Rivaroxaban (Xarelto) for Post-Fontan children

Source: Manufacturer webpage

UNIVERSE clinical trial

• n = 112 (Final n = 98, 64 Rivaroxaban, 34 Aspirin)
• Randomized 2:1 (Rivaroxaban : Aspirin) 
• Open label Rivaroxaban vs. Usual Aspirin.
• Age 2-8 yrs
• Follow up for 12 months.

 

Test occlusion of Fontan fenestration

Test occlusion of Fontan fenestration:

Criteria for decision making in one old publication - Bridges ND, et al. JACC 1995;25:1712-17.

Mean RA pressure > 18 mmHg

AV difference of saturation increased by > 33%

RA saturation < 40%.

In patients with unfavorable outcome (2 yr follow-up after fenestration closure); systemic venous pressure increased more than 40% and systemic venous saturation decreased more than 23%.

There are other criteria in other publications.

Fontan - 10-commandments

From JACC 2012(1) Suppl 1:S1-S42.

Pleural effusion after Fontan Operation

Am J Cardiol 2005;96:130-3
Millwaukee. 2000-2005, n=25 (on protocol) vs. Historic controls from 1997-2000 (n=33). Median duration of pleural effusion decreased (6 days vs. 15 days).

Protocol:
80% maintenance fluids
Lasix 1 mg/kg/dose Q8 hrs, changed to Diuril + Spironolactone Q12 hrs when PO intake starts
Captopril when PO intake starts
Nasal cannula oxygen, at least 0.5 LPM
Low fat diet (30% calories from fat)

(Nitric oxide/Sildenfil)

Other papers:
Curr Opin Pulm Med 2010;16:392-6 (by E. Austin III) - summarizes several recent studies. No signficant conclusions. Highlights the uncertainty of etiology and aproach.