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Surgical evaluation of the modified Fontan procedure
J Weipert1, H Meisner, C Haehnel
1Klinik für Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum München.
Insights
The Fontan operation is an accepted surgical method for complex congenital heart defects, offering an 83.8% ten-year survival rate. Early mortality is lower in tricuspid atresia patients, while complex malformations and single ventricles carry higher risks.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- The Fontan operation is a palliative procedure for complex cyanotic heart disease.
- Patient selection and surgical modifications influence outcomes.
Purpose of the Study:
- To evaluate the outcomes of the Fontan operation in a diverse patient cohort.
- To identify risk factors for mortality and complications.
Main Methods:
- Retrospective review of 152 patients undergoing Fontan operation between 1980 and 1990.
- Analysis of patient groups including tricuspid atresia, single ventricle, and complex malformations.
- Comparison of outcomes based on prior palliative procedures and surgical modifications.
Main Results:
- Overall ten-year survival rate was 83.8%.
- Tricuspid atresia patients had significantly lower early mortality (8.5%) compared to complex malformations (28.2%) and single ventricle (19.4%).
- Fontan-Bjoerk modification was associated with reduced pleural effusion (p < 0.05).
Conclusions:
- Modified Fontan procedures offer an accepted surgical option for complex cardiac malformations.
- Patient-specific factors, particularly the underlying cardiac defect, significantly impact survival.
- Surgical modifications like the Fontan-Bjoerk procedure can improve postoperative outcomes.
Abstract:
From 1980 to 1990 152 patients underwent Fontan operation at our institution. The following patient groups were identified: 1. patients with tricuspid atresia (n = 82, 54.0%); 2. patients with single ventricle (n = 31, 20.3%); 3. patients with a wide variety of non correctable, complex cardiac malformations (n = 39, 25.7%). In 27.0% of the patients a primary Fontan operation was performed. 45.0% of the patients received a previous shunt to increase pulmonary blood flow and in 29.4% of the patients a pulmonary artery band was placed to reduce pulmonary flow. Overall mortality was not significantly different in patients with previous palliative procedures (19.4%, n = 18) as compared to 17.4% (n = 6) in patients with primary Fontan operation. Risk of death was high in the group with complex cardiac malformations (28.2%, n = 11) and in patients with single ventricle (19.4%, n = 6). Early mortality was considerably less in patients tricuspid atresia (8.5%, n = 7). Postoperatively patients with incorporation of the residual right ventricular chamber and pulmonary valve (Fontan-Bjoerk) showed a significant (p less than 0.05) lower incidence of pleural effusion as compared to patients with other modifications of the Fontan procedure. Actuarial survival rate of all patients is 83.8 +/- 3.1% (mean +/- SEM) at ten years. The modified Fontan procedures are providing an accepted surgical method for patients with otherwise non correctable cardiac malformations.