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Published on: December 11, 2017
[Fontan operation: short- and long-term risk factors]
Juan Calderón-Colmenero1, Samuel Ramírez, Regina Viesca
1Servicio de Cardiología Pediátrica, Instituto Nacional de Cardiología Ignacio Chavez, Tlalpan, Mexico, DF. juanecalderon@yahoo.com.mx
Insights
The Fontan procedure outcomes show a 71% survival rate at 55 months, with fenestration improving survival. Higher pulmonary and left atrial pressures increased mortality risk in pediatric heart patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Outcomes Research
Context:
- The Fontan procedure is a palliative surgery for complex single-ventricle congenital heart defects.
- Outcomes vary significantly based on patient selection, surgical technique, and post-operative management.
- Long-term data from specific centers are crucial for understanding the procedure's efficacy and complications.
Purpose:
- To evaluate the outcomes of the Fontan procedure in a cohort of pediatric patients.
- To identify risk factors associated with mortality and morbidity after Fontan palliation.
- To assess the impact of surgical variations, such as fenestration, on patient survival.
Summary:
- This retrospective study analyzed 81 patients (mean age 7 years) undergoing the Fontan procedure between 1989-2003.
- Overall mortality was 28.4%, with cardiogenic shock and arrhythmia as primary causes. Global survival reached 71% at 55 months.
- Fenestration was associated with a lower risk of death, while elevated pulmonary and left atrial pressures significantly increased mortality risk.
Impact:
- Findings highlight the importance of fenestration in Fontan physiology and identify critical hemodynamic parameters predicting adverse outcomes.
- The study provides valuable long-term data for centers performing Fontan procedures, informing surgical decision-making and patient management.
- Identifies key complications like arrhythmia and protein-losing enteropathy, guiding future research and clinical interventions for Fontan patients.
Abstract:
The purpose of this retrospective study was to determine the outcome of patients who underwent a Fontan procedure at National Heart Institute "Ignacio Chávez", Mexico, from January 1989 to December 2003. We had 81 patients with a mean age of 7 years old: 53 with tricuspid atresia, 14 with pulmonary atresia and intact septum, 11 with univentricular atrioventricular connection and 3 with Ebstein's anomaly. An intra-atrial tunnel was performed on 61 patients and an extracardiac conduit on the rest. Of all, 53 underwent a fenestration. The surgical mortality was 13% for tricuspid atresia and 25% for the other diseases. We had an overall mortality of 28.4%, being the main causes cardiogenic shock and arrhythmia. The global survival was 71% in 55 months of following. Takedown was indicated on 5 patients. The patients without fenestration showed to have 2.8 times more risk of death. The mean pulmonary artery pressure > or = 20 mmHg plus the left atrium pressure > or = 10 mmHg increased the death risk 3.6 times. Of the 52% who required readmission, the main causes were hemodynamical failure and infections. The more relevant complications were: arrhythmia (38%), protein-losing enteropathy (8%) and thrombotic cerebral events (1.4%).
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