Abstract 15576: Risk Factors for Fontan-Associated Plastic Bronchitis: A Case Control Study
Objective: The onset of plastic bronchitis (PB) can be debilitating in Fontan survivors. The rarity of this complication makes designing studies to understand risk factors challenging. This 2-center case-control study aimed to assess the associations of PB with antecedent patient factors and PB outcomes.
Methods: Using center registries, known PB patients (n=25) at Boston Children’s and the University of Michigan were matched 1:1 or 1:2 (as available) to non-PB Fontans (n=43) by date of Fontan (within 1 year) and center. The 2 groups were compared for baseline characteristics. Association of patient characteristics with PB was assessed using logistic regression, and association of risk factors with onset of PB was assessed with time-to-event analyses.
Results: The median time from Fontan to PB diagnosis was 2.5 yrs. PB patients were not significantly different from controls in age at stage 2 or Fontan, type of stage 2 or Fontan, pre-Fontan mean pulmonary artery pressure (12.1 vs. 11.6 mmHg, p=.58), or number of pre-Fontan catheter interventions. Systemic right ventricle was more common in PB patients (75% vs. 51%, p=.06). Factors associated with PB included chylothorax at any surgery (44% PB vs 10% control; Odds ratio [OR] 7.3; P=0.003), chest tube (CT) duration at stage II (p=.04) and Fontan (p=.004), post-operative ascites (36% PB vs 12% control; OR 4.2; P=0.02) and post-Fontan aortopulmonary collaterals requiring intervention (52% PB vs 7% control; OR 13.7; P=0.0003). CT drainage > 13 days at Fontan was associated with earlier PB onset. The median post-PB follow-up time was 3.9 years. For PB patients, 5-yr freedom from death post-PB diagnosis was 68%.
Conclusions: A longer duration of CT drainage after surgery, chylothorax, ascites, and need for catheter intervention for AP collaterals are associated with subsequent development of PB. Development of PB leads to shortened patient survival. Better strategies for managing patients at high risk of developing PB are needed.
- © 2013 by American Heart Association, Inc.