12th Annual C. Walton Lillehei Memorial Lecture in Cardiovascular Surgery: Fontan conversion--the Chicago experience

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery

Background:

• This study evaluated the outcomes of 133 Fontan conversions combined with arrhythmia surgery performed between 1994 and 2011.
• The patient cohort primarily consisted of individuals with tricuspid atresia or double-inlet left ventricle who had previously undergone an atriopulmonary connection.

Discussion:

• The procedure demonstrated a low operative mortality rate of 1.5% and a mean length of stay of 14 days.
• Late cardiac transplantation was required in 6% of patients.
• A significant finding was the 85% freedom from arrhythmia recurrence at the 10-year mark.

Key Insights:

• Fontan conversion with arrhythmia surgery is a viable option for select patients with a functionally univentricular heart and prior atriopulmonary connection.
• The intervention leads to substantial improvements in quality of life.
• Long-term arrhythmia control is achievable, with a high success rate in preventing recurrence.

Outlook:

• Further research could explore long-term outcomes beyond 10 years and identify specific patient subgroups who benefit most.
• Investigating alternative surgical approaches or adjunctive therapies may further enhance outcomes.
• This approach represents a critical advancement in managing complex congenital heart disease.