Robert J. Dabal, MD, James K

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Presentation transcript:

The modern Fontan operation shows no increase in mortality out to 20 years: A new paradigm Robert J. Dabal, MD, James K. Kirklin, MD, Manisha Kukreja, MBBS, MPH, Robert N. Brown, BS, David C. Cleveland, MD, Michael C. Eddins, MD, Yung Lau, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 6, Pages 2517-2524.e1 (December 2014) DOI: 10.1016/j.jtcvs.2014.07.075 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Actuarial and parametric survival after the Fontan operation using polytetrafluoroethylene (PTFE) tubes, the lower red line indicates the instantaneous risk (hazard) of death, in which the rapidly falling early phase merges with a constant phase within the first 3 months. The error bars represent ±1SE. The dashed lines enclose the 70% confidence limits. UAB, University of Alabama at Birmingham. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Actuarial survival after Fontan procedure, stratified by era of operations. Error bars represent ±1SE. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Actuarial survival after Fontan procedure, stratified by tube size. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Freedom from reoperation, stratified by tube size. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene; HTx, heart transplantation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Freedom from arrhythmias, stratified by internal versus external PTFE tube. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Percentage of patients in specified NYHA classes at the indicated follow-up intervals after the Fontan operation. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene; NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Nomogram of a solution to the multivariable risk factor equation for survival after Fontan. Solutions are depicted for Fontan procedures performed in 1990, 2000, and 2010. Dashed lines enclose the 90% confidence limits. UAB, University of Alabama at Birmingham; PTFE, polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2517-2524.e1DOI: (10.1016/j.jtcvs.2014.07.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions