Reintervention and survival in 1428 patients in the Australian and New Zealand Fontan Registry

Heart ◽  
2019 ◽  
Vol 106 (10) ◽  
pp. 751-757 ◽  
Author(s):  
Michael Daley ◽  
Karin du Plessis ◽  
Dianna Zannino ◽  
Tim Hornung ◽  
Patrick Disney ◽  
...  
Keyword(s):  
New Zealand ◽  
Single Ventricle ◽  
Interventional Procedure ◽  
Fontan Operation ◽  
Substantial Proportion ◽  
Surgical Interventions ◽  
Fenestration Closure ◽  
Using Data ◽  
Fontan Surgery ◽  
Improvement In Survival

ObjectivePatients undergoing single-ventricle palliation have experienced significant improvement in survival in the recent era. However, a substantial proportion of these patients undergo reoperations. We performed a review of the Australia and New Zealand (ANZ) Fontan Registry to determine the overall reintervention and reoperative burden in these patients.MethodsA retrospective longitudinal cohort study was performed using data from patients who underwent a Fontan operation between 1975 and 2016 from the ANZ Fontan Registry. The data obtained included Fontan operation, reinterventions and most recent follow-up status. We examined the type and timing of reinterventions and survival.ResultsOf the 1428 patients identified, 435 (30%) underwent at least one reintervention after the Fontan operation: 110 patients underwent early reintervention and 413 underwent late reinterventions. Excluding Fontan conversion and transplantation, 220 patients underwent at least one interventional procedure and 209 patients underwent at least one reoperation. Fenestration closure and pacemaker-related procedures were the most common catheter and surgical interventions, respectively. The cumulative incidence of reintervention following Fontan was 23%, 37% and 55% at 10, 20 and 30 years, respectively. Survival and freedom from failure were worse in patients requiring later reintervention after Fontan surgery (51% vs 83% and 42% vs 69%, respectively at 30 years, p<0.001). This difference persisted after excluding pacemaker-related procedures (p<0.001). Operative mortality for non-pacemaker late reoperations after Fontan was 6%.ConclusionsA substantial proportion of Fontan patients require further intervention to maintain effective single-ventricle circulation. Patients undergoing reoperation after Fontan have higher rates of mortality and failure, despite intervention.

Numerical Modeling of Pulsating Inflow to the Pulmonary Arteries in TCPC Morphology Using FSI Approach

2013 ◽  
Author(s):  
Hamid Reza Rajabzadeh ◽  
Bahar Firoozabadi ◽  
Mohammad Said Saidi ◽  
Salman Sohrabi ◽  
Seyyed Mahdi Nemati Mehr
Keyword(s):  
Blood Flow ◽  
Single Ventricle ◽  
Pulmonary Stenosis ◽  
Fontan Operation ◽  
Pulmonary Arteries ◽  
Rigid Wall ◽  
New Approach ◽  
Pulmonary Flow ◽  
Single Ventricle Heart Defect ◽  
Fontan Surgery

The Fontan surgery is performed on patients with a single ventricle heart defect to prevent the combination of highly-oxygenated and poorly-oxygenated blood. Blood flow in total cavopulmonary connection (TCPC) which culminates an ordinary Fontan operation is practically steady-state but this flow is not appropriate for respiratory systems. This article investigates an approach in Fontan surgery that has been recently proposed in order to make the pulmonary blood flow pulsating. Moreover, for investigating the compliance of vessels and its effects on blood flow in TCPC, we have used the FSI (Fluid Structure Interaction) method as well as rigid wall assumption for comparison purposes. Our TCPC model structure has obtained from CT Angiography (CTA) scan of a single ventricle patient who has undergone a normal Fontan surgery. In this new procedure, pulmonary stenosis (PS), containing high pressure and pulsating flow, has been added to the original geometry for pulsating the main flow and then its effect on the general flow in left and right pulmonary arteries has been studied by increasing the inlet velocity to PS. In overall, our results show that this new approach increases the pulsations of pulmonary flow.

