Journal article
Fontan’s operation: is aspirin enough? Is coumadin too much?
The Annals of thoracic surgery, v 73(1), pp 64-68
01 Jan 2002
PMID: 11834064
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background. Thromboembolism after Fontan’s operation is attributed to low flow states, stasis in venous pathways, right to left shunts, blind cul-de-sacs, prosthetic materials, atrial arrhythmias, and hypercoagulable states. We assessed the efficacy of a strategy to reduce thromboembolic events including aspirin anticoagulation.
Methods. From January 1996 through December 2000, 72 patients underwent Fontan procedures. Management included (1) avoidance of direct caval cannulation and central venous lines, (2) inotropic support for 48 to 72 hours to optimize cardiac output, (3) aortopulmonary anastomosis or suture closure of patent pulmonary valves, and (4) administration of aspirin (81 mg per day) beginning on postoperative day one. No other anticoagulation strategies were used. Surveillance included intraoperative and postoperative transesophageal echo, transthoracic echo at discharge, at first reevaluation, and at 6 month intervals, and catheterization 1 year after surgery.
Results. There were no early or late deaths. Follow-up was completed with 2,882 patient-months and a mean of 40 months. There were no documented thromboembolic events; however, all suspicious occurrences were investigated by echo and brain imaging. There were no hemorrhagic events or aspirin-related complications.
Conclusions. Low dose aspirin can be used safely in young patients with Fontan connections. At intermediate follow-up, the strategies described appear effective in preventing thromboembolic complications. Routine use of more aggressive anticoagulation regimens seems unwarranted.
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Details
- Title
- Fontan’s operation: is aspirin enough? Is coumadin too much?
- Creators
- Marshall L Jacobs - St. Christopher's Hospital for ChildrenKamal K Pourmoghadam - St. Christopher's Hospital for ChildrenElaine M Geary - St. Christopher's Hospital for ChildrenAngelo T Reyes - Deborah Heart and Lung CenterNandini Madan - St. Christopher's Hospital for ChildrenLynn B McGrath - Deborah Heart and Lung CenterJohn W Moore - St. Christopher's Hospital for Children
- Publication Details
- The Annals of thoracic surgery, v 73(1), pp 64-68
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000173334200014
- Scopus ID
- 2-s2.0-0036146274
- Other Identifier
- 991021838283404721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery