2399Contemporary outcomes of catheter ablation for adult Fontan patients using advanced technologies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Cazzoli ◽  
S H Larsen ◽  
S Guarguagli ◽  
K Dimopoulos ◽  
A Kempny ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Cox Regression ◽  
Fontan Operation ◽  
Univentricular Heart ◽  
Dramatic Improvement ◽  
3D Image ◽  
Image Integration ◽  
Cox Regression Analysis ◽  
Advanced Technologies ◽  
Fontan Patients

Abstract Background The Fontan operation, followed by the total cavo-pulmonary connection (TCPC), has been the primary technique for surgical treatment of patients with functionally univentricular heart. Post-surgical arrhythmias contribute considerably to the morbidity and mortality within this cohort Purpose To demonstrate feasibility and outcome of catheter ablation procedures aided by three-dimensional (3D) image integration combined with advanced technologies in adult Fontan patients, as well as correlation of arrhythmia type. Methods We included adult pts who underwent catheter ablation between 2008 and 2018. Procedures were carried out with electro-anatomical mapping and 3D image integration. Mapping and ablation were performed manually or with remote magnetic navigation (RMN). A retrograde access via the aortic valve was used to reach the atria in TCPC pts. Results A total of 63 pts were reviewed with either TCPC or Fontan operation (see figure). A total of 215 arrhythmias were inducible (117 in Fontan, 2/procedure, range 1–5; 98 in TCPC, 1/procedure, range 1–5), in 2 pts (3%) no ablation was performed, whereas 8 (3.7%) arrhythmias were not sustained. In TCPC pts 36 (36.7%) were macro-reentrant atrial tachycardia (MRAT) mostly from the right atrium (RA), 31 focal AT (FAT, 31.6%) almost equally from either the RA or the TCPC; 10 (10.2%) were atrio-ventricular nodal re-entrant tachycardia (AVNRT), 7 from twin AV node, and 3 concealed accessory pathways (AP) with AVRT (3%). Nine AT originated from several sites within the left atrium (9.1%). For the MRAT, most of the ablation lines were performed between the TCPC and the tricuspid annulus. In Fontans, all ATs originated from the RA, either MRAT (54, 46.1%) mostly around surgical scars, or FAT (58, 49.6%). Three pts (2.5%) presented in AF, while 1 (0.8%) had a left AP. Irrigated tip ablation resulted in acute success of 78.3% in the TCPC cohort and 76.7% in the Fontan cohort. The mean procedure time was 254±99 min and 255±106 min with a mean fluoroscopy time 2.3±1.9 min and 5.5±4.8 min for each TCPC and Fontan, respectively. During a mean follow-up of 4.2±3.0 years (maximum of 10.8 years), 58% (41–72) of TCPC pts and 22% (10–38) of Fontan pts remained free of symptoms/significant arrhythmia [at 2 years: 69% (55–79) and 31% (18–46), respectively]. Eleven TCPC (26%, 4 new arrhythmias) and 14 Fontan patients (70%, 3 new arrhythmias) needed repeat procedures. In multivariate Cox regression analysis, Fontan operation and female gender were associated with worse outcome, independently of the type of arrhythmia. Conclusions Advances in 3D mapping, image integration and the introduction of RMN has facilitated a dramatic improvement of ablation outcomes for adult patients after single ventricle repair. Patients with TCPC have fewer arrhythmias than Fontans and are more likely to benefit longterm, whilst transbaffle puncture can be avoided using RMN.

P2849Prevalence and significance of sustained pulmonary vein isolation in repeat AF ablation procedures

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D J Nascimento Matos ◽  
D Cavaco ◽  
G Rodrigues ◽  
J Carmo ◽  
M S Carvalho ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cox Regression ◽  
Vena Cava ◽  
Cox Regression Analysis ◽  
Af Ablation ◽  
Rf Applications ◽  
The Right ◽  
Af Recurrence

