Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: A multimodality study

Lars Grosse-Wortmann, Christian Drolet, Andreea Dragulescu, Yasuhiro Kotani, Rajiv Chaturvedi, Kyong Jin Lee, Luc Mertens, Katherine Taylor, Gustavo La Rotta, Glen Van Arsdell, Andrew Redington, Shi Joon Yoo

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined. Methods: The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded. Results: Aortopulmonary collateral flow was 1.59 L/min/m2 ± 0.65 L/min/m2 (range, 0.54 L/min/m2-3.34 L/min/m2), constituting 43% ± 13% (range, 12-87%) of pulmonary blood flow and 35% ± 12% (range, 11-62%) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P <.0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m2 ± 0.38 L/min/m2 vs 1.73 L/min/m2 ± 0.76 L/min/m 2; P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m2 ± 0.65 L/min/m2 vs 1.30 L/min/m2 ± 0.57 L/min/m2, P = .04). Conclusions: Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion.

Original languageEnglish
Pages (from-to)1329-1336
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume144
Issue number6
DOIs
Publication statusPublished - Dec 2012
Externally publishedYes

Fingerprint

Lung
Drainage
Fontan Procedure
Chest Tubes
Cardiac Catheterization
Echocardiography
Length of Stay
Magnetic Resonance Spectroscopy
Hemodynamics
Magnetic Resonance Imaging
Oxygen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion : A multimodality study. / Grosse-Wortmann, Lars; Drolet, Christian; Dragulescu, Andreea; Kotani, Yasuhiro; Chaturvedi, Rajiv; Lee, Kyong Jin; Mertens, Luc; Taylor, Katherine; La Rotta, Gustavo; Van Arsdell, Glen; Redington, Andrew; Yoo, Shi Joon.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 144, No. 6, 12.2012, p. 1329-1336.

Research output: Contribution to journalArticle

Grosse-Wortmann, L, Drolet, C, Dragulescu, A, Kotani, Y, Chaturvedi, R, Lee, KJ, Mertens, L, Taylor, K, La Rotta, G, Van Arsdell, G, Redington, A & Yoo, SJ 2012, 'Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: A multimodality study', Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 6, pp. 1329-1336. https://doi.org/10.1016/j.jtcvs.2012.03.032
Grosse-Wortmann, Lars ; Drolet, Christian ; Dragulescu, Andreea ; Kotani, Yasuhiro ; Chaturvedi, Rajiv ; Lee, Kyong Jin ; Mertens, Luc ; Taylor, Katherine ; La Rotta, Gustavo ; Van Arsdell, Glen ; Redington, Andrew ; Yoo, Shi Joon. / Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion : A multimodality study. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 144, No. 6. pp. 1329-1336.
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abstract = "Objective: Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined. Methods: The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded. Results: Aortopulmonary collateral flow was 1.59 L/min/m2 ± 0.65 L/min/m2 (range, 0.54 L/min/m2-3.34 L/min/m2), constituting 43{\%} ± 13{\%} (range, 12-87{\%}) of pulmonary blood flow and 35{\%} ± 12{\%} (range, 11-62{\%}) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P <.0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m2 ± 0.38 L/min/m2 vs 1.73 L/min/m2 ± 0.76 L/min/m 2; P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m2 ± 0.65 L/min/m2 vs 1.30 L/min/m2 ± 0.57 L/min/m2, P = .04). Conclusions: Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion.",
author = "Lars Grosse-Wortmann and Christian Drolet and Andreea Dragulescu and Yasuhiro Kotani and Rajiv Chaturvedi and Lee, {Kyong Jin} and Luc Mertens and Katherine Taylor and {La Rotta}, Gustavo and {Van Arsdell}, Glen and Andrew Redington and Yoo, {Shi Joon}",
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T1 - Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion

T2 - A multimodality study

AU - Grosse-Wortmann, Lars

AU - Drolet, Christian

AU - Dragulescu, Andreea

AU - Kotani, Yasuhiro

AU - Chaturvedi, Rajiv

AU - Lee, Kyong Jin

AU - Mertens, Luc

AU - Taylor, Katherine

AU - La Rotta, Gustavo

AU - Van Arsdell, Glen

AU - Redington, Andrew

AU - Yoo, Shi Joon

PY - 2012/12

Y1 - 2012/12

N2 - Objective: Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined. Methods: The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded. Results: Aortopulmonary collateral flow was 1.59 L/min/m2 ± 0.65 L/min/m2 (range, 0.54 L/min/m2-3.34 L/min/m2), constituting 43% ± 13% (range, 12-87%) of pulmonary blood flow and 35% ± 12% (range, 11-62%) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P <.0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m2 ± 0.38 L/min/m2 vs 1.73 L/min/m2 ± 0.76 L/min/m 2; P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m2 ± 0.65 L/min/m2 vs 1.30 L/min/m2 ± 0.57 L/min/m2, P = .04). Conclusions: Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion.

AB - Objective: Aortopulmonary collaterals are a frequent phenomenon in patients after bidirectional cavopulmonary connection. The aortopulmonary collateral flow volume can be quantified using cardiac magnetic resonance imaging. However, the significance of aortopulmonary collateral flow for the postoperative outcome after total cavopulmonary connection is unclear and was sought to be determined. Methods: The data from 33 patients were prospectively studied with cardiac magnetic resonance, echocardiography, and cardiac catheterization before the total cavopulmonary connection operation. The early postoperative outcomes after total cavopulmonary connection completion were recorded. Results: Aortopulmonary collateral flow was 1.59 L/min/m2 ± 0.65 L/min/m2 (range, 0.54 L/min/m2-3.34 L/min/m2), constituting 43% ± 13% (range, 12-87%) of pulmonary blood flow and 35% ± 12% (range, 11-62%) of the cardiac index, resulting in a pulmonary blood flow/systemic blood flow ratio of 1.06 ± 0.17 (range, 0.79-1.55). The aortopulmonary collateral flow correlated with pulmonary blood flow/systemic blood flow ratio (r = 0.69, P <.0001), oxygen saturation (r = 0.42, P = .018), and cardiac index (r = 0.53, P = .002). Of the 36 patients, 24 underwent fenestrated total cavopulmonary connection during the study period. The aortopulmonary collateral flow, relative to the cardiac index, correlated with the duration of hospital stay (r = 0.48, P = .02) and pleural drainage (r = 0.45, P = .03). Patients whose pleural drainage lasted 1 week or less had less aortopulmonary collateral flow before the Fontan operation than those with a longer period until chest tube removal (1.23 L/min/m2 ± 0.38 L/min/m2 vs 1.73 L/min/m2 ± 0.76 L/min/m 2; P = .03). Compared with a contemporary group of total cavopulmonary connection patients with fenestration in their extracardiac conduit who were studied prospectively, with a similar protocol, the bidirectional cavopulmonary connection had a greater amount of aortopulmonary collateral flow (1.59 L/min/m2 ± 0.65 L/min/m2 vs 1.30 L/min/m2 ± 0.57 L/min/m2, P = .04). Conclusions: Patients after bidirectional cavopulmonary connection routinely acquire a large amount of aortopulmonary collateral flow. The hemodynamic consequences of aortopulmonary collateral flow translate into adverse outcomes early after total cavopulmonary connection completion.

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