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Intermediate outcomes after the Fontan procedure in the current era
Michael E Mitchell1, Richard F Ittenbach, J William Gaynor
1Department of Surgery, Division of Cardiothoracic Surgery, University of Louisville, Louisville, Ky 40202, USA. mmitchell@ucsamd.com
The Journal of Thoracic and Cardiovascular Surgery
|January 10, 2006
Summary
The Fontan operation shows acceptable intermediate survival outcomes, with most children experiencing good overall health and functional status despite common cardiac rehospitalizations. This study highlights key outcomes for survivors of this complex congenital heart surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Fontan Procedure Outcomes
Background:
- The Fontan operation is a palliative surgical procedure for complex single-ventricle congenital heart defects.
- Understanding intermediate outcomes is crucial for managing patients post-Fontan procedure.
- This study focuses on outcomes in the current era of surgical management.
Purpose of the Study:
- To investigate the intermediate outcomes following the Fontan operation.
- To assess survival, rehospitalization rates, and functional status in Fontan survivors.
Main Methods:
- Cross-sectional analysis of 310 survivors of the Fontan procedure (1992-1999).
- Review of medical records and administration of customized caregiver questionnaires.
- Outcome variables included mortality, rehospitalization, health perception, school performance, and functional status.
Main Results:
- Kaplan-Meier estimates showed 93.9% freedom from death or transplantation at 8 years post-Fontan.
- 54.2% of children experienced at least one cardiac-related rehospitalization.
- At a median follow-up of 8.6 years, 94.6% of guardians reported excellent/good overall health, with most reporting minimal to moderate physical limitations.
Conclusions:
- The Fontan operation demonstrates acceptable intermediate survival rates in this cohort.
- Cardiac-related rehospitalization is frequent, but most patients exhibit good overall health and functional status.
- A significant proportion of patients had hypoplastic left heart syndrome, underscoring the complexity of this population.