Abstract 2008: Coil Embolization of Aortopulmonary Collaterals Prior to Fontan Completion is Not Associated With Functional Outcomes After the Fontan Procedure: A Report From the Pediatric Heart Network (PHN) Fontan Cross-Sectional Study
Background: The practice of coiling aortopulmonary collateral arteries (APC) before the Fontan procedure is controversial. We sought to compare outcomes in patients (pts) with and without pre-Fontan coil embolization of APCs using the PHN Cross-Sectional Fontan Study database.
Methods: We compared hospital length of stay (LOS) after Fontan in pts who did (“coil group,” n=80) vs did not (“no coil group”, n=459) undergo APC coiling. Information on APC size and number was not available. Secondary outcomes included complications after Fontan and testing at cross-sectional follow-up. Patients requiring Fontan conversion (7) were excluded. Univariate methods and multivariate regression, adjusting for potential confounders, were used to compare outcomes.
Results: The 7 PHN centers varied markedly in frequency of pre-Fontan APC coiling (range 0 –30%, p<.001). Patients in the coil group were older at Fontan (3.9±2.2 vs 3.2±1.9 yrs p=.004) and were somewhat more likely to have right ventricular morphology (p=0.054) and atrioventricular valvar regurgitation on pre-Fontan echocardiography (p=.03). They also underwent Fontan surgery more recently (p<.001) with a higher likelihood of a prior stage II procedure (p<.001), and a higher percentage of extracardiac (p<.001) and fenestrated (p<.001) Fontans. In unadjusted analysis, the coil group had shorter median LOS after Fontan (10.5 vs 12 days, p =.03). In adjusted analyses, APC coiling was not associated with LOS (hazard ratio (HR) 0.91, 95% CI 0.70 –1.18, p=.48) or with postoperative complications, but was associated with a higher rate of post-Fontan catheter interventions (HR 1.74, 95% CI 1.04 –2.91, p=.03). The two groups had similar outcomes at cross-sectional follow-up, including % predicted peak oxygen consumption and ventilatory anaerobic threshold, ejection fraction, Child Health Questionnaire Parent Report summary scores, and b-type natriuretic peptide levels.
Conclusion: Management of APCs before Fontan shows marked practice variation. In this retrospective analysis, pre-Fontan coiling of APCs was associated neither with faster postoperative recovery nor with better late outcomes. Because we cannot exclude residual confounding, a randomized clinical trial of this practice is needed.