Publicado por
Journal of the American Heart Association
Descripción
Background: Data are rare about the incidence of severe Fontan-associated liver disease (FALD) and its association with mortality. We sought to: (1) estimate the probability of developing severe FALD in patients who undergo the Fontan procedure (Fontan patients), compared with severe liver complications in patients with a ventricular septal defect; (2) assess the severe FALD-mortality association; and (3) identify risk factors for developing severe FALD.
Methods and Results: Using the Quebec Congenital Heart Disease database, a total of 512 Fontan patients and 10232 patients with a ventricular septal defect were identified. Kaplan-Meier curves demonstrated significantly higher cumulative risk of severe FALD in Fontan patients (11.95% and 52.24% at 10 and 35years, respectively), than the risk of severe liver complica- tions in patients with a ventricular septal defect (0.50% and 2.75%, respectively). At 5years, the cumulative risk of death was 12.60% in patients with severe FALD versus 3.70% in Fontan patients without FALD (log-rank P=0.0171). Cox proportional hazard models identified significant associations between the development of severe FALD and congestive heart failure and supraventricular tachycardia, with hazard ratios (HRs) of 2.36 (95% CI, 1.38–4.02) and 2.45 (95% CI, 1.37–4.39), respectively. More recent Fontan completion was related to reduced risks of severe FALD, with an HR of 0.95 (95% CI, 0.93–0.97) for each more recent year.
Conclusions: This large-scale population-based study documents that severe FALD in Fontan patients was associated with a >3-fold increase in mortality. The risk of FALD is time-dependent and can reach >50% by 35years after the Fontan operation. Conditions promoting poor Fontan hemodynamics were associated with severe FALD development.
Citación recomendada (normas APA)
Carlos Eduardo; Therrien Guerrero Chalela, "Severe Fontan-Associated Liver Disease and Its Association With Mortality", Colombia:Journal of the American Heart Association, 2023. Consultado en línea en la Biblioteca Digital de Bogotá (https://www.bibliotecadigitaldebogota.gov.co/resources/3711880/), el día 2025-05-04.
