Fontan Venovenous Collaterals and Hepatic Fibrosis

Authors

William N. Evans MD, University of Nevada, Las VegasFollow
Ruben J. Acherman MD, University of Nevada, Las VegasFollow
Gary A. Mayman MD, University of Nevada, Las VegasFollow
Alvaro Galindo MD, University of Nevada, Las VegasFollow
Abraham Rothman MD, University of Nevada, Las VegasFollow
Michael L. Ciccolo MD, University of Nevada, Las Vegas
Juan Lehoux MD, University of Nevada, Las Vegas
Brody J. Winn MD, Laboratory Medicine Consultants
Noel S. Yumiaco MD, Laboratory Medicine Consultants
Humberto Restrepo MD, MPH, University of Nevada, Las Vegas

Document Type

Article

Publication Date

8-13-2020

Publication Title

Journal of Cardiatric Surgery

First page number:

1

Last page number:

5

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.

Keywords

Fontan; Hepatic Fibrosis; Liver Biopsy; Venovenous Collaterals

Disciplines

Medical Specialties | Medicine and Health Sciences | Surgery

Language

English

Repository Citation

Evans, W. N., Acherman, R. J., Mayman, G. A., Galindo, A., Rothman, A., Ciccolo, M. L., Lehoux, J., Winn, B. J., Yumiaco, N. S., Restrepo, H. (2020). Fontan Venovenous Collaterals and Hepatic Fibrosis. Journal of Cardiatric Surgery 1-5.
http://dx.doi.org/10.1111/jocs.14951