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>> I'M LINDSAY ROGERS.
I'M ONE OF THE CARDIOLOGY FELLOWS
AT THE CHILDREN'S HOSPITAL OF PHILADELPHIA.
AND I'M HERE AT CARDIOLOGY 2012 PRESENTING AN ABSTRACT
ON THE FONTAN OPERATION.
WE LOOKED AT THE PAST 18 YEARS OF THE FONTAN
OPERATION AT OUR INSTITUTION,
WHICH WAS A TOTAL 771 PATIENTS.
AND WE WANTED TO IDENTIFY VARIABLES ASSOCIATED
WITH INCREASED MORBIDITY AND MORTALITY AFTER
THE FONTAN OPERATION.
AND SO WE LOOKED AT THE LAST 18 YEARS,
WHICH WAS 771 PATIENTS.
AND WE LOOKED AT THREE PRIMARY OUTCOMES,
DEATH AFTER FONTAN, DURATION OF EFFUSION,
AND DURATION OF HOSPITALIZATION AFTER
THE FONTAN OPERATION.
WE DIVIDED THAT LARGE ERA OF 18 YEARS INTO THREE SEPARATE
ERAS BASED ON THE CHANGING OPERATIVE OUTCOMES,
I.E. THE USE OF THE LATERAL TUNNEL,
WHICH HAS DECREASED IN RECENT YEARS,
AND THE INCREASING USE OF EXTRACARDIAC FONTAN.
AND BASED ON THAT WE IDENTIFIED THREE SEPARATE
ERAS BY YEAR AND LOOKED AT CHANGES IN PATIENT
CHARACTERISTICS WHICH SHOWED THAT THE PATIENTS,
IN GENERAL, AT THE TIME OF THE FONTAN HAVE MORE
AV VALVE REGURGITATION AND HIGHER DIASTOLIC PRESSURES
MAY BE ASSOCIATED WITH PATIENTS BEING A BIT SICKER
AT THE TIME OF THE FONTAN OPERATION.
IN ADDITION, WE NOTICED THAT OUR OPERATIVE TIMES HAVE
GOTTEN LONGER SINCE WE STARTED USING
THE EXTRACARDIAC CONDUIT.
AND OUR PATIENT POPULATION IS OLDER AT THE TIME
OF THE FONTAN, WHICH MIRRORS THE USE OF OUR EXTRACARDIAC
CONDUIT AS WELL SO THAT THEY'RE BIGGER AT THE TIME
OF THE OPERATION.
WE IDENTIFIED RISK FACTORS AND PROTECTIVE FACTORS
FOR POOR OUTCOME AFTER THE FONTAN OPERATION SUCH AS
THINGS AS USING A FENESTRATION,
OR MODIFIED ULTRAFILTRATION IS PROTECTIVE FOR EFFUSION,
HOSPITALIZATION AND MORTALITY AFTER THE FONTAN.
AND THEN THINGS SUCH AS HIGHER PULMONARY PRESSURES
ARE ASSOCIATED WITH LONGER STAYS AND LONGER EFFUSIONS.
SO OVERALL THE PATIENT MORTALITY REMAINS VERY LOW
AFTER THE FONTAN OPERATION.
IT'S LESS THAN 1%
AT THE CHILDREN'S HOSPITAL OF PHILADELPHIA.
AND WE HAVE IDENTIFIED SOME IMPORTANT MODIFIABLE RISK
FACTORS IN PATIENTS UNDERGOING THE FONTAN OPERATION.