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The Fontan procedure: contemporary techniques have improved long-term outcomes
Yves d'Udekem1, Ajay J Iyengar, Andrew D Cochrane
1Department of Cardiac Surgery, Royal Children's Hopital, Flemington Road, Parkville, Melbourne 3052, Victoria Australia. yves.dudekem@rch.org.au
Circulation
|September 14, 2007
Summary
Modified Fontan procedures, including lateral tunnel and extracardiac conduits, significantly improve long-term survival and reduce arrhythmias compared to the classical atriopulmonary connection. These advancements enhance outcomes for patients with complex congenital heart disease.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- The Fontan procedure is a palliative surgical intervention for complex single-ventricle congenital heart defects.
- Classical atriopulmonary connection is a traditional method, while lateral tunnel and extracardiac conduit modifications represent newer techniques.
Purpose of the Study:
- To compare the long-term outcomes of patients undergoing modified Fontan procedures (lateral tunnel and extracardiac conduit) versus the classical atriopulmonary connection.
- To identify risk factors influencing mortality and long-term success after Fontan procedures.
Main Methods:
- Retrospective analysis of 305 consecutive patients who underwent a Fontan procedure between 1980 and 2000.
- Comparison of survival rates, need for reoperation or transplantation, and incidence of arrhythmias between different surgical techniques.
- Identification of independent risk factors for mortality using statistical analysis.
Main Results:
- Overall hospital mortality was 3%, with no deaths occurring after 1990. Preoperative elevated pulmonary artery pressures and common atrioventricular valve were independent risk factors for mortality.
- Twenty-year survival was 84%. Fifteen-year survival was significantly higher for lateral tunnel (94%) compared to atriopulmonary connection (81%).
- Modified Fontan procedures were associated with decreased arrhythmia occurrence and improved freedom from supraventricular tachycardia (SVT). Extracardiac conduits showed no observed deaths, SVT, or failure in follow-up.
Conclusions:
- The Fontan procedure, while palliative, has seen improved outcomes due to better patient selection and surgical modifications.
- Lateral tunnel and extracardiac conduit modifications lead to reduced arrhythmias and delayed Fontan circulation failure.
- These advancements offer better long-term results for patients requiring Fontan palliation.