Journal of Cardiac Surgery 2020;1–5
DOI: 10.1111/jocs.14951
© 2020 Wiley Periodicals LLC
Fontan venovenous collaterals
and hepatic fibrosis
Author
William N. Evans, MD, Ruben J. Acherman,
MD, Gary A. Mayman, MD, Alvaro Galindo, MD, Abraham
Rothman, MD, Michael L. Ciccolo, MD, Juan Lehoux, MD, Brody J. Winn, MD, Noel S. Yumiaco,
MD, Humberto Restrepo, MD, MPH
Source
William N. Evans,
MD, Children's Heart Center
Nevada, 3006 S.
Maryland Pkwy, Ste. 690, Las
Vegas, NV 89109.
Email: wnevans50@aol.com
Abstract
Objective: We
hypothesized that a relationship might exist between angiographically demonstrable,
post‐Fontan
venovenous collaterals, and hepatic fibrosis.
Methods: We
analyzed data from post‐Fontan
patients that underwent cardiac catheterization and transvenous‐hepatic biopsy procedures between
March 2012
and March 2020.
From innominate vein angiography, we determined those that either had or lacked
venovenous collaterals. Additionally, we examined
data from
post‐Fontan patients that underwent
hepatic ultrasound, shear‐wave
elastography between January 2017 and March 2020.
Results: We
identified 164 patients that met inclusion criteria. Of the 164, 101(62%) had venovenous collaterals. Of the 101 with collaterals,
average total fibrosis
score (TFS) was
3.2 and the average rate of fibrosis progression was 0.28 vs an average TFS of
2.1 and an average fibrosis progression rate of 0.22 for those without
collaterals (P =
.00001 and P = .01, respectively). Of the 101 with collaterals, oxygen saturation
was 91% ± 4% vs 93% ± 3% (P = .048) without collaterals. Of the 164,
86 (52%)
underwent ultrasound shear‐wave
elastography. Of the 86 patients undergoing elastography, 50 (58%) were
performed in those with collaterals, and
36 (42%) in those
without collaterals. For the 50 with collaterals, average elastography values
were 13.3 vs 11.2 kPa for the 36 without collaterals (P = .006). We found
No statistically
significant differences for age at biopsy, Fontan duration, Fontan‐type, type of functional univentricle, laboratory, clinical, or hemodynamic values
Between those
with or without collaterals.
Conclusions: The
presence of angiographically demonstrated venovenous
collaterals was associated with statistically, significantly more advanced
liver fibrosis than
those without
collaterals.