Related Experiment Videos
[Indications criteria for total cavopulmonary anastomosis (Fontan operation)]
M Kraus1, L Molinari, U Arbenz
1Abteilung für Kardiologie, Universitäts-Kinderspital, Zürich.
Insights
The Fontan criteria accurately predict mortality after the Fontan operation but are less effective for predicting morbidity. Some criteria may require modification, with a potential lower age limit of 2 years suggested.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Context:
- The Fontan operation is a palliative procedure for complex single ventricle congenital heart disease.
- Traditional Fontan criteria are used to assess patient suitability for this surgery.
- Evaluating the predictive accuracy of these criteria is crucial for surgical outcomes.
Purpose:
- To retrospectively assess the predictive value of traditional Fontan criteria for mortality and morbidity following total cavopulmonary anastomosis.
- To identify specific risk factors influencing outcomes after the Fontan procedure.
Summary:
- This study analyzed 51 patients undergoing the Fontan operation between 1982 and 1994.
- Unfulfilled Fontan criteria correlated significantly with increased overall and early mortality.
- Age under 2 years and pulmonary resistance > 4 Woods units were identified as mortality risk factors.
- The number of unmet criteria did not significantly predict postoperative late morbidity.
Impact:
- Fontan criteria are reliable predictors of mortality but have limited value for predicting morbidity.
- Findings suggest potential modifications to existing Fontan criteria.
- Data support a revised lower age limit of 2 years for the Fontan operation.
Objectives:
In a retrospective study we evaluated the predictive value of the traditional risk factors (Fontan criteria) for mortality and morbidity after total cavopulmonary anastomosis (Fontan operation).
Design:
We studied 51 consecutive patients who underwent Fontan operations from 1982 through 1994. Morbidity was assessed by a score taking equally into account rhythm disturbances, cardiovascular hospital admissions and heart failure.
Results:
The mean age at operation was 4.1 +/- 3.4 years. Diagnoses were tricuspid atresia in 20, complex single ventricle in 13 and various complex congenital heart defects in 18 patients. All Fontan criteria were fulfilled in 11 patients while in the remaining 40 up to 6 criteria were not met. The criteria least fulfilled were age in 31 patients and pulmonary artery anatomy in 11. The mean follow-up was 4.6 +/- 3.0 years. The overall 30-day survival was 84% and 1- and 10-year survival 76.5% respectively. All patients who fulfilled all the Fontan criteria survived. The overall mortality and early mortality were associated with a significantly higher number of unfulfilled Fontan criteria (p < 0.01). Age below 2 years at operation and pulmonary resistance > 4 Woods units were risk factors for overall mortality (p < 0.01). The number of unmet Fontan criteria was not significantly different in patients with and without postoperative late morbidity.
Conclusions:
The Fontan criteria are reliable predictors for mortality but have little predictive value for morbidity. Surviving patients who do not fulfil all criteria suggest that some criteria may need to be modified. Our limited data support a lower age limit of 2 instead of 4 years.