Skubera Maciej, Gołąb Aleksandra, Sternalski Tomasz, Trojnarska Olga, Plicner Dariusz, Smaś-Suska Monika, Mazurek-Kula Anna, Bartczak-Rutkowska Agnieszka, Pająk Jacek, Podolec Piotr, Tomkiewicz-Pająk Lidia
Department of Cardiac and Vascular Diseases, John Paul II Hospital, 31-202 Krakow, Poland.
Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
J Clin Med. 2023 May 14;12(10):3465. doi: 10.3390/jcm12103465.
Morbidity and mortality following Fontan (FO) surgery are primarily thromboembolic in nature. However, follow-up data regarding thromboembolic complications (TECs) in adult patients after FO procedure are inconsistent. In this multicenter study, we investigated the incidence of TECs in FO patients.
We studied 91 patients who underwent FO procedure. Clinical data, laboratory, and imaging investigations were collected prospectively during the scheduled medical appointments in 3 Adult Congenital Heart Disease Departments in Poland. TECs were recorded during a median follow-up of 31 months.
Four patients (4.4%) were lost to follow-up. The mean age of patients was 25.3 (±6.0) years at enrollment, and the mean time between FO operation and investigation was 22.1 (±5.1) years. A total of 21 out of 91 patients (23.1%) had a history of 24 TECs since an FO procedure, mainly pulmonary embolism (PE; = 12, 13.2%), including 4 (33.3%) silent PE. The mean time since FO operation to the first TEC was 17.8 (±5.1) years. During follow-up, we documented 9 TECs in 7 (8.0%) patients, mainly PE ( = 5, 5.5%). Most patients with TEC had a left type of systemic ventricle (57.1%). Three patients (42.9%) were treated with aspirin, 3 (3.4%) with Vitamin K antagonists or novel oral anticoagulants, and 1 patient had no antithrombotic treatment at the time of TEC occurrence. Supraventricular tachyarrhythmias were present in 3 patients (42.9%).
This prospective study shows that TECs are common in FO patients, and a significant number of these events occur during adolescence and young adulthood. We also indicated how much TECs are underestimated in the growing adult FO population. The complexity of the problem requires more studies, especially to standardize the prevention of TECs in the whole FO population.
Fontan（FO）手术后的发病率和死亡率主要源于血栓栓塞。然而，关于成年患者FO手术后血栓栓塞并发症（TECs）的随访数据并不一致。在这项多中心研究中，我们调查了FO患者中TECs的发生率。
我们研究了91例行FO手术的患者。在波兰3个成人先天性心脏病科室的定期医疗预约期间，前瞻性收集了临床数据、实验室检查和影像学检查结果。在中位随访31个月期间记录TECs。
4例患者（4.4%）失访。入组时患者的平均年龄为25.3（±6.0）岁，FO手术与检查之间的平均时间为22.1（±5.1）年。91例患者中共有21例（23.1%）自FO手术后有24次TECs病史，主要为肺栓塞（PE；=12，13.2%），包括4例（33.3%）无症状PE。从FO手术到首次发生TEC的平均时间为17.8（±5.1）年。随访期间，我们记录到7例（8.0%）患者发生9次TECs，主要为PE（=5，5.5%）。大多数发生TEC的患者为左心室型（57.1%）。3例患者（42.9%）接受了阿司匹林治疗，3例（3.4%）接受了维生素K拮抗剂或新型口服抗凝剂治疗，1例患者在发生TEC时未接受抗栓治疗。3例患者（42.9%）存在室上性快速心律失常。
这项前瞻性研究表明，TECs在FO患者中很常见，且大量此类事件发生在青少年和青年期。我们还指出在不断增长的成年FO患者群体中，TECs被低估的程度。该问题的复杂性需要更多研究，尤其是要规范整个FO患者群体中TECs的预防。
