The Impact of the Pulmonary Artery Index and Aortopulmonary Collateral Artery Coil Embolization on Intractable Pleural Effusions After a Fontan Surgery

• Published in: International Heart Journal Vol. 62; no. 3; pp. 559 - 565
• Main Authors: Nabeshima, Taisuke, Ishikawa, Yuichi, Sumitomo, Naokata, Go, Kiyotaka, Kodama, Yoshihiko, Kuraoka, Ayako, Nakamura, Makoto, Sagawa, Koichi, Nakano, Toshihide
• Format: Journal Article
• Language: English
• Published: Tokyo International Heart Journal Association 29-05-2021; Japan Science and Technology Agency
• Subjects: Adaptation to Fontan circulation; Early outcomes; Embolization; Fontan procedure; Heart surgery; Magnetic resonance imaging; Multiple regression analysis; Patients; Pleural drainage; Pleural effusion; Postoperative hospital stay; Pulmonary arteries; Pulmonary artery; Surgery; Surgical drains; Wound drainage
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.20-498

An intractable pleural effusion is a common comorbidity of a Fontan operation, occasionally leading to undesirable outcomes. The preventive effect of aortopulmonary collateral (APC) coil embolization against a pleural effusion before a Fontan operation is still controversial.This is a retrospective single-center study; among 227 Fontan cases, 57 cases with complete MRI data were analyzed at first. Factors associated with the duration of pleural drainage (median: 6 (2-41) days) and that of postoperative hospital stay (median: 25 (14-91) days) were analyzed using a multiple regression analysis. The pulmonary artery index (PAI; Nakata index) was associated with both the pleural drainage duration (P < 0.05, r2 = 0.17) and postoperative hospital stay (P < 0.05, r2 = 0.10).Thereafter, all the 227 patients were classified into the following three groups: Group A (12 patients in whom the embolization was performed within 30 days before the Fontan surgery), Group B (131 patients in whom the embolization was performed more than 30 days before the Fontan surgery), and Group C (84 patients in whom the embolization was not performed). Patients in Group A were found to be associated with the shortest length of both periods (P < 0.05).Lower PAI values were related to a prolonged pleural drainage duration and postoperative hospital stay. APC coil embolizations may reduce the risk if they are performed shortly (less than 30 days) before the operation.