Late Status of Fontan Patients With Persistent Surgical Fenestration

Abstract

Objective To determine the effects of creation of a systemic to pulmonary venous atrial level communication (fenestration) at the time of the Fontan procedure on late outcomes. Background Fenestrations are frequently performed during Fontan procedures but late consequences are not well described. Methods Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated. Results Fenestration was performed in 361 patients (67%) and frequency differed by year and center (p<0.001 for each). After adjustment for center, age at Fontan, year of Fontan and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At time of cross-sectional testing 8±3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention, 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared to those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p=0.02) and had lower resting oxygen saturation (median 89 vs. 95%, p<.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post Fontan stroke or thrombosis, and growth did not differ by current fenestration status. Discussion Surgical fenestration is associated with well demonstrated early postoperative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes.

Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake

“…This is similar to data published in 2011 from the PHN. 30 In addition, oxygen saturations at rest and peak exercise were different between groups, which were accounted for by the presence or absence of a fenestration. However, we did not find statistically significant associations between oxygen saturations and exercise performance, a result also encountered by the PHN.…”

“…Single-ventricle morphology 0.982 Right (30) 76.7 ± 20.9 Other morphology 76.6 ± 18.9 (left, biventricular, or indeterminate) (25) Max Vo 2 = maximum oxygen consumption Data are presented as mean ± SD, number and interquartile range, or number and percentage. P <0.05 was considered statistically significant.…”

Almanac 2012: Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…The late results for fenestration of the systemic venous pathway at the time of the Fontan operation were reported in a multi-centre retrospective nonrandomised study. 32 Of the 361 fenestrations, there were few deleterious later outcomes a mean of 8 ± 3 years after surgery. Saturations were 89% versus 95% in the fenestrated group.…”

Almanac 2012: congenital heart disease. The journals present selected research that has driven recent advances in clinical cardiology

“…The late results for fenestra-tion of the systemic venous pathway at the time of the Fontan operation were reported in a multicentre retrospective nonrandomised study (32). Of the 361 fenestrations, there were few deleterious later outcomes a mean of 8±3 years after surgery.…”