Abstract 12757: Prevalence and Outcome of Thrombotic and Embolic Complications in Adults After Fontan Operation
Introduction: There are limited studies of thrombotic and embolic complications (TEC) in the adult Fontan population.
Hypothesis/objectives: To determine the prevalence, risk factors, and outcomes of TECs in this population.
Method: Review of adults with a previous Fontan operation, followed at Mayo Clinic, 1994-2014. Systemic TEC was defined as intracardiac thrombus, ischemic stroke, or systemic arterial embolus. Non-systemic TEC was defined as Fontan conduit/right atrial thrombus or pulmonary embolus.
Results: We identified 387 patients; mean age 28 ±7 years and follow-up 8±2 years. An atriopulmonary connection (APC) was done for 286/387 patients. Atrial arrhythmias were present in 278/387 (72%). There were 121 TECs (systemic n=36, non-systemic n=85) in 98/387 patients (25%). Risk factors for systemic TEC were atrial arrhythmia (hazard ratio [HR], 2.28; P=.001) and APC (HR, 1.98; P=.02); non-systemic TEC also had similar risk factors.
All 98 patients received warfarin but warfarin was discontinued in 10/98 because of bleeding; and 8 of these 10 had a second TEC after discontinuing warfarin. Thrombi resolution occurred in 16/82 (20%) that continued to receive warfarin 16 (20%) and had follow-up imaging; 8 with other comorbid conditions had Fontan conversion. In total, 24/98 patients had a second TEC, most of whom had inadequate anticoagulation.
Conclusions: TEC was not uncommon; risk factors for TEC were APC and atrial arrhythmias. Most patients were treated successfully with warfarin alone. A second TEC occurred in most patients whose anticoagulation was discontinued because of bleeding events.
Legends Kaplan-Meier Curves comparing freedom from TEC.
(A). Freedom from TECs in all patients and in patients with vs without atrial arrhythmia (AA) (P=.002).
(B). Freedom from TECs in all patients and in patients with vs without atriopulmonary connection (APC) (P=.001). “No APC” group comprise of patients with total cavopulmonary connections.
Author Disclosures: A. Egbe: None. H. Connolly: None. T. Niaz: None. D. Driscoll: None.
- © 2016 by American Heart Association, Inc.