Cardiac Catheterization During Early Post-Operative Fontan Completion In Current Era: Nicklaus Children’s Hospital Experience

Background
Despite of improvements in the surgical technique and postoperative care of Fontan operation, significant morbidity and mortality are still common especially persistent pleural effusions and hypoxia. Cardiac catheterization both for hemodynamic evaluation and interventions are frequently performed. Our objective is to describe the types of catheter intervention, indications and outcomes in this group of patients.

Methods
Cardiac surgical database of the Nicklaus Children’s Hospital was retrospectively reviewed. Patients who underwent Fontan operation and had cardiac catheterization within 30 days after the Fontan completion from 1/2008 to 12/2015 were included. Clinical variables such as the indication of the cardiac catheterization, findings, and types of interventions were collected.

Results
Total of 113 patients underwent extracardiac Fontan completion during the study period with median length of hospital stay of 11 days (5 – 67 days). Twenty-two patients (19%) with median age of 3.7 years (1.5– 7.7 years) underwent 25 cardiac catheterizations. The majority were patients with hypoplastic left heart syndrome (n= 11, 50%)and the median postoperative day whencatheterizationwas performed is 11 days (range 1-22 days). The indications were persistent pleural effusion in 64%, hypoxia 28% and lower body edema 8%. Four procedures were hemodynamic evaluation without any intervention. The median Fontan pressures were 14mmHg (range 9-21mmHg). Interventions resultedonstent placementin either the branch pulmonary arteries (n=13, 52%), the most common being at the left of the Fontan anastomosis; aortopulmonary collateral occlusion (n=4, 12%) and pulmonary artery balloon angioplasty (n=3, 12%).The median day of discharge after intervention was 11days(range 3-60 days)There were no significant procedural complications.

Conclusions
The need for early postoperative cardiac catheterization is relatively common in post Fontan patients. Percutaneous intervention can be safely performed. This might help optimize Fontan physiology and shorten length of hospital stay after Fontan operation.