title: Risk factors for cerebrovascular events following fontan palliation in patients with a functional single ventricle.
abstract: The risk for cerebrovascular events (CVEs) is increased in children with functional single ventricles (FSVs). However, there are limited data indicating the prevalence of CVEs or the role of preventative therapy. To measure the prevalence of clinically evident CVEs in patients with FSVs, identify risk factors, and analyze the effect of aspirin on the risk for CVEs, a retrospective chart review was performed on all patients who underwent Fontan palliation at the University of Michigan from January 1, 1975, to June 30, 1998 (n = 402). Data collected included original anatomy, Fontan type, date of CVE, medications at the time of CVE, intraoperative placement of fenestration, and date of last follow-up. The overall mortality rate was 12%. There were 38 CVEs (9%), of which only 11 (3%, or 0.0036/patient-year) could not be attributed to a defined event (catheterization, extracorporeal membrane oxygenation, or cardiac arrest). Anticoagulation with aspirin was associated with a statistically significantly decreased risk for CVEs. Fontan type was not associated with the risk for CVEs. Thus, patients with FSVs are at increased risk for CVEs, although the de novo risk was low. Aspirin use is associated with a decreased risk for CVEs.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Piers C A
authors.initials: PC
authors.lastname: Barker
authors.forename: Cheryl
authors.initials: C
authors.lastname: Nowak
authors.forename: Karen
authors.initials: K
authors.lastname: King
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Caren S
authors.initials: CS
authors.lastname: Goldberg
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin