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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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; n = 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 (n = 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%).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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; n = 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 (n = 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%).
CONCLUSIONS: 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.
摘要：
背景：Fontan（FO）手术后的发病率和死亡率本质上主要是血栓栓塞。然而,关于FO手术后成年患者血栓栓塞并发症(TECs)的随访数据不一致.在这项多中心研究中，我们调查了FO患者的TECs发生率。
方法：我们研究了91例接受FO手术的患者。临床数据,实验室,在波兰3个成人先天性心脏病科的预约医疗期间,前瞻性地收集了影像学检查.在31个月的中位随访期间记录TEC。
结果：4例患者（4.4%）失访。患者的平均年龄为25.3（±6.0）岁，FO手术至调查的平均时间为22.1(±5.1)年。91名患者中有21名（23.1％）自FO手术以来有24个TECs病史，主要是肺栓塞（PE；n=12，13.2%），包括4个（33.3%）沉默PE。从FO手术到第一次TEC的平均时间为17.8(±5.1)年。随访期间,我们记录了7例(8.0%)患者的9例TECs，主要是PE（n=5，5.5%）。大多数TEC患者患有左型心室（57.1％）。3例患者（42.9%）接受阿司匹林治疗，3（3.4％）与维生素K拮抗剂或新型口服抗凝剂，1例患者在TEC发生时未接受抗血栓治疗。3例患者出现室上性快速性心律失常（42.9％）。
结论：这项前瞻性研究表明，TECs在FO患者中很常见，这些事件中的大量发生在青春期和成年期。我们还指出，在不断增长的成年FO人口中，TECs被低估了多少。问题的复杂性需要更多的研究,特别是在整个FO人群中规范TECs的预防。
方法：我们研究了91例接受FO手术的患者。临床数据,实验室,在波兰3个成人先天性心脏病科的预约医疗期间,前瞻性地收集了影像学检查.在31个月的中位随访期间记录TEC。
结果：4例患者（4.4%）失访。患者的平均年龄为25.3（±6.0）岁，FO手术至调查的平均时间为22.1(±5.1)年。91名患者中有21名（23.1％）自FO手术以来有24个TECs病史，主要是肺栓塞（PE；n=12，13.2%），包括4个（33.3%）沉默PE。从FO手术到第一次TEC的平均时间为17.8(±5.1)年。随访期间,我们记录了7例(8.0%)患者的9例TECs，主要是PE（n=5，5.5%）。大多数TEC患者患有左型心室（57.1％）。3例患者（42.9%）接受阿司匹林治疗，3（3.4％）与维生素K拮抗剂或新型口服抗凝剂，1例患者在TEC发生时未接受抗血栓治疗。3例患者出现室上性快速性心律失常（42.9％）。
结论：这项前瞻性研究表明，TECs在FO患者中很常见，这些事件中的大量发生在青春期和成年期。我们还指出，在不断增长的成年FO人口中，TECs被低估了多少。问题的复杂性需要更多的研究,特别是在整个FO人群中规范TECs的预防。
