FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3136139191> ?p ?o ?g. }

• W3136139191 endingPage "1476" @default.
• W3136139191 startingPage "1475" @default.
• W3136139191 abstract "Central MessageRefining long-term Fontan outcomes is the next challenging frontier in our battle against single ventricle disease.See Article page XXX. Refining long-term Fontan outcomes is the next challenging frontier in our battle against single ventricle disease. See Article page XXX. Total cavopulmonary connection and establishment of Fontan circulation has revolutionized the care of patients with single ventricle physiology.1Jacobs J.P. Maruszewski B. Functionally univentricular heart and the Fontan operation: lessons learned about patterns of practice and outcomes from the congenital heart surgery databases of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons.World J Pediatr Congenit Heart Surg. 2013; 4: 349-355Crossref PubMed Scopus (26) Google Scholar However, longitudinal follow-up shows that the functional health status of Fontan survivors decreases over time,2Atz A.M. Zak V. Mahony L. Uzark K. D'agincourt N. Goldberg D.J. et al.Longitudinal outcomes of patients with single ventricle after the Fontan procedure.J Am Coll Cardiol. 2017; 69: 2735-2744Crossref PubMed Scopus (104) Google Scholar and that a substantial number requires reintervention to maintain effective Fontan circulation.3Daley M. du Plessis K. Zannino D. Hornung T. Disney P. Cordina R. et al.Reintervention and survival in 1428 patients in the Australian and New Zealand Fontan registry.Heart. 2020; 106: 751-757Crossref PubMed Scopus (7) Google Scholar Late Fontan failure can result from primary single ventricle dysfunction and/or failure of Fontan circuit. The optimal management of patients with failing Fontan circulation remains a monumental challenge, and the appropriate timing of cardiac replacement therapy is one of the most difficult clinical decisions to make. Many patients with Fontan circulation exhibit extracardiac organ dysfunction, frequently hepatic and renal pathology inherent to their chronically elevated venous pressures. The Model for End Stage Liver Disease (MELD) score was originally developed to quantify the degree of liver and kidney dysfunction using serum creatinine, bilirubin, and prothrombin time international normalized ratio (INR) values. However, many Fontan patients receive therapeutic anticoagulation for thromboembolic prophylaxis, fenestration patency, or mechanical support, which precludes use of the MELD score. The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score has previously been shown to correlate with survival following heart transplantation in adults.4Grimm J.C. Shah A.S. Magruder J.T. Kilic A. Valero III, V. Dungan S.P. et al.MELD-XI score predicts early mortality in patients after heart transplantation.Ann Thorac Surg. 2015; 100: 1737-1743Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar In this issue of the Journal, Amdani and colleagues5Amdani S. Simpson K.E. Thrush P. Shih R. Simmonds J. Knecht K. et al.Hepatorenal dysfunction assessment with the model for end-stage liver disease excluding INR score predicts worse survival after heart transplant in pediatric Fontan patients.J Thorac Cardiovasc Surg. February 18, 2021; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar present data from the multi-institutional Pediatric Heart Transplant Society database demonstrating that the MELD-XI score reliably identifies pediatric Fontan patients at increased risk for mortality following heart transplantation. Patients with MELD-XI scores in the top 25th percentile at the time of heart transplantation had inferior 1- and 5-year posttransplantation survival. On the face of it, these results imply that Fontan patients with worse liver and kidney function do poorly and, in that regard, are quite intuitive. Furthermore, because the authors used a percentile cutoff within their cohort to define high MELD score, how that value applies to an individual Fontan patient remains to be seen. In addition to high MELD-XI score, the authors report that a history of protein-losing enteropathy and the presence of a ventricular assist device (VAD) at transplantation also predicted poor outcome. These sobering data remind us once again that Fontan circulation is a suboptimal physiology with an ongoing hazard for multi–organ system dysfunction and death. An interesting observation in this study is that VAD implantation was associated with improved MELD-XI scores during the waitlist period. VAD implantation comes with unique challenges in the single ventricle population6Miller J.R. Lancaster T.S. Callahan C. Abarbanell A.M. Eghtesady P. An overview of mechanical circulatory support in single-ventricle patients.Transl Pediatr. 2018; 7: 151-161Crossref PubMed Scopus (14) Google Scholar and was encountered in only approximately 5% of the patients at heart transplantation in this study. Given the small numbers, VAD use did not correlate statistically with better heart transplantation outcomes; yet the ability to improve end-organ function using a VAD is encouraging and should further strengthen ongoing efforts to identify better devices to support the failing Fontan circulation. That said, this study, like previous smaller studies, shows that early identification of Fontan failure before progression to advanced liver and kidney dysfunction is paramount to maximize post–heart transplantation survival. Could proper utilization of the MELD-XI score allow for timely referral for transplant evaluation? Or is there an earlier and more reliable predictor of progressive liver dysfunction? Studies of routine surveillance of Fontan patients suggest that virtually all of them will demonstrate some degree of liver disease by adolescence (Figure 1).7Emamaullee J. Zaidi A.N. Schiano T. Kahn J. Valentino P.L. Hofer R.E. et al.Fontan-associated liver disease: screening, management, and transplant considerations.Circulation. 2020; 142: 591-604Crossref PubMed Scopus (12) Google Scholar Could we then predict even before reaching Fontan circulation who would progress to multiorgan dysfunction following Fontan completion? And if so, could we directly proceed with heart transplantation from the Glenn stage without transitioning through the Fontan circuit and the obligatory pressurization of the venous system? This study by Amdani and colleagues gives us strong reasons to pursue the answers to these daunting questions. Clearly, refining long-term Fontan outcomes is the next challenging frontier in our battle against single ventricle disease. Hepatorenal dysfunction assessment with the Model for End-Stage Liver Disease Excluding INR score predicts worse survival after heart transplant in pediatric Fontan patientsThe Journal of Thoracic and Cardiovascular SurgeryPreviewFontan physiology results in multiorgan dysfunction, most notably affecting the liver and kidney. We evaluated the utility of Model for End-Stage Liver Disease Excluding INR (MELD-XI) score, a score evaluating the function of both liver and kidney to identify Fontan patients at increased risk for morbidity and mortality post–heart transplant. Full-Text PDF" @default.
