2024
Life and Death: A Multicenter Study Evaluating Cardiologists’ Approach to Difficult Conversations with Fontan Patients and Families
Lee S, Rathod R, Valente A, Davey B, Wu F, Drucker N, Lombardi K, St. Clair N, Azcue N, Toro-Salazar O, Elder R. Life and Death: A Multicenter Study Evaluating Cardiologists’ Approach to Difficult Conversations with Fontan Patients and Families. Pediatric Cardiology 2024, 1-8. PMID: 39164409, DOI: 10.1007/s00246-024-03631-5.Peer-Reviewed Original ResearchPatient-related barriersGoals of carePhysician demographic dataProvider-relatedEnrollment of individualsPerceived barriersRisk counselingLongitudinal careMental healthThematic approachYears post fellowshipFontan patientsLack of familiarityAdverse event riskDifficult conversationsOutpatient cardiologistPsychosocial stressorsNarrative commentsSignificant barriersAdolescent/young adultPatient-relatedSocial barriersDemographic dataCardiologists' attitudesCare
2023
How Good Are Cardiologists at Predicting Major Adverse Events in Fontan Patients?
Elder R, Valente A, Davey B, Wu F, Drucker N, Lombardi K, Lee S, McCollum S, Shabanova V, St. Clair N, Azcue N, Toro-Salazar O, Rathod R. How Good Are Cardiologists at Predicting Major Adverse Events in Fontan Patients? JACC Advances 2023, 3: 100736. PMID: 38939804, PMCID: PMC11198720, DOI: 10.1016/j.jacadv.2023.100736.Peer-Reviewed Original ResearchMajor adverse eventsBeta-blocker useFontan patientsSimple kappa coefficientAdverse eventsAtrioventricular valve regurgitationBlocker useSystolic dysfunctionCardiac admissionsValve regurgitationRisk cohortMulticenter studyPatientsResults OverallLateral tunnelLinear mixed effects modelsCardiologistsFontanKappa coefficientMixed effects modelsEffects modelRiskMonthsYearsRegurgitationFontan-related morbidity and paced QRS duration: A case series
Keaney J, Simmons M, Elder R, Beach C. Fontan-related morbidity and paced QRS duration: A case series. Progress In Pediatric Cardiology 2023, 69: 101641. DOI: 10.1016/j.ppedcard.2023.101641.Peer-Reviewed Original Research
2020
A window into portal hemodynamics in adult fontan patients?
Simmons MA, Revzin M, To U, Liapakis A, Fahey J, Elder RW. A window into portal hemodynamics in adult fontan patients? International Journal Of Cardiology 2020, 323: 61-64. PMID: 32979426, DOI: 10.1016/j.ijcard.2020.09.047.Peer-Reviewed Original ResearchConceptsAdult Fontan patientsFontan patientsSpleen stiffnessCongenital heart diseaseLiver stiffnessShear wave elastographyControl patientsPortal hemodynamicsLiver diseaseHeart diseaseFontan-associated liver diseaseLimited subgroup analysisPortal venous hemodynamicsAssociated liver diseasePassive hepatic congestionUltrasound shear wave elastographyFontan circulationStudy cohortHealthy patientsHepatic congestionVenous hemodynamicsSubgroup analysisLiver fibrosisHealthy controlsPatients
2019
Surveillance and screening practices of New England congenital cardiologists for patients after the Fontan operation
Davey B, Toro‐Salazar O, Gauthier N, Valente A, Elder R, Wu F, Berman N, Pollack P, Lee J, Rathod R. Surveillance and screening practices of New England congenital cardiologists for patients after the Fontan operation. Congenital Heart Disease 2019, 14: 1013-1023. PMID: 31642600, DOI: 10.1111/chd.12854.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultCardiologistsChildChild, PreschoolFontan ProcedureHealth Care SurveysHealth Services AccessibilityHealthcare DisparitiesHeart Defects, CongenitalHeart Function TestsHumansNew EnglandPractice Patterns, Physicians'Predictive Value of TestsReferral and ConsultationRisk FactorsTreatment OutcomeYoung AdultConceptsHigh-risk Fontan patientsFontan patientsCongenital cardiologistsLow riskMagnetic resonance imaging availabilityQuality of life testHigh-risk populationEvidence-based guidelinesFontan operationFontan procedureCardiac catheterizationScreening low-riskAnticoagulation regimensPractice of screeningFontanAspirin monotherapyCardiology associationsPatientsCardiac physiciansComplex patientsScreening practicesOutcome measuresCardiologistsYears of practiceDesigning future research studies
2016
Superior Mesenteric Arterial Flow Pattern is Associated with Major Adverse Events in Adults with Fontan Circulation
Mori M, Shioda K, Elder RW, Pernetz MA, Rodriguez FH, Rangosch A, Kogon BE, Book WM. Superior Mesenteric Arterial Flow Pattern is Associated with Major Adverse Events in Adults with Fontan Circulation. Pediatric Cardiology 2016, 37: 1013-1021. PMID: 27033246, DOI: 10.1007/s00246-016-1382-y.Peer-Reviewed Original ResearchConceptsVelocity time integralAdult Fontan patientsEnd-diastolic velocitySystolic/diastolic ratioMajor adverse eventsAdverse eventsMesenteric arterial flowFontan patientsFontan circulationResistive indexDiastolic ratioArterial flowSuperior mesenteric arterial flowDiastolic velocity-time integralAdult Fontan populationSystolic velocity time integralVenous outflow obstructionCox regression analysisPediatric Fontan patientsKaplan-Meyer analysisNon-event groupArterial flow patternsFontan populationAdult patientsOutflow obstructionCatheter‐measured Hemodynamics of Adult Fontan Circulation: Associations with Adverse Event and End‐organ Dysfunctions
