Risk Factors and Long-Term Prognosis for Chylothorax After Total Cavopulmonary Connection in Children: A Retrospective Study From a Single Center

Background: Chylothorax is a severe complication after total cavopulmonary connection (TCPC) in children. This study was performed to evaluate the incidence, risk factors, and short- and long-term prognosis for chylothorax.Methods: We retrospectively reviewed the electronic records of patients who underwent TCPC between January 2008 and December 2020 in Fuwai Hospital. Patients were divided into two groups based on the occurrence of post-operative chylothorax. Univariate and multivariate analyses were performed to identify risk factors, and long-term survival was estimated by the Kaplan–Meier method.Results: Of 386 patients included in our study, chylothorax occurred in 60 patients (15.5%). Compared with the non-chylothorax group, the prevalence of prolonged intensive care unit (ICU) stay (p = 0.000) and post-operative hospital stay (p = 0.000) were greater in patients with chylothorax. Post-operative adverse events in terms of infection (p = 0.002), ascites (p = 0.001), prolonged pleural effusion (p = 0.000), and diaphragmatic paralysis (p = 0.026) were more frequent in chylothorax patients. The median follow-up duration was 4.0 (2.0, 6.8) years. The chylothorax group had significantly lower survival rates at 1 year (92.4 vs. 99.3%, p < 0.001) and 10 years (84.6 vs. 91.6%, p < 0.001), respectively. Having a right dominant ventricle [odds ratio (OR) = 2.711, 95% confidence interval (CI) = 1.285–5.721, p = 0.009] and a higher peak central venous pressure (CVP) on post-operative day (POD) 0 (OR = 1.116, 95% CI = 1.011–1.233, p = 0.030) were the risk factors for the development of chylothorax after TCPC operation.Conclusion: The incidence of chylothorax in patients undergoing TCPC is lower than previously reported but is associated with poor early- and long-term survival. Having a right dominant ventricle and a higher peak CVP on POD 0 are the risk factors for chylothorax after TCPC operation.

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Reappraisal of lung manifestations in the setting of Fontan circulation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211056711 ◽

2021 ◽

pp. 021849232110567

Author(s):

Meletios Kanakis ◽

Thomas Martens ◽

Martin Kostolny ◽

Konstantinos Petsios ◽

Nicholas Giannopoulos ◽

...

Keyword(s):

Blood Flow ◽

Literature Review ◽

Clinical Experience ◽

Fontan Circulation ◽

Total Cavopulmonary Connection ◽

Central Venous ◽

Term Survival ◽

Long Term Survival ◽

Cavopulmonary Connection

Fontan circulation is a well-established palliation in patients with functional single ventricles. Absence of a sub-pulmonary pumping chamber creates a unique physiology in which blood flow is mainly guided by negative intrathoracic and elevated central venous pressures. Various pulmonary anatomic or pathophysiologic changes can jeopardize optimal Fontan circulation. Long-term survival of patients who have undergone the contemporary total cavopulmonary connection is satisfactory. Thorough literature review in conjunction with accumulated clinical experience can lead clinicians to extract conclusions regarding Fontan and lung interactions indicating the purpose of this review.

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Long-term survival of distal cholangiocarcinoma after pancreaticoduodenectomy combined with portal vein system resection and reconstruction

10.21203/rs.3.rs-33592/v1 ◽

2020 ◽

Author(s):