Pulmonary vasodilator therapy in the failing Fontan circulation: rationale and efficacy

2015 ◽  
Vol 25 (8) ◽  
pp. 1489-1492 ◽  
Author(s):  
Brian S. Snarr ◽  
Stephen M. Paridon ◽  
Jack Rychik ◽  
David J. Goldberg
Keyword(s):  
Single Ventricle ◽  
Fontan Operation ◽  
Vasodilator Therapy ◽  
Pulmonary Vasodilators ◽  
Pulmonary Vasodilator ◽  
Fontan Physiology ◽  
Fontan Surgery ◽  
Failing Fontan ◽  
Fontan Patients

AbstractThe Fontan operation is the final step of palliation for patients with a functionally single ventricle. Since its introduction in the 1970s, the Fontan surgery has become part of a successful surgical strategy that has improved single ventricle mortality. In recent years, we have become more aware of the limitations and long-term consequences of the Fontan physiology. Pulmonary vascular resistance plays an important role in total cavopulmonary circulation, and has been identified as a potential therapeutic target to mitigate Fontan sequelae. In this review, we will discuss the results of different pulmonary vasodilator trials and the use of pulmonary vasodilators as a treatment strategy for Fontan patients.

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.

scholarly journals Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: The Australia and New Zealand Fontan Registry experience

2014 ◽  
Vol 148 (2) ◽  
pp. 566-575 ◽  
Author(s):  
Ajay J. Iyengar ◽  
David S. Winlaw ◽  
John C. Galati ◽  
David S. Celermajer ◽  
Gavin R. Wheaton ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Adverse Outcomes ◽  
Fontan Surgery

Abstract 16822: Growth Curves Describing a Single Ventricle Population After Fontan Procedure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bethany Runkel ◽  
Vincent Staggs ◽  
Chelsea Hosey Cojocari ◽  
Jonathan B Wagner
Keyword(s):  
Single Ventricle ◽  
Multiple Stressors ◽  
Pediatric Population ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Growth Patterns ◽  
Growth Charts ◽  
Genetic Syndrome ◽  
Adiposity Rebound ◽  
Extracardiac Conduit

Introduction: Complex single ventricle congenital heart disease (CHD) patients are subject to multiple stressors early in life that affect somatic growth. Pre-Fontan growth patterns are well-described, but post-Fontan growth has not been extensively studied in the current era. We sought to describe post-Fontan growth patterns by creating sex-specific body mass index (BMI)-for-age curves. Hypothesis: There is no difference in the growth of post-Fontan pediatric patients when compared to published normative data. Methods: A single-center, preexisting database was retrospectively queried for all patients who underwent Fontan procedure between 2006 and 2018. Patients with a genetic syndrome, a primary endocrine disorder, or significant prematurity were excluded. BMI-for-age curves were created for both male and female patients using anthropometric data extracted from the electronic medical record. Curves were then visually compared with Centers for Disease Control and Prevention (CDC) growth charts. Results: Of 227 patients who underwent primary Fontan operation, 37 were excluded. Of the remaining 190 patients, 59% were male. All had an extracardiac conduit, half had right-ventricular dominant CHD, and 15% had a Fontan fenestration. Median age and weight at surgery were 3.9 years and 15 kilograms, respectively. BMI curves were similar in appearance to CDC BMI-for-age growth charts, with adiposity rebound at age 6. BMI increased more rapidly in teen boys compared with girls, and a total of five patients (2.6%) had BMI values greater than 25 kg/m 2 at 16 years of age. Conclusion: Post-Fontan patients at our institution demonstrate BMI-for-age patterns similar to those of the general population during childhood and early adolescence, with adiposity rebound occurring at a typical age. Though excess weight gain does not completely spare patients with single ventricle CHD, overweight status appears to be less common than in the general pediatric population.

scholarly journals Coping with emotion in New Zealand Business schools

2021 ◽  
Author(s):  
◽  
Alice Scahill
Keyword(s):  
New Zealand ◽  
Coping Strategies ◽  
Business Schools ◽  
Tertiary Education ◽  
Early Career ◽  
Specific Level ◽  
Systemic Factors ◽  
Emotional Demands ◽  
Negative Impacts ◽  
Using Data

