Systemic ventricle morphology impact on ten-year survival after Fontan surgery

Abstract

Background The Fontan procedure has been applied in many patients with single-ventricle physiology, with quite low mortality rates all over the world, and a 8.6%–9.1% rate in Indonesia. Structural and characteristic differences in the morphologically left and right ventricles influence the role of the systemic ventricle in the functionally univentricular heart and impact on postoperative outcomes. Mid- and long-term survival based on systemic ventricle morphology remains controversial. This study aimed to investigate the impact of systemic ventricle morphology on ten-year survival after the Fontan procedure. Methods The 162 patients who underwent a Fontan operation at our institution between 2008 and February 2018 and survived to discharge were reviewed and followed up until March 2018. Data were extracted from the registry and pediatric surgical conferences, medical records, surgery reports, echocardiography and catheterization reports, and follow-up to the end of the study period. Median follow-up was 26.5 months (range 10.75–54 months). Results The patients were divided into 2 groups based on systemic ventricle morphology. Seventy-four patients were included in the left morphology group and 88 in the right morphology group. There was no difference in 10-year survival rates between the two type of systemic ventricle morphology. Postoperative thromboembolic events influenced the 10-year survival rate after the Fontan procedure (hazard ratio 4.84, 95% confidence interval: 1.26–18.55, p = 0.021). Conclusion Systemic ventricle morphology was not associated with the 10-year survival rate after the Fontan procedure. Postoperative thromboembolic events accounted for a 4.84-times higher mortality risk after the Fontan procedure.

Failures of the Fontan System in Univentricular Hearts and Mortality Risk in Heart Transplantation: A Systematic Review and Meta-Analysis

“…No differences in mortality were demonstrated in these patients at the time of transplantation. While the morphology of the systemic ventricle is associated with immediate mortality at the time of cavopulmonary bypass, no differences in the presentation of HF or other failures have been demonstrated when comparing a right or left morphology of the single ventricle [106,107]. Variables such as hospitalizations due to HF or sudden death events are directly associated with mortality in transplant patients [108], and these variables were not controlled in the meta-analysis.…”

Fontan operation experience and results of our cardiovascular surgery center

“…Previously known myocardial dysfunction or atrioventricular valve insu ciency was not observed in the patients who were lost. In a 10-year study by Mira Fauziah et al systemic ventricular morphology was not associated with the 10-year survival rate after Fontan surgery (14). The probable cause was the problem of meeting the systemic venous return by the pulmonary system, diameter mismatch or increased pulmonary vascular resistance.…”

Impact of older age at Fontan completion on mid-term survival

“…Patients who met the inclusion criteria were divided into two different groups; age at Fontan completion (operation) < 6 and ≥ 6 years old. This age cutoff was based on a previous average age for Indonesian Fontan patients by Fauziah et al [ 10 ]. Clinical follow-up was completed by medical record review, phone calls, or mails.…”

“…Some experts argue that postponing Fontan completion could delay the onset of Fontan complications. Fauziah et al reported that most patients who underwent Fontan completion in Indonesia were older than patients in developed countries, with a median age of 6 years (range 3–22 years) [ 10 ].…”