title: Prevalence and outcome of thrombotic and embolic complications in adults after Fontan operation.
abstract: There are limited studies of thrombotic and embolic complications (TEC) in the adult Fontan population. The purpose of the study was to determine the prevalence, risk factors, and outcomes of TECs in this population.
  
  
  METHODS
  Retrospective review of adults with a previous Fontan operation, with follow-up at Mayo Clinic, 1994-2014. Systemic TEC was defined as intracardiac thrombus, ischemic stroke, or systemic arterial embolus. Nonsystemic TEC was defined as Fontan conduit/right atrial thrombus or pulmonary embolus.
  
  
  RESULTS
  We identified 387 patients with a mean (SD) age of 28 (7) years and a mean follow-up of 8 (2) years. An atriopulmonary connection (APC) was done for 286 patients (74%). Atrial arrhythmias were present in 278 (72%). There were 121 TECs (systemic n=36, nonsystemic n=85) in 98 patients (25%). Risk factors for systemic TEC were atrial arrhythmia (hazard ratio 2.28, P=.001) and APC (hazard ratio 1.98, P=.02); nonsystemic TEC also had similar risk factors. All 98 patients received warfarin. Warfarin was discontinued in 10 of 98 because of bleeding, and 8 of these 10 subsequently had a second TEC. Among the 82 patients who had follow-up imaging, 16 (20%) had resolution of thrombus. In total, 24 of 98 patients had a second TEC, most of whom had inadequate anticoagulation.
  
  
  CONCLUSIONS
  Thrombotic and embolic complication was not uncommon; risk factors for TEC were APC and atrial arrhythmias. Most patients were treated successfully with warfarin alone. A second TEC occurred in most patients whose anticoagulation was discontinued because of bleeding events.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address: egbe.alexander@mayo.edu.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Egbe
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Department of Pediatric, Mayo Clinic, Rochester, MN.
authors.forename: Talha
authors.initials: T
authors.lastname: Niaz
authors.affiliation: Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Vidhushei
authors.initials: V
authors.lastname: Yogeswaran
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN.
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Taggart
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN.
authors.forename: Muhammad Y
authors.initials: MY
authors.lastname: Qureshi
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Poterucha
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Arooj Razzaq
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN.
authors.forename: David J
authors.initials: DJ
authors.lastname: Driscoll
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications; D004617:Embolism / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011651:Pulmonary Artery / Q000601:surgery; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology