Outcomes after the Fontan procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Intensive Care Medicine

Background:

• Significant advancements in pediatric cardiac care have improved survival rates for infants with critical congenital heart disease.
• The single-ventricle population has particularly benefited from staged palliation, including the Fontan procedure, leading to increased survival.
• Recent studies highlight progressive improvements in outcomes following the Fontan procedure due to surgical and technological innovations.

Purpose of the Study:

• To review recent outcomes and persistent morbidities in single-ventricle patients after Fontan completion.
• To assess the impact of surgical innovations and technological advancements on Fontan procedure outcomes.

Main Methods:

• Review of recent studies focusing on outcomes after the Fontan procedure.
• Analysis of surgical innovations (lateral tunnel, extracardiac modifications, fenestration) and technological improvements (modified ultrafiltration).

Main Results:

• Improved early postoperative survival and intermediate/late outcomes reported in recent studies.
• Surgical and technological advancements have contributed to better results after Fontan completion.
• Despite improvements, significant morbidities remain, impacting long-term patient health.

Conclusions:

• While the Fontan procedure has seen survival improvements, persistent morbidities necessitate ongoing research and management strategies.
• Key long-term complications include cardiac dysfunction, hemodynamic abnormalities, reduced exercise capacity, arrhythmias, protein-losing enteropathy, growth issues, and cognitive deficits.