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Surveillance Testing and Preventive Care After Fontan Operation: A Multi-Institutional Survey. Pediatr Cardiol 2019 Jan;40(1):110-115

Date

08/31/2018

Pubmed ID

30159585

DOI

10.1007/s00246-018-1966-9

Scopus ID

2-s2.0-85053230079   14 Citations

Abstract

More children with single ventricle heart disease are surviving after Fontan surgery. This circulation has pervasive effects on multiple organ systems and has unique modes of failure. Many centers have created multidisciplinary programs to care for these patients. Our aim was to survey such programs to better understand current approaches to care. We hypothesized that significant variability in surveillance testing strategy would be present. Eleven academic institutions with established Fontan care programs performing a combined estimated 300 Fontan surgeries per year, with a total population of 1500-2000 Fontan patients, were surveyed using a REDCap survey regarding surveillance testing and basic practice philosophies. Fontan care programs were structured both as consultative services (64%) and as the primary clinical team (9%). Electrocardiograms (73%) and echocardiograms (64%) were most commonly obtained annually. Serum studies, including complete blood count (73%), complete metabolic panel (73%), and Brain-type natriuretic peptide (54%), were most commonly obtained annually. Hepatic testing consisted of liver ultrasound in most centers, obtained biennially (45%) or > every 2 years (45%). Liver biopsy was not routinely recommended (54%). Neurodevelopmental outcomes were assessed at most institutions (54%), with a median frequency of every 3-4 years. There is considerable variability in the surveillance testing regimen and management strategy after a Fontan procedure at surveyed programs. There is an urgent need for surveillance guidelines to reduce variability, define quality metrics, streamline collaborative practice, and prospective research to better understand the complex adaptations of the body to Fontan physiology.

Author List

Di Maria MV, Brown DW, Cetta F, Ginde S, Goldberg D, Menon SC, Phelps HM, Rychik J, Schumacher KR, Thrush P, Veldtman G, Wright G, Younoszai AK

Author

Salil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Critical Pathways
Female
Fontan Procedure
Heart Defects, Congenital
Heart Ventricles
Humans
Male
Program Evaluation
Surveys and Questionnaires