Abstract Introduction Pulmonary vein (PV) reconnection is a common cause of relapse after catheter ablation of atrial fibrillation (AF). However, some patients have AF recurrence despite durable PV isolation. The aim of this study was to assess the PV isolation status at the time of a second catheter ablation (redo) procedure, and its relationship with subsequent AF relapse. Methods Consecutive patients with symptomatic drug-resistant AF who underwent redo procedures from January 2006 to December 2017 were identified in a single-center observational registry. Pulmonary vein isolation status was assessed during the electrophysiologic study with a circular mapping catheter. Additional radiofrequency (RF) energy applications were also recorded. AF relapse was defined as symptomatic or documented AF/atrial tachycardia/atrial flutter after a 3-month blanking period. Results We identified 240 patients (77 [32%] females, median age 61 [IQR 53–67] years, 85 [35%] with non-paroxysmal AF) undergoing redo procedures during the study period. At the time of redo, 17 (7%) of the patients presented bidirectional conduction block of all PVs. PV reconnection occurred in 157 (65%) of cases in the left superior vein, 142 (59%) in the left inferior vein, 177 (73%) in the right superior vein, and 163 (68%) in the right inferior vein (table). All of the PVs were reconducted in 91 (38%) patients. Additional RF applications were performed in the left atrium (LA) roof, LA posterior wall, cavotricuspid isthmus, mitral isthmus, superior vena cava, coronary sinus, and left atrial appendage ostium, at the operator's discretion (table 1). Over a median follow-up of 2-years (IQR 1–5), 126 patients (53%) suffered AF recurrence, yielding a mean relapse rate of 17%/year. In multivariate Cox regression analysis, the lack of PV reconnection at the time of redo emerged as an independent predictor of subsequent relapse (HR 1.97, 95% CI 1.12–3.49, p=0.019) even after adjustment for univariate predictors including non-paroxysmal AF, body mass index, female sex, and active smoking. Conclusion In patients undergoing redo AF ablation procedures, less than 10% present with complete PV isolation. Despite being relatively infrequent, this finding is independently associated with greater likelihood of subsequent recurrence, suggesting that other mechanisms, not fully addressed by additional RF applications, are at play.

scholarly journals Catheter ablation for atrial arrhythmias in adults with congenital heart disease: recurrence rates and predictors of acute procedural success

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A El-Medany ◽  
N Sunderland ◽  
R Dobson ◽  
A Nisbet
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Congenital Heart ◽  
Cox Regression ◽  
Atrial Arrhythmia ◽  
Cox Regression Analysis ◽  
Time To Recurrence ◽  
Procedural Success

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are an important cause of morbidity and emergency hospitalisation in patients with adult congenital heart disease (ACHD), and this is due to a combination of surgical scar, residual haemodynamic lesions, and cardiac chamber dilatation. The most effective available treatment is catheter ablation, although this can be extremely challenging owing to abnormal anatomy and problems accessing intra cardiac sites critical to the arrhythmia mechanism. However, outcomes of catheter ablation and analysis of factors which may predict recurrence of arrhythmia remain poorly defined.  Purpose  To define the cohort of ACHD patients undergoing catheter ablation for atrial arrhythmia in a large tertiary centre, characterise outcomes, and determine factors associated with arrhythmia recurrence. Methods Retrospective study of all catheter ablations for atrial arrhythmias in ACHD patients between April 13, 2016 and December 16, 2019 at our institution.  Patients were identified using a field search through a centralised database; and pre-specified clinical and procedural data of interest, and time from ablation to recurrence were determined from the computerised electronic record. Binary logistical regression and cox regression analysis were used to determine potential predictors of acute procedural success and arrhythmia recurrence respectively.  Results Among 90 patients (mean age 43 ± 15 years) who underwent catheter ablation for atrial arrhythmia, 39 (43%) were treated for macro-reentrant atrial tachycardia, 19 (21%) for focal atrial tachycardia, 9 (10%) for multifocal atrial tachycardia, 10 (10%) for atrial fibrillation, 7 (8%) for atrioventricular nodal reentrant tachycardia, and 6 (7%) for atrioventricular reentrant tachycardia. 35 (39%) of patients had "severe" complexity ACHD as per the Bethesda classification. 35 (39%) experienced recurrent arrhythmia with a median time to recurrence of 120 days. Age, gender, body mass index, complexity of congenital heart disease, and previous surgical repair were not identified as being significantly associated with recurrence, however univariate cox regression analysis showed a significantly longer time to recurrence in cases utilising electroanatomical mapping and demonstrating non-inducibility of arrhythmia in the lab post ablation (p < 0.001). There was 1 case of post-ablation bradycardia requiring pacemaker implantation, but no other complications. Conclusion Catheter ablation for atrial arrhythmia in ACHD patients is safe and effective, with a majority of patients achieving multiple arrhythmia-free months. Non-inducibility of arrhythmia post procedure and use of electroanatomical mapping are predictors of freedom from recurrence of atrial arrhythmia, suggesting effective characterisation and ablation of the arrhythmia mechanism is more important than the underlying substrate. These findings may aid management decisions for recurrent arrhythmia in ACHD patients.

