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The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period

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Abstract

Despite advancements in postoperative outcomes after Fontan surgery, there remains a risk of suboptimal outcomes and significant morbidity in the early postoperative period. Anatomical obstructions in the Fontan pathway can lead to prolonged pleural effusion or ascites, cyanosis, and low cardiac output syndrome (LCOS). Transcatheter interventions offer an alternative to early re-surgery for treating these complications. Over a 13-year period, early catheter angiography, performed within 30 days post-index procedure, was administered to 41 patients, identifying anatomical issues that necessitated re-intervention in 39 cases. This led to transcatheter interventions in 37 (10.4%) of the 344 Fontan surgery patients. The median age was 4.8 years (IQR: 4–9.4), and the median weight was 16.5 kg (IQR: 15–25.2), with females comprising 51.4% (19/37) of this group. The primary indications for the procedures were persistent pleural effusion or ascites in 27 patients (66%), LCOS in 8 patients (20%), and cyanosis in 6 patients (14%). Among the 37 undergoing transcatheter intervention, 30 were treated solely with this method and discharged, three died in ICU follow-up, and four required early re-surgery. No procedural mortality was observed. Our findings demonstrate that transcatheter interventions, including stent implantation, balloon angioplasty, and fenestration dilation, are safe and effective in the early post-Fontan period. Therefore, they should be considered an integral part of the management strategy for this patient group.

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Funding

This study was not funded by any internal or external funds.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey

    Ibrahim Halil Demir, Dursun Muhammed Ozdemir, Ilker Kemal Yucel, Emine Hekim Yılmaz, Mustafa Orhan Bulut, Murat Surucu & Ahmet Celebi

  2. Department of Pediatric Cardiovascular Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Oktay Korun

  3. Department of Pediatric Cardiovascular Surgery, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Numan Ali Aydemir

Authors
  1. Ibrahim Halil Demir
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  2. Dursun Muhammed Ozdemir
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  3. Ilker Kemal Yucel
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  4. Emine Hekim Yılmaz
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  5. Mustafa Orhan Bulut
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  6. Murat Surucu
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  7. Oktay Korun
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  8. Numan Ali Aydemir
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  9. Ahmet Celebi
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Contributions

IHD, IKY, DMO, AC: Conceptualization. IHD, IKY, DMO, AC: Methodology. IHD, DMO, EHY, OK: Formal analysis and investigation. IHD, IKY, DMO, MS, OK, MOB: Writing—original draft preparation. IHD, DMO, IKY, OK: riting—review and editing. Supervision: IKY, IHD, NAA, AC.

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Correspondence to Ibrahim Halil Demir.

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The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written and informed consent were taken from the parents before the interventional procedures.

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Demir, I.H., Ozdemir, D.M., Yucel, I.K. et al. The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period. Pediatr Cardiol 45, 986–997 (2024). https://doi.org/10.1007/s00246-024-03455-3

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  • DOI: https://doi.org/10.1007/s00246-024-03455-3

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