Thorac Cardiovasc Surg 2012; 60 - V33
DOI: 10.1055/s-0031-1297423

Thromboprophylaxis after Fontan procedure – long term results

H Mair 1, S Güthoff 1, F Vogt 1, R Sodian 1, C Schmitz 1
  • 1Dept. of Cardiac Surgery, University of Munich, Munich, Germany

Objectives: Anticoagulation after Fontan procedures is controversial. First, necessity is not proven and second, stabilization of the anticoagulation level in children may be difficult. We therefore assessed an anticoagulation management with INR self-determination of the children by their parents.

Methods: The parents of 35 patients after Fontan operation (23 male) were trained to measure the INR-levels of their children (mean age: 4.8±3.4 years) using portable photometers and to adjust the coumarin dosage. All patients had undergone a Fontan-type operation in two steps (14 lateral tunnel, 21 extra-cardiac Fontan). Previous palliative operations had been carried out in all patients. The therapeutic range was determined INR 2.0–3.5.

Results: Mean follow-up time after Fontan procedure was 9.6±3.8 years. In a standard questionnaire 88% of the parents estimated self-monitoring easy to manage. It was well tolerated in 81% by the patients. There were no problems to obtain the blood sample from any child. In 3 patients (4.3yrs, 8.6yrs and 15.2yrs after extra-cardiac Fontan operation) clinical relevant thrombosis occurred, but in 2 patients anticoagulation was discontinued due to in-hospital tratment. Two patients died 2.9 years (unclear reason) and 3.3 years (pneumonia) after Fontan operation.

INR self management was carried out for 4.9±3.8 years (0.7yrs –8.1yrs). Thereafter 15.8% discontinued anticoagulation therapy, 36.8% switched to acetylsalicylic acid (ASA) and 47.3% are still on coumarin-therapy. There was no significant difference between ASA, coumarin or discontinued therapy regarding adverse events. In echocardiography all patients had good LV-function. The patients presented no aortic valve regurgitation >2.

Conclusions: INR self-management is well tolerated by the majority of the patients. Prophylactic anticoagulation therapy after Fontan operation is safe in a therapeutic range of INR 2.0–3.5. Thus far, it is unclear if ASA or coumarin-therapy with INR-self monitoring is superior for thromboprophylaxis.