• W3136139191 created "2021-03-29" @default.
• W3136139191 creator A5006593302 @default.
• W3136139191 creator A5086368016 @default.
• W3136139191 date "2022-04-01" @default.
• W3136139191 modified "2023-10-16" @default.
• W3136139191 title "Commentary: The MELD-XI score in Fontan patients: It's about time" @default.
• W3136139191 cites W1858312919 @default.
• W3136139191 cites W2136161940 @default.
• W3136139191 cites W2619236316 @default.
• W3136139191 cites W2802444458 @default.
• W3136139191 cites W2982313576 @default.
• W3136139191 cites W3048669732 @default.
• W3136139191 cites W3132468540 @default.
• W3136139191 doi "https://doi.org/10.1016/j.jtcvs.2021.03.036" @default.
• W3136139191 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/33838911" @default.
• W3136139191 hasPublicationYear "2022" @default.
• W3136139191 type Work @default.
• W3136139191 sameAs 3136139191 @default.
• W3136139191 citedByCount "0" @default.
• W3136139191 crossrefType "journal-article" @default.
• W3136139191 hasAuthorship W3136139191A5006593302 @default.
• W3136139191 hasAuthorship W3136139191A5086368016 @default.
• W3136139191 hasBestOaLocation W31361391911 @default.
• W3136139191 hasConcept C126322002 @default.
• W3136139191 hasConcept C141071460 @default.
• W3136139191 hasConcept C164705383 @default.
• W3136139191 hasConcept C17744445 @default.
• W3136139191 hasConcept C199539241 @default.
• W3136139191 hasConcept C2776974648 @default.
• W3136139191 hasConcept C2778198053 @default.
• W3136139191 hasConcept C2778921608 @default.
• W3136139191 hasConcept C2779473830 @default.
• W3136139191 hasConcept C71924100 @default.
• W3136139191 hasConcept C83867959 @default.
• W3136139191 hasConceptScore W3136139191C126322002 @default.
• W3136139191 hasConceptScore W3136139191C141071460 @default.
• W3136139191 hasConceptScore W3136139191C164705383 @default.
• W3136139191 hasConceptScore W3136139191C17744445 @default.
• W3136139191 hasConceptScore W3136139191C199539241 @default.
• W3136139191 hasConceptScore W3136139191C2776974648 @default.
• W3136139191 hasConceptScore W3136139191C2778198053 @default.
• W3136139191 hasConceptScore W3136139191C2778921608 @default.
• W3136139191 hasConceptScore W3136139191C2779473830 @default.
• W3136139191 hasConceptScore W3136139191C71924100 @default.
• W3136139191 hasConceptScore W3136139191C83867959 @default.
• W3136139191 hasIssue "4" @default.
• W3136139191 hasLocation W31361391911 @default.
• W3136139191 hasLocation W31361391912 @default.
• W3136139191 hasOpenAccess W3136139191 @default.
• W3136139191 hasPrimaryLocation W31361391911 @default.
• W3136139191 hasRelatedWork W2003938723 @default.
• W3136139191 hasRelatedWork W2047967234 @default.
• W3136139191 hasRelatedWork W2118496982 @default.
• W3136139191 hasRelatedWork W2164883216 @default.
• W3136139191 hasRelatedWork W2329808383 @default.
• W3136139191 hasRelatedWork W2362265450 @default.
• W3136139191 hasRelatedWork W2375703560 @default.
• W3136139191 hasRelatedWork W2439875401 @default.
• W3136139191 hasRelatedWork W4247718175 @default.
• W3136139191 hasRelatedWork W2525756941 @default.
• W3136139191 hasVolume "163" @default.
• W3136139191 isParatext "false" @default.
• W3136139191 isRetracted "false" @default.
• W3136139191 magId "3136139191" @default.
• W3136139191 workType "article" @default.