Shaocheng Lyu ◽

Lixin Li ◽

Xin Zhao ◽

Zhangyong Ren ◽

Di Cao ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Portal Vein ◽

Survival Rates ◽

Term Survival ◽

Distal Cholangiocarcinoma ◽

Long Term Survival ◽

Vein System ◽

Overall Survival Rates

Abstract BACKGROUND: Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. And the 5-year survival rate of distal cholangiocarcinoma after pancreatoduodenectomy ranged from 22–47%. Pancreatoduodenectomy combined with portal vein system resection and reconstruction for distal cholangiocarcinoma is rarely reported because it’s not common. To our knowledge, only few reports have provided the detail outcome and long-term survival of distal cholangiocarcinoma after pancreaticoduodenectomy combined with portal vein system resection and reconstruction. Therefore, we developed a program to analysis the risk factors of prognosis for distal cholangiocarcinoma patients after pancreaticoduodenectomy, and to evaluate the vascular invasion type, operation procedure and long-term survival of patients with portal vein system invasion. METHODS: Retrospective reviewed for 123 distal cholangiocarcinoma patients after pancreatoduodenectomy between January 2011 and December 2019. Portal vein system invasion in 17 patients according to the pathology. Multivariable regression Cox models produced survival estimate to the distal cholangiocarcinoma patients. Then patients were grouped according to portal vein system invasion, and tumor-free and overall survival rates were investigated with the Kaplan-Meier analysis. Finally, the vascular invasion type and operation procedure were analyzed to the distal cholangiocarcinoma patients with portal vein system invasion. RESULTS: The 1-year, 3-year, 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, 31.5%. Multifactor Cox regression showed tumour differentiation degree (RR = 1.440, 95%CI:1.009–2.055), portal vein system invasion (RR = 1.860, 95%CI:1.057–3.275) and lymph node metastasis (RR = 2.097, 95%CI: 1.054–4.174) as independent risk factors for long-term survival. There were 17 patients underwent pancreatoduodenectomy combined with portal vein system resection and reconstruction. The patients with portal vein system invasion had larger tumor diameter, longer operation time, more blood transfusion rate and more lymph node metastasis rate than control group (P < 0.05). The 1-year, 2-year overall survival rates for patients without and with portal vein system invasion were 79.7%, 58.9% and 48.6%, 10.8% (p = 0.000). The median overall survival time for patients without and with portal vein system invasion were 49.1 and 14.2 months, respectively. CONCLUSION: The portal vein system invasion is an important independent risk factors for long-term survival to the patients with distal cholangiocarcinoma, and the long-term survival is poor. Pancreatoduodenectomy combined with portal vein system resection and reconstruction did not increase the incidence of perioperative complication rate and mortality. At present, surgery maybe still the only effective method for distal cholangiocarcinoma patients with portal vein system invasion.

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Influence of fenestration on long-term Fontan survival

Cardiology in the Young ◽

10.1017/s1047951121003516 ◽

2021 ◽

pp. 1-6

Author(s):

Ondřej Materna ◽

Vojtěch Illinger ◽

Denisa Jičínská ◽

Karel Koubský ◽

Jan Kovanda ◽

...

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Composite Endpoint ◽

Total Cavopulmonary Connection ◽

Term Survival ◽

Fenestration Closure ◽

The Difference ◽

Group 2 ◽

Cavopulmonary Connection

Abstract Introduction: Fenestration in the total cavopulmonary connection system may improve the outcome of patients with significant risk factors for Fontan haemodynamics. Our study aims to analyse the difference in long-term survival between non-fenestrated and fenestrated patients. Methods: All consecutive patients (n = 351) who underwent total cavopulmonary connection between 1992 and 2016 were identified. Six early deaths were excluded resulting in a group of 345 patients. Median (interquartile range,) length of follow-up was 14.4 (7.1–19.7) years. Freedom from the composite endpoint of death, total cavopulmonary connection take-down or indication for a heart transplant was analysed. Results: Fenestration was absent in 237 patients (68.7%, Group 1), was created and closed later in 79 patients (22.9%, Group 2), and remained open in 29 patients (8.4%, Group 3). Mean survival probability until composite endpoint was 97.1 and 92.9% at 10 and 20 years, respectively. Patients with patent fenestration had worse survival (p < 0.001) as compared to both the non-fenestrated and fenestration closure groups. Despite a similar outcome, exercise capacity was lower in Group 2 than 1 (p = 0.013). In 58 patients with interventional fenestration closure, Nakata index was lower at the time of closure than pre-operatively, and both the pressure in the circuit and oxygen saturation in the aorta increased significantly (p < 0.001). Conclusions: Patients with persisting risk factors preventing fenestration closure are at higher risk of reaching the composite endpoint. Patients after fenestration closure have the worse functional outcome; their survival is, however, not different from the non-fenestrated group.

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Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis

Journal of Clinical Medicine ◽

10.3390/jcm11010089 ◽

2021 ◽

Vol 11 (1) ◽

pp. 89

Author(s):

Anna Polewczyk ◽

Wojciech Jacheć ◽

Dorota Nowosielecka ◽

Andrzej Tomaszewski ◽

Wojciech Brzozowski ◽

...

Keyword(s):

Risk Factors ◽

Tricuspid Valve ◽

Lead Extraction ◽

Common Mechanism ◽

Term Survival ◽

Long Term Survival ◽

Valve Dysfunction ◽

Valve Function ◽

Long Term Prognosis

Background: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. Methods: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008–2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. Results: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. Conclusions: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.

