Evolution of staged approach for Fontan operation.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Physiology

Background:

• The Fontan operation has evolved, with pulmonary vascular resistance and ventricular function critical for predicting outcomes.
• The bidirectional cavopulmonary shunt has improved early and late results by controlling pulmonary blood flow and reducing ventricular overload.

Purpose of the Study:

• To evaluate the efficacy of a staged surgical approach for the Fontan procedure.
• To determine if this strategy prevents increased pulmonary vascular resistance and impaired ventricular function.

Main Methods:

• A staged approach involving initial palliative procedures (e.g., pulmonary artery banding, systemic pulmonary shunt) followed by a bidirectional cavopulmonary shunt.
• Simultaneous surgical repairs for associated cardiac anomalies were performed.
• Investigated outcomes in 18 patients with complex cardiac morphology unsuitable for biventricular repair.

Main Results:

• Twenty-six palliative procedures were performed with a 3.8% operative mortality.
• Fifteen patients subsequently underwent a modified Fontan operation with a 7.1% operative mortality.
• All patients awaiting Fontan completion were deemed suitable, indicating success in maintaining candidacy.

Conclusions:

• A staged surgical strategy for the Fontan procedure provides a favorable prognosis.
• This approach effectively manages complex congenital heart defects, optimizing candidates for the Fontan operation.