Hakami L, Hagl C, Dalla-Pozza R, Haas N, Ulrich S and Reif S
Ludwig-Maximilians-University of Munich, Germany
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Introduction: End stage of surgical treatment for single ventricle anatomy is Fontan (total cavopulmonary connection (TCPC)) still the most applied method. Despite the regular occurrence of Fontan-associated liver decease (FALD) in the time after surgery, there is still not enough data to specify the risk of patients to develop structural or functional dysfunction of the liver in the follow up. Aim: The aim of this study was to evaluate potential complications and parameters, which might be associated with a higher occurrence of early dysfunction of the liver. Methods: Retrospective and descriptive analysis included 201 patients (female=80 (39.8%), male=121 (60.2%)) with single ventricle physiology, who underwent Fontan-Procedure from 2003-2015. The first step surgery was performed in N=70 (34.8%) and the second step in N=113 (56.2%) on our center. Results: Several patients showed complications before Fontan surgery: dilatation of IVC n=27 (13.4%), ascites n=9 (10.1%) and other complications n=55 (48.7%). Patients with a dilatation of IVC before Fontan (n=27) showed a dilatation after the procedure in 37.0% (n=10), whereas patients without dilatation before Fontan surgery (n=171) showed a dilatation after the procedure in only 29.2% (n=50). Observing ascites there was no clear difference as patients with ascites after stage I (n=9) 44.4% (n=4) showed ascites after Fontan and on the other hand the patients without ascites after stage I (n=80) 53.8% (n=43) showed ascites later on in the follow up. From patients with other complications (e.g. infections and others) (n=46; 39.0%) before Fontan procedure 28.2% (n=13) showed dilatation of IVC in the follow up compared to the patients with no other complications before Fontan (n=72; 61.0%), where n=21 (29.2%) showed dilatation of IVC after the same. Conclusion: Patients collective was small, although when all patients may have a previous diagnostic of lever function with laboratory tests and FibroScan before Fontan procedure, it could select the patients, who has had associated complications at time before Fontan procedure. Common risks for patients after Fontan could be screened for early change in clinical liver parameters such as dilatation of IVC and ascites in all patients to detect liver dysfunction as early as possible. FibroScan as an imaging for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis should be considered as a standard methodic in the perioperative evaluation for single ventral circulation after Fontan.