scholarly journals Peak oxygen uptake on cardio pulmonary exercise testing predicts mortality in adult Fontan patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Meneguzzo ◽  
G Costola ◽  
A Constantine ◽  
M Ministeri ◽  
I Rafiq ◽  
...  
Keyword(s):  
Heart Rate ◽  
Nyha Class ◽  
Fontan Operation ◽  
Multivariable Analysis ◽  
Exercise Intolerance ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Asymptomatic Patients ◽  
Fontan Patients ◽  
Clear Relation

Abstract Introduction The Fontan operation has revolutionized the outcome of patients with univentricular hearts. However, long-term morbidity and mortality remain high and exercise intolerance in common in this population. Previous studies have failed to demonstrate a clear relation between exercise capacity, expressed as peak oxygen consumption (pVO2), and the risk of death in contrast with other congenital and non-congenital cohorts. Aims To investigate the correlates of pVO2 in the Fontan population and its relation to mortality. Methods Data were collected retrospectively on consecutive patients with a Fontan circulation who underwent a cardiopulmonary exercise test (CPET) between 2005–2019. Clinical and exercise data were collected at the time of CPET and patients were followed thereafter. Cox regression analysis was used to assess the association between exercise parameters and mortality. Different methods of estimating predicted pVO2 were compared in their impact on the prognostic value of pVO2. Results A total of 152 patients were included. Mean age at CPET was 28.9±9.3 years and 74 (48.7%) were female. The majority of patients had a total cavo-pulmonary connection (TCPC; 53.3%) followed by atrio-pulmonary (2.1%) and other Fontan variants 4.6%. The majority of patients reported no limitation on physical activity [AC1] (NYHA class I, 91, 62.3%). Baseline oxygen saturation was 93±5% and 26 (17.6%) patients had a persistent fenestration. On exercise, pVO2 was 21.9±7.4ml/min and was significantly reduced in the majority of asymptomatic patients (56.1±17.4% predicted according to the Wasserman/Hansen (WH) formula). The VE/VCO2 slope was raised (>33) in 92 (60.9%) patients. A total of 88 (58.7%) patients had an impaired heart rate reserve, and were unable to achieve a heart rate of at least 70% predicted. Over a median follow-up of 4.6 [2.5–8.9] years, 25 (16.4%) patients died. pVO2 expressed as ml/min was the only exercise parameter related to mortality in this cohort (HR 0.93, 95% CI: 0.87–0.99, p=0.03).pVO2 was even more strongly related to mortality when expressed as percentage of predicted using the WH formula (HR 0.76, 95% CI: 0.59–0.98, p=0.03), but not the Jones formula for predicted pVO2 (HR 0.83, 95% CI: 0.67–1.02, p=0.08). Additional predictors of outcome included NYHA class (no asymptomatic patients died), use of loop diuretics and a non-TCPC circulation, but not age or sex were not (Figure 1). On multivariable analysis, percent predicted pVO2 (WH) remained a predictor of outcome (HR per 10 unit increase 0.65, 95% CI: 0.46–0.93, p=0.017) with NYHA class and diuretic treatment, and with the type of Fontan operation. Conclusion A clear relation between pVO2 and mortality could be demonstrated in this Fontan population by using unadjusted pVO2, or appropriate estimates of predicted pVO2. CPET can thus be used for the risk stratification of Fontan patients, providing that care is taken in the way that pVO2 is reported and interpreted. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation

2020 ◽  
Vol 9 (10) ◽  
pp. 3164
Author(s):  
Yong-Soo Baek ◽  
Jong-Il Choi ◽  
Yun Gi Kim ◽  
Kwang-No Lee ◽  
Seung-Young Roh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cox Regression ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Index Procedure ◽  
Cox Regression Analysis ◽  
Circumferential Pulmonary Vein Isolation

Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation.