Mori M, Hebson C, Shioda K, Elder RW, Kogon BE, Rodriguez FH, Jokhadar M, Book WM. Catheter‐measured Hemodynamics of Adult Fontan Circulation: Associations with Adverse Event and End‐organ Dysfunctions. Congenital Heart Disease 2016, 11: 589-597. PMID: 26932151, DOI: 10.1111/chd.12345.Peer-Reviewed Original ResearchMeSH KeywordsAdultCardiac CatheterizationChi-Square DistributionFemaleFontan ProcedureGeorgiaHeart Defects, CongenitalHeart FailureHeart TransplantationHemodynamicsHumansKidney DiseasesLinear ModelsLiver DiseasesMaleMultivariate AnalysisPredictive Value of TestsProportional Hazards ModelsRetrospective StudiesRisk FactorsTime FactorsTreatment OutcomeYoung AdultConceptsPulmonary capillary wedge pressureHigh central venous pressureCentral venous pressureEnd-organ dysfunctionSystemic vascular resistance indexCox proportional hazards analysisAdult Fontan patientsProportional hazards analysisCardiac indexFontan patientsAdverse eventsFontan circulationHemodynamic measurementsHigh systemic vascular resistance indexMultivariate Cox proportional hazards analysisRight heart catheterization dataSignificant associationLow cardiac indexVascular resistance indexCapillary wedge pressureChild-Pugh scoreSerious adverse eventsVenous outflow obstructionHigher cardiac indexPost-Fontan patients
2014
Risk Factors for Major Adverse Events Late after Fontan Palliation
Elder RW, McCabe NM, Veledar E, Kogon BE, Jokhadar M, Rodriguez FH, McConnell ME, Book WM. Risk Factors for Major Adverse Events Late after Fontan Palliation. Congenital Heart Disease 2014, 10: 159-168. PMID: 25130602, PMCID: PMC4512755, DOI: 10.1111/chd.12212.Peer-Reviewed Original ResearchConceptsMajor adverse eventsAdult Fontan patientsAdverse eventsRisk factorsFontan patientsFontan palliationOxygen desaturationPortal hypertensionVentricular functionAdverse outcomesTransplant-free survival rateLate-term outcomesSystemic oxygen desaturationSystolic ventricular functionAdverse event profileCongestive heart failureKaplan-Meier methodTertiary academic centerAdditional risk factorsImportant risk factorMode of deathFontan failureFontan typeSystemic ventricleThromboembolic eventsBeyond a Broken Heart: Circulatory Dysfunction in the Failing Fontan
Mori M, Aguirre AJ, Elder RW, Kashkouli A, Farris AB, Ford RM, Book WM. Beyond a Broken Heart: Circulatory Dysfunction in the Failing Fontan. Pediatric Cardiology 2014, 35: 569-579. PMID: 24531876, DOI: 10.1007/s00246-014-0881-y.Peer-Reviewed Original ResearchConceptsAdult Fontan patientsFontan patientsCirculatory dysfunctionPortal hypertensionPostsinusoidal portal hypertensionMultiple organ involvementPulmonary blood flowFailing FontanClinical deteriorationFontan palliationHeart transplantationHepatic dysfunctionLate morbidityVentricular dysfunctionOrgan involvementUniventricular heartVentricular functionLiver diseaseHepatic perfusionPulmonary vasculatureCardiac functionLiver histopathologyBlood flowCirrhotic diseaseClinicopathologic states
2013
Hemodynamic Phenotype of the Failing Fontan in an Adult Population
Hebson CL, McCabe NM, Elder RW, Mahle WT, McConnell M, Kogon BE, Veledar E, Jokhadar M, Vincent RN, Sahu A, Book WM. Hemodynamic Phenotype of the Failing Fontan in an Adult Population. The American Journal Of Cardiology 2013, 112: 1943-1947. PMID: 24075283, PMCID: PMC4505550, DOI: 10.1016/j.amjcard.2013.08.023.Peer-Reviewed Original ResearchConceptsFontan failureCardiac indexFontan patientsLiver diseaseSVR indexLower systemic vascular resistance indexNormal systolic ventricular functionSystemic vascular resistance indexAdult Fontan patientsSimilar cardiac indexSystolic ventricular functionVascular resistance indexSignificant liver diseasePediatric Fontan patientsCase-cohort analysisFailing FontanPF cohortsPortal hypertensionAdult patientsCatheterization findingsFontan circulationHeart failureVentricular functionCirculatory derangementsPediatric cohortFeatures of portal hypertension are associated with major adverse events in Fontan patients: The VAST study
Elder RW, McCabe NM, Hebson C, Veledar E, Romero R, Ford RM, Mahle WT, Kogon BE, Sahu A, Jokhadar M, McConnell ME, Book WM. Features of portal hypertension are associated with major adverse events in Fontan patients: The VAST study. International Journal Of Cardiology 2013, 168: 3764-3769. PMID: 23849105, PMCID: PMC3805740, DOI: 10.1016/j.ijcard.2013.06.008.Peer-Reviewed Original ResearchConceptsMajor adverse eventsPortal hypertensionAdverse eventsPost-Fontan patientsFontan patientsVAST scoresSingle-ventricle palliationFuture prospective studiesCongestive hepatopathyEarly referralHeart transplantRetrospective reviewClinical manifestationsProspective studyHepatic fibrosisClinical significanceHypertensionLiver evaluationPatientsLogistic regressionTransplantScoresSignificant relationshipPalliationFontan