Journal of Cardiac Surgery 2020;1–5
© 2020 Wiley Periodicals LLC
Fontan venovenous collaterals and hepatic fibrosis
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
William N. Evans, MD, Children's Heart Center
Nevada, 3006 S. Maryland Pkwy, Ste. 690, Las
Vegas, NV 89109.
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.