P5701Impact of VT pleomorphism on the prognostic value of non-inducibility after catheter ablation in patients with non-ischemic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Kimura ◽  
M Ebert ◽  
A P Wijnmaalen ◽  
S Trines ◽  
M De Riva Silva ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Low Voltage ◽  
Electrical Storm ◽  
Genetic Mutations ◽  
Recurrence Rates ◽  
Cox Regression Analysis ◽  
Favorable Prognosis ◽  
Acute Success

Abstract Background In patients with non-ischemic cardiomyopathy (NICM), non-inducibility after catheter ablation has been associated with lower VT recurrence rates. We hypothesized that induced VT pleomorphism (PL-VT) may be indicative for a complex VT substrate that might be associated with poor ablation outcome independently of non-inducibility at the end of the procedure. Methods Consecutive patients with left-dominant NICM undergoing VT ablation (2008–2018) were included. All patients underwent genetic screening. PL-VT was defined as occurrence of ≥1 morphologically distinct QRS lasting for ≥6 consecutive beats during the same induced VT episode. Complete acute success was defined as non-inducibility of any VT at the end of procedure. Results Eighty-five patients (56±15 yrs, LVEF 38±12%), inducible for 365 VTs (median 3/patient, IQR 1–6) were included. PL-VT was observed in 29 patients (34%). Patients with PL-VT had more often anteroseptal substrates, a higher number of induced VTs, and larger endocardial bipolar (<1.5 mV) and unipolar low voltage (<8.01 mV) areas. Pathogenic genetic mutations were more frequently recognized in patients with PL-VT than in those without (59 vs. 34%, P=0.03), but there was no significant correlation in each representative mutation (Lamin A/C, Phospholamban, or Titin). Complete acute success was achieved in 34 patients (40%) and comparable between patients with PL-VT and those without (41 vs. 39%, P=0.85). After a median of 24 months, 53 patients (62%) had VT recurrence and 23 (27%) died. In multivariate Cox regression analysis, PL-VT and inducibility of any VT were significantly associated with VT recurrence (HR 4.07, CI 1.82–8.92; P=0.001, HR 2.22, CI 1.10–4.78; P=0.026, respectively) independent of NYHA, LVEF, electrical storm, genetic mutations, low voltage area, substrate location, and number of induced VTs. Of importance, the co-existence of PL-VT and persistent VT inducibility identified those at highest risk for VT recurrence after 2-years. (PL-VT (−)/complete success, 27%, PL-VT (−)/non-complete success, 50%, PL-VT (+)/complete success, 58%, PL-VT (+)/non-complete success 94%, Log-rank P<0.001, see figure). Figure 1 Conclusions Induced PL-VT was not associated with acute outcome but higher VT recurrence rate after catheter ablation in patients with NICM. Moreover, co-existence of PL-VT and persistent VT inducibility identifies patients at highest risk for VT recurrence whereas non-inducible patients without PL-VT have a favorable prognosis.

Predictive Model for Live Birth at 12 Months After Starting In-Vitro Fertilization Treatment

MedPharmRes ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 5-20
Author(s):  
Vu Ho ◽  
Toan Pham ◽  
Tuong Ho ◽  
Lan Vuong
Keyword(s):  
In Vitro Fertilization ◽  
Live Birth ◽  
Cox Regression ◽  
Financial Burden ◽  
Oocyte Retrieval ◽  
Operating Characteristics ◽  
Vitro Fertilization ◽  
Cox Regression Analysis ◽  
Significant Difference

IVF carries a considerable physical, emotional and financial burden. Therefore, it would be useful to be able to predict the likelihood of success for each couple. The aim of this retrospective cohort study was to develop a prediction model to estimate the probability of a live birth at 12 months after one completed IVF cycle (all fresh and frozen embryo transfers from the same oocyte retrieval). We analyzed data collected from 2600 women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at a single center in Vietnam between April 2014 and December 2015. All patients received gonadotropin-releasing hormone (GnRH) antagonist stimulation, followed by fresh and/or frozen embryo transfer (FET) on Day 3. Using Cox regression analysis, five predictive factors were identified: female age, total dose of recombinant follicle stimulating hormone used, type of trigger, fresh or FET during the first transfer, and number of subsequent FET after the first transfer. The area under the receiver operating characteristics curve for the final model was 0.63 (95% confidence interval [CI] 0.60‒0.65) and 0.60 (95% CI 0.57‒0.63) for the validation cohort. There was no significant difference between the predicted and observed probabilities of live birth (Hosmer-Lemeshow test, p > 0.05). The model developed had similar discrimination to existing models and could be implemented in clinical practice.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

