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The modified Fontan operation for children less than 4 years old
D A Bartmus1, D J Driscoll, K P Offord
1Section of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905.
Journal of the American College of Cardiology
|February 1, 1990
Summary
Younger children undergoing the modified Fontan operation face poorer survival rates. Age under 4 years is an independent risk factor for adverse outcomes following this complex cardiac surgery.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- The modified Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
- Survival rates after the Fontan procedure have improved, but risk factors require ongoing investigation.
Purpose of the Study:
- To identify preoperative clinical and hemodynamic predictors of survival in patients undergoing the modified Fontan operation.
- Specifically, to evaluate the impact of early age at operation on outcomes.
Main Methods:
- Retrospective analysis of 500 patients who underwent the modified Fontan operation between 1973 and 1987.
- Multivariate analysis was used to assess the association between preoperative data and survival.
Main Results:
- Twenty patients (33 boys, 21 girls) were less than 4 years old at the time of surgery.
- Factors associated with poorer survival included absence of tricuspid atresia, asplenia, age less than 4 years, atrioventricular valve dysfunction, earlier surgical year, and specific hemodynamic parameters.
- Age less than 4 years was identified as an independent risk factor for poorer survival.
Conclusions:
- Younger age at the time of the modified Fontan operation is a significant independent risk factor for reduced survival.
- Preoperative clinical and hemodynamic assessment is crucial for identifying high-risk patients.