Anticoagulation therapy outcome in children after extracardiac conduit Fontan-Kreutzer operation

HENDLER MF; MESCHENGIESER SS; SÁNCHEZ-LUCEROS A; CASAIS P; CONEJEROS W; SCHLICHTER A; KREUTZER GO; LAZZARI MA

Barcelona, España

Congreso; World Congress of Cardiology.; 2006

European Society of Cardiology. World Heart Federation

Fontan-Kreutzer operation (F-KO) is performed in children with a variety of univentricular heart defects. Several modifications, including extracardiac PTFE graft conduit, have been undertaken to improve mortality and morbidity, mostly due to thromboembolic events (TE) and arrhythmias. TE have been reported in the postoperative period and several years after surgery, with an overall incidence as high as 33%. We conducted a prospective cohort study to evaluate the occurrence of bleeding and TE in children with the same type of F-KO, anticoagulated with acenocoumarol (INR target: 2.0-3.0). Measure for the quality of anticoagulation was evaluated with data obtained from Rosendaal’s program. Between 8/1999 and 8/2005, 64 patients (median age at surgery: 8.2, range: 2-21 years) started anticoagulation immediately after withdrawal of chest tube drainage [6.3 (2-25days)]. Total follow-up time: 160.6 years. Median follow-up: 30.2 months (range:5-76 months). Patients remained within the IRN target 60.1%, IRN>3.0: 18.6% and IRN<2.0: 21.2% of time. There were 7 TE: 4 strokes occurred in the early postoperative period while anticoagulation had not been started and considered related to surgery procedures. Two of these patients had also atrial flutter. Three events occurred during anticoagulation therapy: 2 ischemic strokes without neurological sequelae and 1 fatal pulmonary embolism (1.86/100 patient-year). There were 13 minor hemorrhages and 1 major bleeding event (0.62/100 patient-year). There were not cerebral or fatal hemorrhages. Fontan-Kreutzer operation (F-KO) is performed in children with a variety of univentricular heart defects. Several modifications, including extracardiac PTFE graft conduit, have been undertaken to improve mortality and morbidity, mostly due to thromboembolic events (TE) and arrhythmias. TE have been reported in the postoperative period and several years after surgery, with an overall incidence as high as 33%. We conducted a prospective cohort study to evaluate the occurrence of bleeding and TE in children with the same type of F-KO, anticoagulated with acenocoumarol (INR target: 2.0-3.0). Measure for the quality of anticoagulation was evaluated with data obtained from Rosendaal’s program. Between 8/1999 and 8/2005, 64 patients (median age at surgery: 8.2, range: 2-21 years) started anticoagulation immediately after withdrawal of chest tube drainage [6.3 (2-25days)]. Total follow-up time: 160.6 years. Median follow-up: 30.2 months (range:5-76 months). Patients remained within the IRN target 60.1%, IRN>3.0: 18.6% and IRN<2.0: 21.2% of time. There were 7 TE: 4 strokes occurred in the early postoperative period while anticoagulation had not been started and considered related to surgery procedures. Two of these patients had also atrial flutter. Three events occurred during anticoagulation therapy: 2 ischemic strokes without neurological sequelae and 1 fatal pulmonary embolism (1.86/100 patient-year). There were 13 minor hemorrhages and 1 major bleeding event (0.62/100 patient-year). There were not cerebral or fatal hemorrhages. Conclusions: In our experience, no major difficulties occurred in the management of children under anticoagulation treatment. Our data may justify the recommendation of oral anticoagulation prophylaxis soon after F-KO, considering the high morbidity of TE in this population. Citation: European Heart Journal 2006, 27 (Suppl 1): 805