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Evolution of the Fontan procedure in a single center
K Bando1, M W Turrentine, H J Park
1Section of Cardiothoracic Surgery, Riley Hospital for Children, Indianapolis, Indiana, USA. kobando@hsp.ncvc.go.jp
The Annals of Thoracic Surgery
|July 13, 2000
Summary
Modified Fontan operations show excellent outcomes for single ventricle patients. Careful patient selection for staged, fenestrated, or completed Fontan procedures minimizes mortality and improves long-term survival.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Physiology
Background:
- Single ventricle variants require complex surgical palliation.
- The Fontan operation and its modifications are key surgical strategies.
Purpose of the Study:
- To compare outcomes of different Fontan operation modifications.
- Evaluate the efficacy of staged, fenestrated, and completed Fontan procedures.
Main Methods:
- Retrospective analysis of 129 patients undergoing modified Fontan operations.
- Multivariate analysis of preoperative risk factors and operative results.
Main Results:
- Overall early and late mortality rates were 5.4% and 0.8%.
- Introduction of hemi-Fontan and fenestrated Fontan reduced takedowns in high-risk patients.
- Low incidence of atrial dysrhythmias (4.7%) and stroke (2.3%); Down's syndrome predicted mortality.
Conclusions:
- Patient selection is crucial for successful Fontan modifications.
- Modified Fontan procedures yield excellent early and late survival.
- Midterm functional outcomes are favorable with low complication rates.