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Published on: May 2, 2025
Long-term results of Fontan procedure in 43 patients
Barbara Lubiszewska1, Jacek Rózański, Marcin Demkow
1First Department of Coronary Artery Disease, National Institute of Cardiology, Warsaw, Poland.
Insights
The modified Fontan procedure offers improved long-term survival and good quality of life for patients with univentricular heart conditions, including tricuspid atresia. Most survivors achieve functional New York Heart Association class I or II status.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Adult Congenital Heart Disease
Background:
- The Fontan operation addresses systemic hypoxemia and ventricular overload in complex heart conditions.
- Long-term outcomes regarding systemic venous and atrial hypertension post-Fontan were initially uncertain.
Purpose of the Study:
- To evaluate late mortality and current clinical status of patients who underwent a modified Fontan procedure.
- To assess outcomes in patients with tricuspid atresia and other forms of univentricular heart disease.
Main Methods:
- Retrospective review of clinical records for 43 early survivors of the modified Fontan procedure.
- Determination of patient outcomes, late mortality rates, and current clinical status.
Main Results:
- Overall late survival reached 76.8% over a 20-year period.
- Improved surgical techniques and exclusion of homografts reduced reoperation and complication rates.
- Late mortality was primarily associated with atrioventricular valve dysfunction and replacement; 97% of survivors are in NYHA class I or II.
Conclusions:
- A 20-year experience with the modified Fontan procedure shows improved outcomes for tricuspid atresia and univentricular hearts.
- Most survivors lead good quality lives into adulthood.
- The procedure facilitates long-term functional recovery in complex pediatric cardiac patients.
Background:
The Fontan operation eliminates the systemic hypoxemia and ventricular volume overload characteristic of prior forms of palliation, however, late outcome of systemic venous and right atrial hypertension were unknown when the procedure was initially proposed.
Aim:
We assessed the late mortality and the present clinical status atresia and other forms of univentricular heart who had modified Fontan procedure performed between 1981 and 1998, and survived early perioperative period.
Methods:
We reviewed the clinical records of 43 early survivors of the modified Fontan procedure. Patients' outcome and late mortality rates were determined and present clinical status was ascertained in all patients.
Results:
Late overall survival was 76.8%. Reoperation and late complication rates steadily declined according to surgery modification and homografts exclusion. Late mortality was increased only in patients with important atrio-ventricular valve dysfunction and valve replacement. Ninety seven percent of surviving patients are currently in New York Heart Association class I or II.
Conclusions:
Our 20-year experience with modified Fontan procedure for tricuspid atresia and various forms of univentricular heart has resulted in improved outcome with most survivors now leading lives of good quality into adulthood.