Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis

Christopher E Greenleaf; Zhia Ning Lim; Wen Li; Damien J LaPar; Jorge D Salazar; Antonio F Corno

doi:10.3389/fped.2022.915045

Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis

Front Pediatr. 2022 Oct 4:10:915045. doi: 10.3389/fped.2022.915045. eCollection 2022.

Authors

Christopher E Greenleaf¹, Zhia Ning Lim², Wen Li³, Damien J LaPar¹, Jorge D Salazar¹, Antonio F Corno¹

Affiliations

¹ Pediatric and Congenital Cardiac Surgery, Children's Heart Institute, Memorial Hermann Children's Hospital, UTHealth, McGovern Medical School, Houston, TX, United States.
² University College of London (UCL) Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
³ Division of Clinical and Translational Sciences, Department of Internal Medicine, UTHealth, McGovern Medical School, Houston, TX, United States.

Abstract

Background: Meta-analysis of the impact on clinical outcome from transcatheter closure of Fontan fenestration.

Methods: Cochrane, Embase, MEDLINE, and Open-Gray were searched. Parameters such as changes in oxygen saturation, cavo-pulmonary pressure, maximum heart rate during exercise, exercise duration, and oxygen saturation after fenestration closure were pooled and statistical analysis performed.

Results: Among 922 publications, 12 retrospective observational studies were included. The included studies involved 610 patients, of which 552 patients (90.5%) had a fenestration. Of those patients, 505 patients (91.5%) underwent attempt at trans-catheter closure. When it could be estimated, the pooled overall mean age at trans-catheter fenestration closure was 6.6 ± 7.4 years, and the mean follow-up time was 34.4 ± 10.7 months. There were 32 minor (6.3%) and 20 major (4.0%) complications during or after trans-catheter Fontan fenestration closure. The forest plots demonstrate that following fenestration closure, there was a significant increase in the mean arterial oxygen saturation of 7.9% (95% CI 6.4-9.4%, p < 0.01). There was also a significant increase in the mean cavo-pulmonary pressure of 1.4 mmHg (95% CI 1.0-1.8 mmHg, p < 0.01) following fenestration closure. The exercise parameters reported in 3 studies also favored closing the fenestration as well, yet the exercise duration increase of 1.7 min (95% CI 0.7-2.8 min, p < 0.01) after fenestration closure is probably clinically insignificant.

Conclusion: Late closure of a Fontan fenestration has the impact of improving resting oxygen saturation, exercise oxygen saturation, and a modest improvement of exercise duration. These clinical benefits, however, may be at the expense of tolerating slightly higher cavo-pulmonary mean pressures.

Keywords: Fontan circulation; congenital heart defects; congenital heart surgery; fenestration; meta-analysis; systematic literature review; univentricular hearts.

Publication types

Systematic Review