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Drug therapy in the prevention of failure of the Fontan circulation: a systematic review

Published online by Cambridge University Press:  07 March 2016

Nathalie J. Oldenburger ,
Arenda Mank ,
Jonathan Etnel ,
Johanna J. M. Takkenberg  and
Willem A. Helbing
Nathalie J. Oldenburger
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
Arenda Mank
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
Jonathan Etnel
Affiliation:
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
Johanna J. M. Takkenberg
Affiliation:
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
Willem A. Helbing*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
*
Correspondence to: W. A. Helbing, MD, PhD, Department of Paediatrics, Division of Paediatric Cardiology, Erasmus Medical Centre, Sophia Children’s Hospital, Sp-2.457, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 10 703 62 64; E-mail: w.a.helbing@erasmusmc.nl
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Abstract

Background

The Fontan circulation is the optimal treatment for patients with univentricular hearts. These patients are at high risk of circulatory failure. There is no consensus on the optimal drug treatment for the prevention of failure of the Fontan circulation. The aim of this systematic review was to provide an overview of evidence for drug therapy used in the prevention of Fontan circulatory failure.

Methods

We searched the Embase database for articles that reported drug therapy in Fontan patients. Studies published between 1997 and 2014 were included if efficacy or safety of medication was assessed, drug therapy aimed to prevent or treat failure of the Fontan circulation, and if the full text was available. Case reports were excluded.

Results

A total of nine studies were included with a total of 267 Fontan patients; four studies evaluated the medication sildenafil, one iloprost, three bosentan, and one enalapril. Among all, two sildenafil studies reported improvement in exercise capacity, one in exercise haemodynamics, and one in ventricular performance. In the largest study of bosentan, an increase in exercise capacity was found. Enalapril did not result in improvements.

Conclusion

The studies analysed in this review suggest that bosentan, sildenafil, and iloprost may improve exercise capacity at the short term. Given the limitations of the studies, more, larger, placebo-controlled studies with longer follow-up periods are needed to better understand which drug therapies are effective in the prevention of failure of the Fontan circulation.

Keywords

Fontan circulationdrug therapysildenafilbosentanenalapril
Type
Review Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 842 - 850
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Copyright
© Cambridge University Press 2016 

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Footnotes

*

Both authors contributed equally.

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