Fontan conversion with arrhythmia surgery

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Electrophysiology

Background:

• Hemodynamic abnormalities and refractory atrial arrhythmias are common complications after Fontan operations, leading to significant morbidity and mortality.
• Fontan conversion surgery aims to address these issues, but its efficacy with concomitant arrhythmia surgery requires further investigation.

Purpose of the Study:

• To review the experience with Fontan conversion and concomitant arrhythmia surgery in patients with late sequelae of the Fontan operation.
• To evaluate the safety, efficacy, and long-term outcomes of this combined surgical approach.

Main Methods:

• A retrospective review of 16 patients who underwent Fontan conversion and arrhythmia surgery between 1996 and 2004.
• Procedures included Fontan conversion to an extracardiac conduit or intracardiac lateral tunnel, with arrhythmia surgery (isthmus cryoablation or right-sided maze) and permanent pacemaker implantation in select cases.

Main Results:

• No mortality was observed. All patients improved to New York Heart Association functional class I or II.
• At a mean follow-up of 26.9 months, 16 patients maintained sinus rhythm, with only 2 experiencing transient, well-controlled atrial flutter. Two patients required permanent pacemakers during follow-up.

Conclusions:

• Fontan conversion combined with arrhythmia surgery and permanent pacemaker placement is a safe and effective strategy.
• This approach significantly improves functional class and demonstrates a low incidence of recurrent arrhythmias, with a high likelihood of requiring permanent pacemakers.