Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience

Background: Single ventricle patients palliated with the Fontan operation may eventually require heart (OHT) or combined heart-liver transplantation (CHLT) to treat Fontan circulatory failure. This study aims to characterize the safety and tolerability of coiling aortopulmonary and venovenous collat...

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Autores principales:	Weiyi Tan, Leigh Reardon, Jeannette Lin, Gentian Lluri, Prashanth Venkatesh, Katia Bravo-Jaimes, Reshma Biniwale, Glen Van Arsdell, Reid D. Ponder, Jamil Aboulhosn
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Fontan Single ventricle Aortopulmonary collateral Venovenous collateral Coiling Embolization Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/8717e297d4e845848e4eec6742b72e34
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spelling	oai:doaj.org-article:8717e297d4e845848e4eec6742b72e342021-11-10T04:42:07ZOcclusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience2666-668510.1016/j.ijcchd.2021.100260https://doaj.org/article/8717e297d4e845848e4eec6742b72e342021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666668521001841https://doaj.org/toc/2666-6685Background: Single ventricle patients palliated with the Fontan operation may eventually require heart (OHT) or combined heart-liver transplantation (CHLT) to treat Fontan circulatory failure. This study aims to characterize the safety and tolerability of coiling aortopulmonary and venovenous collaterals and its impact on morbidity and mortality in patients with Fontan circulatory failure undergoing OHT or CHLT. Methods: This retrospective observational cohort study included patients with Fontan circulatory failure who underwent OHT or CHLT between January 1, 2004 and December 30, 2020. Patients were separated into two groups; those who underwent procedure(s) for comprehensive coil embolization of aortopulmonary and venovenous collaterals prior to listing for transplantation (coiling), and those who did not (no coiling). Collateral burden quantification and procedural characteristics were recorded for the coiling group and perioperative outcomes were compared between the two groups. Results: Twenty-nine patients were in the study. The coiling (n = 10) group had a significant reduction in intraoperative collateral flow when compared to the no coiling (n = 19) group (10% versus 42% with severe collateral flow, p = 0.002). While there was no significant difference in blood product transfusion requirements or in the morbidity/mortality between the two groups, there was a trend towards a reduction in postoperative bleeding complications and reoperations for bleeding in the subgroup of patients receiving CHLT and coiling compared to those without coiling. Conclusions: Elimination of collaterals prior to OHT and CHLT is a safe and well-tolerated procedure in patients with Fontan circulatory failure and appears to decrease collateral bleeding during the transplant operation.Weiyi TanLeigh ReardonJeannette LinGentian LluriPrashanth VenkateshKatia Bravo-JaimesReshma BiniwaleGlen Van ArsdellReid D. PonderJamil AboulhosnElsevierarticleFontanSingle ventricleAortopulmonary collateralVenovenous collateralCoilingEmbolizationDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 6, Iss , Pp 100260- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Fontan Single ventricle Aortopulmonary collateral Venovenous collateral Coiling Embolization Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Fontan Single ventricle Aortopulmonary collateral Venovenous collateral Coiling Embolization Diseases of the circulatory (Cardiovascular) system RC666-701 Weiyi Tan Leigh Reardon Jeannette Lin Gentian Lluri Prashanth Venkatesh Katia Bravo-Jaimes Reshma Biniwale Glen Van Arsdell Reid D. Ponder Jamil Aboulhosn Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
description	Background: Single ventricle patients palliated with the Fontan operation may eventually require heart (OHT) or combined heart-liver transplantation (CHLT) to treat Fontan circulatory failure. This study aims to characterize the safety and tolerability of coiling aortopulmonary and venovenous collaterals and its impact on morbidity and mortality in patients with Fontan circulatory failure undergoing OHT or CHLT. Methods: This retrospective observational cohort study included patients with Fontan circulatory failure who underwent OHT or CHLT between January 1, 2004 and December 30, 2020. Patients were separated into two groups; those who underwent procedure(s) for comprehensive coil embolization of aortopulmonary and venovenous collaterals prior to listing for transplantation (coiling), and those who did not (no coiling). Collateral burden quantification and procedural characteristics were recorded for the coiling group and perioperative outcomes were compared between the two groups. Results: Twenty-nine patients were in the study. The coiling (n = 10) group had a significant reduction in intraoperative collateral flow when compared to the no coiling (n = 19) group (10% versus 42% with severe collateral flow, p = 0.002). While there was no significant difference in blood product transfusion requirements or in the morbidity/mortality between the two groups, there was a trend towards a reduction in postoperative bleeding complications and reoperations for bleeding in the subgroup of patients receiving CHLT and coiling compared to those without coiling. Conclusions: Elimination of collaterals prior to OHT and CHLT is a safe and well-tolerated procedure in patients with Fontan circulatory failure and appears to decrease collateral bleeding during the transplant operation.
format	article
author	Weiyi Tan Leigh Reardon Jeannette Lin Gentian Lluri Prashanth Venkatesh Katia Bravo-Jaimes Reshma Biniwale Glen Van Arsdell Reid D. Ponder Jamil Aboulhosn
author_facet	Weiyi Tan Leigh Reardon Jeannette Lin Gentian Lluri Prashanth Venkatesh Katia Bravo-Jaimes Reshma Biniwale Glen Van Arsdell Reid D. Ponder Jamil Aboulhosn
author_sort	Weiyi Tan
title	Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
title_short	Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
title_full	Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
title_fullStr	Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
title_full_unstemmed	Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience
title_sort	occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in fontan patients: a single-center experience
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/8717e297d4e845848e4eec6742b72e34
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Occlusion of aortopulmonary and venovenous collaterals prior to heart or combined heart-liver transplantation in Fontan patients: A single-center experience

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