Fontan fenestration closure and event-free survival

Abstract

Objectives The purpose of this study was to evaluate the association of open and closed Fontan fenestration status with event-free survival. Methods All patients who underwent a fenestrated Fontan procedure at our institution from January 1994 through June 2007 were reviewed. Patient information was obtained from medical records. Patients were assigned to one of two study groups, Open vs Closed, based on their most recent fenestration status. Clinically relevant morbid events were tabulated and Kaplan-Meier event analysis used to create event-free probability curves with log-rank comparisons. Results 161 patients were classified as Open and 51 as Closed. The median (inter-quartile range) time to event was 1.1 (0.1,3.3) years after the Fontan procedure; whereas, median time to closure was 1.2 (0.7,3.3) years. Median time to event was 1.5 (0.1,4.6) years in the Closed group and 1.1 (0.1,3.3) years in the Open group. Event-free probability analysis revealed no significant difference between groups (P=0.15). Follow-up median arterial oxygen saturation was higher in the Closed group – 96.0 (94.0,97.0)%, compared to the Open group – 91.0 (86.0,95.0)% (P<0.0001). Conclusions Fenestration closure was associated with higher arterial oxygen saturation, but not higher event-free survival. Time to event was slightly less than time to fenestration closure, suggesting potential merit in the evaluation of earlier fenestration closure. Adoption of specific fenestration management guidelines might help improve overall outcomes and enhance the quality of future studies.

Incidence and factors influencing the spontaneous closure of Fontan fenestration

“…In the literature, there is a wide variation in the rate of spontaneous closure of the fenestration ranging from 8% to 29%. 16,17 Consistent with this, the rate of spontaneous closure in our patients was 22%.…”

“…Currently, there is limited data on medium and long term effects and the rate of spontaneous closure of the fenestration. In the literature, there is a wide variation in the rate of spontaneous closure of the fenestration ranging from 8% to 29% . Consistent with this, the rate of spontaneous closure in our patients was 22%.…”

“…Transcatheter closure of the Fontan fenestration has been well described in the literature. In some institutions, patients with persistently persistent fenestration undergo elective transcatheter closure 1‐3 years following the Fontan operation . Test occlusion of the fenestration is performed in the catheterization laboratory with a balloon catheter in order to assess the feasibility and success of device closure, by simulating post‐occlusion hemodynamics.…”

A computational study of the Fontan circulation with fenestration or hepatic vein exclusion

“…In the extracardiac Fontan, a path may be established by creating a small hole in both the continuation of the inferior vena cava and the atrium, and then surgically connecting them together. We remark that fenestrations may be given at the time of Fontan conversion, usually with the expectation that the small hole or conduit will eventually close [14]. Our modeling focuses on quantifying the effect of fenestrations created after the Fontan surgery in response to complications.…”

Fate of fenestration in children treated with fontan operation

“…However, a number of studies have shown no significant difference in early or late mortality, duration of pleural drainage, or length of hospital stay between fenestrated and nonfenestrated patients . Fenestration closure has been associated with greater arterial oxygen saturation, reduced need for anticongestive medication, and improved somatic growth but it seems to have a limited effect on event‐free survival or long‐term outcome .…”