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Single-stage versus two-stage modified Fontan procedure
Sukasom Attanavanich1, Alisa Limsuwan, Suthep Vanichkul
1Cardiovascular & Thoracic Unit, Division of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. rasac@mucc.mahidol.ac.th
Insights
The two-stage modified Fontan procedure offers superior outcomes compared to the single-stage approach, significantly reducing operative mortality and improving patient condition in complex pediatric heart surgeries.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- The modified Fontan procedure is a critical intervention for complex single-ventricle congenital heart defects.
- Comparing single-stage versus two-stage approaches is essential for optimizing surgical outcomes.
Purpose of the Study:
- To compare the clinical outcomes of single-stage and two-stage modified Fontan procedures.
- To determine the potential superiority of one surgical approach over the other.
Main Methods:
- Retrospective analysis of 28 pediatric patients undergoing modified Fontan procedures between October 1995 and October 2005.
- Categorization into single-stage (15 patients) and two-stage (13 patients) groups.
- Evaluation of pulmonary artery growth and clinical parameters in the two-stage group.
Main Results:
- Operative mortality was significantly lower in the two-stage group (0%) compared to the single-stage group (26.6%).
- The two-stage approach, often involving a bidirectional Glenn shunt, led to decreased cyanosis and volume overload.
- No significant difference in pulmonary artery growth was observed between the groups.
- Older children undergoing the two-stage procedure showed better outcomes, including improved oxygen saturation and less atrioventricular valve regurgitation.
Conclusions:
- The two-stage modified Fontan procedure is associated with better clinical outcomes and reduced mortality in pediatric patients.
- Patient age and staged surgical approach are critical factors influencing the success of the modified Fontan procedure.
- The bidirectional Glenn shunt as a preliminary step may offer benefits in managing cyanosis and volume overload.
Abstract:
We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.
