The Fontan Procedure
- 11 September 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 116 (11_supplem), I157-64
- https://doi.org/10.1161/circulationaha.106.676445
Abstract
To determine whether patients undergoing the lateral tunnel and extracardiac conduit modifications of the Fontan procedure have better outcomes than patients undergoing a classical atriopulmonary connection. Between 1980 and 2000, 305 consecutive patients underwent a Fontan procedure at our institution. There were 10 hospital deaths (mortality: 3%) with no death after 1990. Independent risk factors for mortality were preoperative elevated pulmonary artery pressures (P=0.002) and common atrioventricular valve (P=0.04). Fontan was taken down during hospital stay in 7 patients. A mean of 12+/-6 years of follow-up was obtained in the 257 nonforeign Fontan survivors. Completeness of concurrent follow-up was 96%. Twenty-year survival was 84% (95% CI: 79 to 89%). Recent techniques improved late survival. The 15-year survival after atriopulmonary connection was 81% (95% CI: 73% to 87%) versus 94% (95% CI: 79% to 98%) for lateral tunnel (P=0.004). Nine pts required heart transplantation (8 atriopulmonary connection, 1 lateral tunnel). Undergoing a Fontan modification independently predicted decreased occurrence of arrhythmia, and 15-year freedom from SVT was 61% (95% CI: 51% to 70%) for atriopulmonary connection versus 87% (95% CI: 76% to 93%) for lateral tunnel (P=0.02). Freedom from Fontan failure (death, take-down, transplantation, or NYHA class III-IV) was 70% (95% CI: 58% to 79%) at 20 years. After extra-cardiac conduits, no death, SVT, or failure was observed. The Fontan procedure remains a palliation, but outcomes of patients have improved. Better patient selection minimizes hospital mortality. Patients with lateral tunnel and extracardiac conduit modifications experience less arrhythmia and are likely to have failure of their Fontan circulation postponed.Keywords
This publication has 9 references indexed in Scilit:
- Anatomic correction of congenitally corrected transposition and its close cousinsCardiology in the Young, 2006
- Salvaging the Failing Fontan: Lateral Tunnel Versus Extracardiac ConduitThe Annals of Thoracic Surgery, 2005
- Evidence of pulmonary vascular disease after heart transplantation for Fontan circulation failureThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Extracardiac Fontan operation for complex cardiac anomalies: Seven years' experienceThe Journal of Thoracic and Cardiovascular Surgery, 1997
- Functional outcome after the Fontan operation: Factors influencing late morbidityThe Journal of Thoracic and Cardiovascular Surgery, 1997
- Fontan operation in five hundred consecutive patients: Factors influencing early and late outcomeThe Journal of Thoracic and Cardiovascular Surgery, 1997
- Fontan's procedure in two stagesThe American Journal of Surgery, 1993
- Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operationsThe Journal of Thoracic and Cardiovascular Surgery, 1988
- Surgical repair of tricuspid atresiaThorax, 1971