Results of the modified Fontan procedure are not related to age at operation

The modified Fontan procedure represents the final stage for the palliation of hearts with single-ventricle physiology. Different opinions exist regarding the optimal timing of the operation, with most centres advocating early intervention. By contrast, over the past decade, we have progressively increased the age at Fontan operation with the aim to potentially delay the onset of late Fontan failure, and to possibly use larger extracardiac conduits. We retrospectively reviewed our surgical experience with Fontan operation, to understand the impact of this strategy on morbidity and mortality.

Between 1990 and 2008, 65 patients underwent a modified Fontan operation at our institution (extracardiac conduit in 52 and lateral tunnel in 13). The median age at operation in our series was 7.3 years (range: 2.2-15.8 years) and this value was used to divide the study cohort into two groups. Group A (n=28) included patients with an age at Fontan operation 7 years of age. Preoperative characteristics, intra-operative data and short- and medium-term results were assessed.

No differences in baseline characteristics, morbidity and mortality were evident between groups. Hospital mortality was 0% in group A and 5.4% (2/37) in group B (p=0.5). Prolonged pleural effusions were present in eight patients in group A (29%) and seven in group B (19%, p=0.39). After a mean follow-up of 5.7+/-5.4 years (range: 0.3-18 years), the overall mortality of group A (1/28) was similar to that of group B (2/37) (3.6% vs 5.4%, p=0.999). The incidence of arrhythmias, protein-losing enteropathy, Fontan take down and re-operation were not different between the two groups.

The modified Fontan operation can be performed safely in older patients without affecting operative and medium-term follow-up results. Postponing the extracardiac Fontan operation may have the advantage of the use of a larger conduit.