Open Access

ARTICLE

Surveillance and screening practices of New England congenital cardiologists for patients after the Fontan operation

Brooke T. Davey¹, Olga H. Toro‐Salazar¹, Naomi Gauthier^2,3, Anne Marie Valente², Robert W. Elder⁴, Fred M. Wu², Norman Berman³, Phyllis Pollack⁵, Ji Hyun Lee¹, Rahul H. Rathod²

1 Connecticut Children’s, Hartford, Connecticut
2 Boston Children’s Hospital, Boston, Massachusetts
3 Children’s Hospital at Dartmouth‐ Hitchcock, Lebanon, New Hampshire
4 Yale‐New Haven Children’s Hospital, New Haven, Connecticut
5 Child Heart Associates, Worcester, Massachusetts

* Corresponding Author: Brooke T. Davey, Connecticut Children's, 282 Washington St., Hartford, CT 06106. Email:

Congenital Heart Disease 2019, 14(6), 1013-1023. https://doi.org/10.1111/chd.12854

Abstract

Introduction: Surveillance and management guidelines for Fontan patients are lacking due to the paucity of evidence in the literature of screening efficacy on outcome measures.
Methods: The Fontan Working Group within the New England Congenital Cardiology Association designed an electronic survey to assess surveillance practices for pa‐ tients with Fontan procedures among New England congenital cardiologists and to explore variability in screening low‐risk vs high‐risk Fontan patients across regional programs.
Results: Fifty‐six cardiologists representing 12 regional programs responded to the survey, comprising ~40% of the total New England congenital cardiac physicians. The majority of desired testing and consultation was available within 50 miles of the pa‐ tient's home institution with some limitations of cardiac catheterization and cardiac magnetic resonance imaging availability. Surveillance and screening were less fre‐ quent in low‐risk Fontan patients compared to high‐risk Fontan patients. Counseling practices were similar for both low‐risk and high‐risk Fontan patients. Aspirin mono‐ therapy was recommended by 82% of providers for low‐risk Fontan patients, while anticoagulation regimens were more varied for the high‐risk population. Practitioners with ≤15 years of experience were more likely to provide quality of life testing in both low‐risk and high‐risk Fontan patients. There were no other major differences in test‐ ing frequencies by years of practice, quaternary vs nonquaternary care facility, or the number of Fontan patients in a practice.
Conclusion: This survey provides insight into regional practices of screening and surveillance of Fontan patients. These data may be used to design future research studies and evidence‐based guidelines to streamline the approach to manage these complex patients.

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