[Fontan operation: short- and long-term risk factors]

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.