N = 25) with aggressive APC coiling, the 1-year survival rate was 92% (P = 0.018). APC coiling before Fontan completion decreases chest tube output and hospitalization days. It may also improve the 1-year survival rate after heart transplantation for children with failed Fontan.