<p>Emotion is an integral aspect of organisational life and this thesis examines the emotional demands that academics experience in their workplace and the consequences this has for them. At a more specific level, the thesis examines the strategies that academics use to cope with these emotional demands, and how these strategies develop and change over the duration of their career. Using data collected from interviews with academics from business schools across the New Zealand tertiary education sector, findings are presented which demonstrate how academics develop coping strategies and how the organisation provides support. The implications from these findings could have significant effects for organisational practice. Firstly, these findings illustrate that academics experiences emotion in relation to personal, interpersonal, and systemic factors. Secondly, academics adopt a wide array of coping strategies, which have been personally developed by each individual over time. They are not given any organisational training or support for their development of these strategies. In addition, academics use coping strategies both in the workplace and at home in order to attempt to mitigate the negative impacts of the emotional demands of their roles. Finally, academics in their early career lack adequate coping strategies, and appear to have the lowest levels of organisational commitment.</p>

scholarly journals The Costs and Benefits of Covid-19 Lockdowns in New Zealand

2021 ◽  
Author(s):  
Martin Lally
Keyword(s):  
New Zealand ◽  
Vaccination Campaign ◽  
Quality Adjusted Life Year ◽  
Mitigation Strategy ◽  
Health Interventions ◽  
Costs And Benefits ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Using Data ◽  
Quality Adjusted Life

This paper considers the costs and benefits of New Zealand's Covid-19 nation-wide lockdown strategy relative to pursuit of a mitigation strategy in March 2020. Using data available up to 28 June 2021, the estimated additional deaths from a mitigation strategy are 1,750 to 4,600, implying a Cost per Quality Adjusted Life Year saved by locking down in March 2020 of at least 13 times the generally employed threshold figure of $62,000 for health interventions in New Zealand; the lockdowns do not then seem to have been justified by reference to the standard benchmark. Using only data available to the New Zealand government in March 2020, the ratio is similar and therefore the same conclusion holds that the nation-wide lockdown strategy was not warranted. Looking forwards from 28 June 2021, if a new outbreak occurs that cannot be suppressed without a nation-wide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020; this would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.

scholarly journals Attenuation of peak ground accelerations in some recent New Zealand earthquakes

1993 ◽  
Vol 26 (1) ◽  
pp. 3-13 ◽  
Author(s):  
D. J. Dowrick ◽  
S. Sritharan
Keyword(s):  
New Zealand ◽  
Strong Motion ◽  
Medium Size ◽  
Data Sets ◽  
Fault Rupture ◽  
Motion Data ◽  
Peak Ground Accelerations ◽  
The Mean ◽  
Using Data ◽  
Event Based

The attenuation of peak ground accelerations was studied for eight New Zealand earthquakes which occurred in the period 1987 to 1991. These events were of medium size with moment magnitudes in the range Mw = 5.8 - 6.7, with depth to centroids of the fault rupture ranging from 4 to 60 km. Attenuation of peak ground accelerations was examined for each event, based on the slope distance from the rupture surface to each strong motion data site. The mean regression attenuation curve for each event was compared with those derived by others using data sets from other parts of the world, allowance being made for source mechanism and depth. Excepting the 1988 Te Anau event, the other seven New Zealand events as a set closely match a Japanese model, but give significantly stronger accelerations than those predicted by the models from western USA and Europe.

Effect of Accessory Pulmonary Blood Flow on Survival After the Bidirectional Glenn Procedure

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Richard D. Mainwaring ◽  
John J. Lamberti ◽  
Karen Uzark ◽  
Robert L. Spicer ◽  
Mark W. Cocalis ◽  
...  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Fontan Operation ◽  
Right Ventricular Outflow Tract ◽  
Bidirectional Glenn ◽  
Actuarial Analysis ◽  
Bidirectional Glenn Procedure ◽  
Glenn Procedure

Background —The bidirectional Glenn procedure (BDG) is used in the staged surgical management of patients with a functional single ventricle. Controversy exists regarding whether accessory pulmonary blood flow (APBF) should be left at the time of BDG to augment systemic saturation or be eliminated to reduce volume load of the ventricle. The present study was a retrospective review of patients undergoing BDG that was conducted to assess the influence of APBF on survival rates. Methods and Results —From 1986 through 1998, 149 patients have undergone BDG at our institution. Ninety-three patients had elimination of all sources of APBF, whereas 56 patients had either a shunt or a patent right ventricular outflow tract intentionally left in place to augment the pulmonary blood flow provided by the BDG. The operative mortality rate was 2.2% without APBF and 5.4% with APBF. The late mortality rate was 4.4% without APBF and 15.1% with APBF. Actuarial analysis demonstrates a divergence of the Kaplan-Meier curves in favor of patients in whom APBF was eliminated ( P <0.02). One hundred seven patients have subsequently undergone completion of their Fontan operation, so the actuarial analysis includes the operative risk of this second operation. Conclusions —The results suggest that the elimination of APBF at the time of BDG may confer a long-term advantage for patients with a functional single ventricle.

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