Abstract 9902: Relationship Between Preoperative Hemodynamics, Fenestration, and Fontan Hospitalization Length of Stay

Abstract

Introduction: Using a multi-center Pediatric Heart Network dataset linking surgical (STS) and catheterization (IMPACT) data, we sought to evaluate factors associated with use of Fontan fenestration and the impact of fenestration on post-Fontan length of stay (LOS) in the context of pre-operative hemodynamics. Methods: Centers participated using a data sharing agreement permitting linkage of de-identified STS and IMPACT data. Patients 2-6 years old at Fontan surgery from 2010-2020 with catheterization <1 year prior were included. Multivariable logistic regression was used to evaluate factors associated with fenestration. Full model covariates included center, ventricular morphology, Fontan type (lateral tunnel [LT] vs extracardiac conduit [ECC]), age at Fontan, sex, race and hemodynamic variables. Post-Fontan LOS was analyzed by fenestration status across hemodynamic variables using non-parametric ANOVA and by multivariable linear regression. Results: The cohort included 702 patients (7 centers). Median age at Fontan was 3.4 years (IQR 2.7-4.2) with fenestration used in 465 (66.2%). In multivariable modeling, factors associated with fenestration included center (range 27-93% use, p<0.0001), Fontan type (OR 14.1 for LT, p<0.0001) and ventricular morphology (P=0.007). Addition of hemodynamic variables (mean pulmonary artery pressure [mPAP], end diastolic pressure and pulmonary vascular resistance index) did not improve the model (Figure). While Fenestration was independently associated with a decreased LOS (p=0.04), exploratory analysis demonstrated the benefit was most pronounced at mPAP ≥ 13mmHg (median 9 vs 12 days, p=0.001). Conclusions: There is wide center variability in use of Fontan fenestration that is not explained by pre-operative hemodynamics. Fenestration is independently associated with shorter LOS but those with mPAP ≥ 13 mmHg at pre-Fontan catheterization benefit the most from fenestration with shorter post-Fontan LOS.