Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and...

Area of Science:

• Congenital Heart Surgery
• Pediatric Cardiology
• Cardiovascular Research

Background:

• The extracardiac Fontan operation is a complex surgical procedure for single-ventricle physiology.
• Understanding long-term sequelae is crucial for patient management.

Purpose of the Study:

• To determine the prevalence of specific complications after extracardiac Fontan operations.
• To evaluate the efficacy of different conduit materials and identify risk factors for adverse outcomes.

Main Methods:

• Studied 65 patients undergoing extracardiac Fontan operation (ages 3-31).
• Conduits were polytetrafluoroethylene (n=50) or "viable" in situ pericardium (n=15).
• Assessed mortality, Fontan failure, ventricular function, arrhythmias, thromboembolism, and growth via serial echocardiograms, radionuclide studies, and cardiac catheterization.

Main Results:

• Operative mortality was 3%; conduit thrombosis occurred in 4.6%.
• Supraventricular arrhythmias were observed in 9.2% perioperatively and 4.7% late postoperatively.
• Risk factors for arrhythmias included ventricular dysfunction, heterotaxy, venous anomalies, and prior Glenn operation. Actuarial survival at 79 months was 96.9%.

Conclusions:

• Supraventricular arrhythmias are more frequent in patients with heterotaxy, bilateral vena cavae, ventricular dysfunction, or undergoing completion Fontan.
• Viable pericardial tunnels may reduce arrhythmias, eliminate anticoagulation needs, and support growth in select patients.