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High frequency of arrhythmias after Fontan operation indicates earlier anticoagulant therapy
S Sugimoto1, N Takagi, Y Hachiro
1Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Cho-ku, Sapporo 060-8556, Japan. satoru-sugimoto@hokkaido.med.or.jp
Insights
Long-term survivors of modified Fontan operations face significant late morbidity, primarily from arrhythmias. Early anticoagulation is recommended to manage thrombogenic risks in these patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Modified Fontan operations have increased long-term survival.
- Late morbidity following these procedures is becoming more evident.
Purpose of the Study:
- To evaluate the late sequelae in long-term survivors of modified Fontan operations.
Main Methods:
- Retrospective analysis of 14 long-term survivors who underwent modified Fontan operations between 1981-1990.
- Assessment of survival rates, morbidity, and quality of life at least 10 years post-operation.
Main Results:
- Early mortality was 17.6%.
- 10-year survival rate was 79% after excluding early deaths.
- Arrhythmias, particularly atrial fibrillation/flutter, were the primary cause of late morbidity, with a 10-year arrhythmia-free rate of 50%.
- Quality of life was generally good (NYHA Class I/II), but arrhythmias posed a significant threat.
Conclusions:
- Long-term survivors require vigilant management of arrhythmias.
- Treatment strategies include anti-arrhythmics, anticoagulants, catheter ablation, or conversion to total cavopulmonary connection.
- Anticoagulants should be considered early postoperatively due to unknown timing of thrombogenic arrhythmias.
Background:
As patients began to survive for longer periods following modified Fontan operations (conventional atrio-pulmonary connection), the late morbidity after this procedure became increasingly apparent. The purpose of the present study was to evaluate late sequelae of modified Fontan operations in long-term survivors (n=14) at our institute.
Methods And Results:
The cohort consisted of patients who underwent a modified Fontan operation between 1981 and 1990. Thus, all patients were examined at least 10 years postoperatively in this study. Early mortality, within 30 days of the operation, was 17.6% (three of 17 patients died from low output syndrome). Excluding these early deaths, the cumulative survival rate at 5 and 10 years was 100 and 79%, respectively. Arrhythmias including atrial fibrillation or flutter were the main late causes of morbidity. The arrhythmia-free rate at 5 and 10 years was 77 and 50%, respectively. Although the quality of life was considered good because all patients (n=11) who survived for 10 years or more were in class I or II according to the New York Heart Association classification, most of them in fact suffered from potentially life-threatening arrhythmias.
Conclusions:
Meticulous attention to and utilization of established treatment strategies for arrhythmias including anti-arrhythmics, anticoagulants, catheter ablation or re-operation converting the circulation to the total cavopulmonary connection must be considered in long-term survivors following the modified Fontan operation. The fact that no one knows when the thrombogenic arrhythmias occur suggests anticoagulants should be initiated in the early postoperative period.