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Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01506-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lytfi Krasniqi ◽

Mads P. Kronby ◽

Lars P. S. Riber

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Significant Risk ◽

Valve Prosthesis ◽

Term Survival ◽

Long Term Survival ◽

All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

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The influence of thrombophilia on the long-term survival of patients with a history of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th12-05-0361 ◽

2013 ◽

Vol 109 (01) ◽

pp. 79-84 ◽

Cited By ~ 12

Author(s):

Sylvia Reitter-Pfoertner ◽

Thomas Waldhoer ◽

Michaela Mayerhofer ◽

Ernst Eigenbauer ◽

Cihan Ay ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Multivariable Analysis ◽

Factor V Leiden ◽

Arterial Disease ◽

Factor V ◽

Term Survival ◽

Long Term Survival ◽

History Of

SummaryData on the long-term survival following venous thromboembolism (VTE) are rare,and the influence of thrombophilia has not been evaluated thus far. Our aim was to assess thrombophilia-parameters as predictors for long-term survival of patients with VTE. Overall, 1,905 outpatients (99 with antithrombin-, protein C or protein S deficiency, 517 with factor V Leiden, 381 with elevated factor VIII and 160 with elevated homocysteine levels, of these 202 had a combination and 961 had none of these risk factors) were included in the study between September 1, 1994 and December 31, 2007. Retrospective survival analysis showed that a total of 78 patients (4.1%) had died during the analysis period, among those four of definite or possible pulmonary embolism and four of bleeding. In multivariable analysis including age and sex an association with increased mortality was found for hyperhomocysteinemia (hazard ratio 2.0 [1.1.-3.5]) whereas this was not the case for all other investigated parameters. We conclude that the classical hereditary thrombophilia risk factors did not have an impact on the long-term survival of patients with a history of VTE. Thus our study supports the current concept that thrombophilia should not be a determinant for decision on long term anticoagulation. However, hyperhomocysteinaemia, known as a risk factor for recurrent VTE and arterial disease, might impact survival.

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Incidence, Predictors, and Impact of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting in Military Veterans

Texas Heart Institute Journal ◽

10.14503/thij-15-5532 ◽

2016 ◽

Vol 43 (5) ◽

pp. 397-403 ◽

Cited By ~ 10

Author(s):

Shuab Omer ◽

Lorraine D. Cornwell ◽

Ankur Bakshi ◽

Eric Rachlin ◽

Ourania Preventza ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Artery Bypass ◽

Military Veterans ◽

Survival Rates ◽

Postoperative Atrial Fibrillation ◽

Bypass Grafting ◽

Term Survival ◽

Long Term Survival

Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013. Multivariable logistic regression identified predictors of postoperative atrial fibrillation. Kaplan-Meier analysis was used to evaluate long-term survival (the primary outcome measure), morbidity, and length of hospital stay. Postoperative atrial fibrillation occurred in 215 patients (17.2%). Independent predictors of this sequela were age ≥65 years (odds ratios [95% confidence intervals], 1.7 [1.3–2.4] for patients of age 65–75 yr and 2.6 [1.4–4.8] for patients >75 yr) and body mass index ≥30 kg/m2 (2.0 [1.2–3.2]). Length of stay was longer for patients with postoperative atrial fibrillation than for those without (12.7 ± 6.6 vs 10.3 ± 8.9 d; P ≤0.0001), and the respective 30-day mortality rate was higher (1.9% vs 0.4%; P=0.014). Seven-year survival rates did not differ significantly. Older and obese patients are particularly at risk of postoperative atrial fibrillation after CABG. Patients who develop the sequela have longer hospital stays than, but similar long-term survival rates to, patients who do not.

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Advanced gastric adenocarcinoma — influence of preoperative radiation therapy on toxicity and long-term survival rates

Gastroenterology ◽

10.1016/s0016-5085(00)81993-9 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1521

Author(s):

Carlos E. Malzoni ◽

Sergio Santoro ◽

Victor Strassmann ◽

Shalon Kalnicki ◽

Claudio Bresciani

Keyword(s):

Radiation Therapy ◽

Gastric Adenocarcinoma ◽

Survival Rates ◽

Preoperative Radiation ◽

Term Survival ◽

Long Term Survival ◽

Preoperative Radiation Therapy ◽

Advanced Gastric Adenocarcinoma

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A New Aortic Arch Dissection Classification: The Fuwai Classification

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.710281 ◽

2021 ◽

Vol 8 ◽

Author(s):

Juntao Qiu ◽

Xinjin Luo ◽

Jinlin Wu ◽

Wei Pan ◽

Qian Chang ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Survival Rates ◽

Innominate Artery ◽

Long Term Results ◽

Surgical Mortality ◽

Left Carotid Artery ◽

Term Survival ◽

Long Term Survival

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications.Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation.Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19).Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

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