JCK E-Oral Presentation 1 (II-JCKEOP01)

[II-JCKEOP01-06] Perioperative effects of the Tolvaptan for the Fontan Patients

^○Takeshi Konuma¹, Syuhei Toba¹, Ayano Hutuki¹, Kohsuke Kurihara², Noriko Yodoya², Hiroyuki Ohashi², Hirobumi Sawada², Yosihide Mitani², Jyunya Hirayama², Hideto Shinpo¹ (1.Departmemt of Thoracic and Cardiovascular Surgery, Mie University, Japan 2.Departmemt of Pediatrics, Mie University, Japan)

We have increasing an opportunity to give Tolvaptan in perioperative period, but a case of the Fontan patient is rarely reported. Recently we have some Fontan patients who improved prolonged pleural drainage after Tolvaptan administration.
Subject and Method
From Jan 2009 to 2016 Aug 14 patients underwent extracardiac TCPC procedure. Tolvaptan was administrated to the 5 patients whose urine output decreased and needed prolonged pleural drainage (Group T). And we compared another 7 patients as control (Group C). A dosage of Tolvaptan was 0.75-7.5mg (0.25mg/kg).
Results
Age at operation (y) : 3.5±0.5 Group T, 2.7±0.3 Group C (p=0.01), BW(kg),:12.1±0.9 Group T, 11.6±1.6 Group C (p= 0.5), Duration of pleural drainage (d) : 21.6±9.6 Group T, 4.6±1.8 Group C (p=0.0002)．Age at the Fontan operation was higher and the duration of pleural drainage was longer in T group. There was no differences between two gropes in PA index, Rp(μm²), PA pressure(mmHg)，and EF(%), EDP(mmHg).
Four cases (80%) were extubated in operation room in Group T and 5 cases (55%) in Group C. ICU stay (d) was 3.6±3.5, Group C:2.0±1.7 (p=0.2). In group T, urine volume before and after Tolvaptan administration was 37:68 (ml/kg) (p=0.04), Pleural effusion drainage (ml/kg) was 10.8:6.8 (p=0.13). Urine volume and less pleural effusion were observed after administration. Duration of pleural drainage was 6.7 days（2-13）in average. Blood test showed after administration, TP: 3.8±0.5 Group T, 4.4±0.7 Group C (p=0.003), Na: 139.4±6.4 Group T, 138.0±23.9 Group C (p=0.7), K: 4.0±0.6 Group T, 3.9±0.5 Group C (p=0.2).
Conclusion
In Perioperative prolonged pleural drainage Fontan cases, urine volume increased and pleural effusion decreased after Tolvaptan administration. Chest drainage tube was extubated without delay after administration except for chylothorax case.
Any side effect, hypernatremia nor liver dysfunction was not observed.