title: Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study.
abstract: BACKGROUND
  The practice of coiling aortopulmonary collaterals (APCs) before Fontan completion is controversial, and published data are limited. We sought to compare outcomes in subjects with and without pre-Fontan coil embolization of APCs using the Pediatric Heart Network Fontan Cross-Sectional Study database which enrolled survivors of prior Fontan palliation.
  
  
  METHODS
  We compared hospital length of stay after Fontan in 80 subjects who underwent APC coiling with 459 subjects who did not. Secondary outcomes included post-Fontan complications and assessment of health status and ventricular performance at cross-sectional evaluation (mean 8.6 ± 3.4 years after Fontan).
  
  
  RESULTS
  Centers varied markedly in frequency of pre-Fontan APC coiling (range 0%-30% of subjects, P < .001). The coil group was older at Fontan (P = .004) and more likely to have single right ventricular morphology (P = .054) and pre-Fontan atrioventricular valve regurgitation (P = .03). The coil group underwent Fontan surgery more recently (P < .001), was more likely to have a prior superior cavopulmonary anastomosis (P < .001), and more likely to undergo extracardiac Fontan connection (P < .001) and surgical fenestration (P < .001). In multivariable analyses, APC coiling was not associated with length of stay (hazard ratio for remaining in-hospital 0.91, 95% CI 0.70-1.18, P = .48) or postoperative complications, except more post-Fontan catheter interventions (hazard ratio 1.74, 95% CI 1.04-2.91, P = .03), primarily additional APC coils. The groups had similar outcomes at cross-sectional evaluation.
  
  
  CONCLUSIONS
  Management of APCs before Fontan shows marked practice variation. We did not find an association between pre-Fontan coiling of APCs and shorter postoperative hospital stay or with better late outcomes. Prospective studies of this practice are needed.
authors: Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA. puja.banka@childrens.harvard.edu
authors: Puja
authors: P
authors: Banka
authors: Lynn A
authors: LA
authors: Sleeper
authors: Andrew M
authors: AM
authors: Atz
authors: Collin G
authors: CG
authors: Cowley
authors: Dianne
authors: D
authors: Gallagher
authors: Matthew J
authors: MJ
authors: Gillespie
authors: Eric M
authors: EM
authors: Graham
authors: Renee
authors: R
authors: Margossian
authors: Brian W
authors: BW
authors: McCrindle
authors: Charlie J
authors: CJ
authors: Sang
authors: Ismee A
authors: IA
authors: Williams
authors: Jane W
authors: JW
authors: Newburger
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D007902:Length of Stay; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011651:Pulmonary Artery; D012189:Retrospective Studies; D013895:Thoracic Arteries; D016896:Treatment Outcome; D016277:Ventricular Function, Left