[I-OEP04-2] Fontan手術後fenestrationの経カテーテル的デバイス閉鎖における適応基準の考察
Keywords:fenestration, Fontan, closure
Background：Patent fenestration in Fontan circulation may cause adverse outcomes due to a right-to-left shunting. The criteria for effective and safe closure of fenestration remains unclear.
Objectives The objective was to identify the optimal criteria for closure of fenestration.
Methods：This was a retrospective study to evaluate the patients who was brought to the cardiac catheterization for an indication of fenestration closure over 26 years. The primary outcome was development of the composite events consisting of death, transplant, transplant evaluation, protein losing enteropathy, plastic bronchitis or worsening NYHA class. The study cohort was divided into two groups: device closure vs. no closure. The data were compared between the two groups.
Results：Among 41 patients who brought to the catheterization, 34 received closure and 7 did not receive. On the median follow up of 3 years(1 month to 12.6 years),the incidence of primary outcome was significantly higher in no closure group(43％ vs. 6％,p＜0.01). No closure group had a higher incidence of more than moderate atrioventricular valve regurgitation(odds ratio 1.8,p＜0.02), NYHA class III-IV symptoms(2.7,p＜0.01), use of ACEI/ARB(1.4,p＜0.05) and furosemide(1.6, p=0.01), lower pre-closure SaO2(83％ vs. 89％,＜0.05), and balloon-occlusion SaO2(91％ vs. 94％,p＜0.01).
Conclusion：The criteria for safe and effective Fontan fenestration closure was less than moderate atrioventricular valve regurgitation, NYHA class I-II symptoms, no need of ACEI/ARB and furosemide, and higher SaO2 at baseline and balloon-occlusion test.
Objectives The objective was to identify the optimal criteria for closure of fenestration.
Methods：This was a retrospective study to evaluate the patients who was brought to the cardiac catheterization for an indication of fenestration closure over 26 years. The primary outcome was development of the composite events consisting of death, transplant, transplant evaluation, protein losing enteropathy, plastic bronchitis or worsening NYHA class. The study cohort was divided into two groups: device closure vs. no closure. The data were compared between the two groups.
Results：Among 41 patients who brought to the catheterization, 34 received closure and 7 did not receive. On the median follow up of 3 years(1 month to 12.6 years),the incidence of primary outcome was significantly higher in no closure group(43％ vs. 6％,p＜0.01). No closure group had a higher incidence of more than moderate atrioventricular valve regurgitation(odds ratio 1.8,p＜0.02), NYHA class III-IV symptoms(2.7,p＜0.01), use of ACEI/ARB(1.4,p＜0.05) and furosemide(1.6, p=0.01), lower pre-closure SaO2(83％ vs. 89％,＜0.05), and balloon-occlusion SaO2(91％ vs. 94％,p＜0.01).
Conclusion：The criteria for safe and effective Fontan fenestration closure was less than moderate atrioventricular valve regurgitation, NYHA class I-II symptoms, no need of ACEI/ARB and furosemide, and higher SaO2 at baseline and balloon-occlusion test.