The modified fontan operation

Knott‐Craig, Christopher J.; Danielson, Gordon K.; Schaff, Hartzell V.; Puga, Francisco J.; Weaver, Amy L.; Driscoll, David

doi:10.1016/s0022-5223(95)70208-3

Cited by 164 publications

(19 citation statements)

References 36 publications

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“…Many authors believe that hypoplastic left heart syndrome is an increased risk of mortality or complications after Fontan procedure [5,18,19]. Our observations do not confirm these reports.…”

Section: Discussioncontrasting

confidence: 87%

Results of the Fontan operation with no early mortality in 248 consecutive patients

2017

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A b s t r a c t Background:The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects. Aim:The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. Methods:In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weighing 14.6 ± 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a "beating heart" without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 ± 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme.Results: All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 ± 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 ± 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke. Conclusions:Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation.

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Section: Discussioncontrasting

confidence: 87%

Results of the Fontan operation with no early mortality in 248 consecutive patients

2017

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“…Even in ideal Fontan candidates, the instantaneous risk of death from cardiac failure progressively increases 2 years from surgery, with an 86% 5-year and 74% 15-year survival. 5 The attrition rate is known to be highest in the first 6 months after Fontan completion, 6 but arrhythmias, protein losing enteropathy 7 and progressive cardiac failure can occur as late and possibly fatal complications. Since SV circulation appears to have a limited durabil- ity per se, increasing referrals for OHT can be predicted.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, both Fontan take-down and rescue-OHT are not an easy task to reach in failing Fontan. 6 Our provocative inference is that high-risk Fontan completion may hazard a future transplant option. Moreover, albeit the charges for OHT usually exceed that for a Fontan procedure, Fontan palliation in high-risk patients is ultimately more costly and increases postoperative morbidity, 18 delivering only a brief delay before transplantation referral.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic Heart Transplantation for Congenital Heart Disease: An Alternative for High-Risk Fontan Candidates?

et al. 2003

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Objective-Evaluation of incremental risk factors for early mortality in children undergoing orthotopic heart transplantation (OHT) for congenital heart disease. Methods-Between 1988 and 2002, 43 patients (mean age 9.1Ϯ7.2 years) underwent 44 OHT for complex TGA (6), DORV (4), single ventricle (21), and other end-stage structural heart disease (11). Two discernible ventricular chambers were present in 18 pts (41.8%). Previous reconstructive or palliative procedures had been previously accomplished in 35 pts (83.3%), including atrial switch (5), systemic-to-pulmonary shunts (10), cavopulmonary anastomosis (9), Fontan completion (6), and others (5). Results-30-day survival for the 2-ventricle subgroup was 94.4Ϯ5.4% compared with 67.2Ϯ9.5% for the single ventricle subgroup (Pϭ0.04) (overall 78.6%Ϯ3.3%). OHT following single ventricle staging to bi-directional cavopulmonary anastomosis exhibited 100% early survival, as opposed to 62.5Ϯ17.1% for OHT after systemic-to-pulmonary shunts, and 33.3Ϯ19.2% for OHT following failing Fontan (Pϭ0.010). HLHS diagnosis (0.0085) and failing Fontan (Pϭ0.003) were identified as independent predictors of early mortality by regression logistic modeling, while Fontan stage represented the only predictor of overall mortality by Cox proportional hazard. Overall 10-year survival was 54.3Ϯ11%. Conclusions-OHT for structural congenital heart disease with single ventricle physiology entails substantial early mortality and bi-directional cavopulmonary anastomosis enables the best transition to heart transplant. OHT should be considered in the decision making process as an alternative to Fontan completion in high-risk candidates, since rescue-OHT after failing Fontan seems unwarranted.

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“…Some have reported satisfactory outcome following Fontan operation performed in children as young as 7 months (2). Others have reported that younger age at Fontan is associated with increased morbidity and mortality (3–5). There are also conflicting reports regarding weight with some studies suggesting that lower weight at Fontan operation (in particular weight <10 kg) is a risk factor for post-operative morbidity, while others have not shown this to be the case (6–8).…”

Section: Introductionmentioning

confidence: 99%

Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

Wallace

Jaggers

et al. 2011

The Annals of Thoracic Surgery

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Background The impact of age and weight on outcomes following the Fontan operation is unclear. Previous analyses have suggested that lower weight-for-age z-score is an important predictor of poor outcome in patients undergoing bidirectional Glenn. We evaluated variation in age, weight, and weight-for-age z-score at Fontan across institutions, and the impact of these variables on post-operative morbidity and mortality. Methods Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000–2009) were included. Center variation in age, weight, and weight-for-age z-score were described. Multivariable analysis was performed to evaluate the impact of age, weight, and weight-for-age z-score on in-hospital mortality, Fontan failure (combined in-hospital mortality and Fontan takedown/revision), post-operative length of stay, and complications, adjusting for other patient and center factors. Results A total of 2747 patients (68 centers) were included: 61% male; 45% right dominant lesions (38% left dominant, 17% undifferentiated). An extracardiac conduit Fontan (vs. lateral tunnel) was performed in 63%; 65% were fenestrated. Median age and weight at Fontan operation and proportion with weight-for-age z-score <−2 varied across centers ranging from 1.7–4.8 yrs, 10.5–16.1 kg, and 0%–30%, respectively. In multivariable analysis, age and weight were not significantly associated with outcome. Weight-for-age z-score <−2 was associated with increased in-hospital mortality (OR 2.73, 95%CI 1.09–6.86), Fontan failure (OR 2.59, 95%CI 1.24–5.40), and longer length of stay (+1.2 days, 95%CI 0.1–2.4). Conclusions Weight-for-age z-score <−2 is associated with significant morbidity and mortality following the Fontan operation independent of other patient and center characteristics.

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The modified fontan operation

Cited by 164 publications

References 36 publications

Results of the Fontan operation with no early mortality in 248 consecutive patients

Results of the Fontan operation with no early mortality in 248 consecutive patients

Orthotopic Heart Transplantation for Congenital Heart Disease: An Alternative for High-Risk Fontan Candidates?

Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

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