2015 ◽  
Vol 24 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Petra A. Golovics ◽  
Laszlo Lakatos ◽  
Michael D. Mandel ◽  
Barbara D. Lovasz ◽  
Zsuzsanna Vegh ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cox Regression ◽  
Diagnostic Procedures ◽  
Population Based ◽  
Disease Course ◽  
Inception Cohort ◽  
Disease Extent ◽  
Cox Regression Analysis ◽  
Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

Red Blood Cell Indices in Relation to Post-stroke Psychiatric Disorders: A Longitudinal Study in a Follow-up Stroke Clinic

2020 ◽  
Vol 17 (3) ◽  
pp. 218-223
Author(s):  
Haichao Wang ◽  
Li Gong ◽  
Xiaomei Xia ◽  
Qiong Dong ◽  
Aiping Jin ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Blood Cell ◽  
Cox Regression ◽  
Depression And Anxiety ◽  
Cox Regression Analysis ◽  
Post Stroke ◽  
Rbc Indices ◽  
Post Stroke Depression

Background: Depression and anxiety after stroke are common conditions that are likely to be neglected. Abnormal red blood cell (RBC) indices may be associated with neuropsychiatric disorders. However, the association of RBC indices with post-stroke depression (PSD) and poststroke anxiety (PSA) has not been sufficiently investigated. Methods: We aimed to investigate the trajectory of post-stroke depression and anxiety in our follow- up stroke clinic at 1, 3, and 6 months, and the association of RBC indices with these. One hundred and sixty-two patients with a new diagnosis of ischemic stroke were followed up at 1, 3, and 6 months, and underwent Patient Health Questionnaire-9 (PHQ-9) and the general anxiety disorder 7-item (GAD-7) questionnaire for evaluation of depression and anxiety, respectively. First, we used Kaplan-Meier analysis to investigate the accumulated incidences of post-stroke depression and post-stroke anxiety. Next, to explore the association of RBC indices with psychiatric disorders after an ischemic stroke attack, we adjusted for demographic and vascular risk factors using multivariate Cox regression analysis. Results: Of the 162 patients with new-onset of ischemic stroke, we found the accumulated incidence rates of PSD (1.2%, 17.9%, and 35.8%) and PSA (1.2%, 13.6%, and 15.4%) at 1, 3, and 6 months, respectively. The incident PSD and PSA increased 3 months after a stroke attack. Multivariate Cox regression analysis indicated independent positive associations between PSD risk and higher mean corpuscular volume (MCV) (OR=1.42, 95% CI=1.16-1.76), older age (OR=2.63, 95% CI=1.16-5.93), and a negative relationship between male sex (OR=0.95, 95% CI=0.91-0.99) and PSA. Conclusion: The risks of PSD and PSA increased substantially 3 months beyond stroke onset. Of the RBC indices, higher MCV, showed an independent positive association with PSD.

Impact of the Fontan Operation on Organ Systems

2019 ◽  
Vol 19 (3) ◽  
pp. 205-214
Author(s):  
Miriam Michel ◽  
Manuela Zlamy ◽  
Andreas Entenmann ◽  
Karin Pichler ◽  
Sabine Scholl-Bürgi ◽  
...  
Keyword(s):  
Systematic Study ◽  
Fontan Operation ◽  
Gastrointestinal System ◽  
Adjunct Treatment ◽  
Organ Systems ◽  
Fontan Surgery ◽  
Fontan Patients

: In patients having undergone the Fontan operation, besides the well discussed changes in the cardiac, pulmonary and gastrointestinal system, alterations of further organ systems including the hematologic, immunologic, endocrinological and metabolic are reported. As a medical adjunct to Fontan surgery, the systematic study of the central role of the liver as a metabolizing and synthesizing organ should allow for a better understanding of the pathomechanism underlying the typical problems in Fontan patients, and in this context, the profiling of endocrinological and metabolic patterns might offer a tool for the optimization of Fontan follow-up, targeted monitoring and specific adjunct treatment.

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