Surgical reinterventions following the Fontan procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Cardiac Reconstructive Procedures

Background:

• The Fontan procedure is a critical palliative surgery for functional single ventricle.
• While Fontan outcomes have improved, some patients require further cardiac interventions.
• Data on the outcomes of these reinterventions are limited.

Purpose of the Study:

• To analyze the outcomes of patients undergoing reoperations after a Fontan procedure.
• To identify indications and types of reinterventions performed.
• To assess morbidity and mortality associated with these subsequent surgeries.

Main Methods:

• Retrospective review of the Cardiac Surgery and Cardiac Intensive Care Unit databases at The Children's Hospital of Philadelphia.
• Inclusion criteria: patients who underwent cardiac surgery after a Fontan operation between January 1, 1995, and December 31, 2001.
• Data collected included types of procedures, indications, and patient outcomes.

Main Results:

• 123 procedures were performed in 71 patients, with a median time of 3.6 years from Fontan to reoperation.
• Common indications included arrhythmia, cyanosis, failing Fontan circulation, and atrioventricular valve regurgitation.
• Procedures varied, with pacemaker insertion (48%) being most frequent. Hospital mortality was highest for cardiac transplantation (44%).

Conclusions:

• Surgical reinterventions after the Fontan procedure are necessary for various reasons impacting Fontan circulation.
• Most reinterventions can be performed with acceptable morbidity and mortality.
• Cardiac transplantation following a Fontan procedure is associated with poor survival rates.