Benefits of Coiling Aorto-Pulmonary Collaterals in Children with Complex Congenital Heart Diseases.

Abstract

This study investigates the benefits of coiling aortopulmonary collaterals (APCs) before Fontan completion and prior to heart transplantation due to failed Fontan. The advantages of APC coiling in these situations remain unclear. Outcomes were compared between those undergoing the Fontan operation between June 2013 and December 2015, who did not undergo coiling of APCs, and those between January 2016 and May 2022, when aggressive coiling of APCs was performed. The 1-year post-transplant survival was compared for patients from Memphis, TN, where aggressive APC coiling was performed before transplantation, to a previously published report from St. Louis, MO, where APCs were actively coiled and an earlier era when they were not. The 44 Fontan patients with prior APC coiling were compared to 22 patients matched for age, diagnosis, and hemodynamics. The chest tube output (22.6 ± 6.1 vs. 41.8 ± 8.2 mL/kg; P < 0.001), the chest tube duration (5.1 ± 1.1 vs. 10.3 ± 4.5 days; P < 0.001), and the hospital length of stay (9.9 ± 1.7 vs. 27.4 ± 6.2 days; P < 0.001) were significantly lower for those who had APC coiling compared to those who did not. In St. Louis, MO, when APCs were not coiled before transplantation (N = 27), the 1-year survival rate was 66%, which improved to 85% (N = 20) in the era of APC coiling. In the Memphis experience (N = 25) with aggressive APC coiling, the 1-year survival rate was 92% (P = 0.018). APC coiling before Fontan completion decreases chest tube output and hospitalization days. It may also improve the 1-year survival rate after heart transplantation for children with failed Fontan.