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Analysis of the risk factors for early failure after extracardiac Fontan operation
Stanislav Ovroutski1, Christian Sohn, Payman Barikbin
1German Heart Institute Berlin, Berlin, Germany. ovroutski@dhzb.de
Insights
Patients with heterotaxia, systemic right ventricle, or low arterial oxygen saturation face high risks for early Fontan failure after extracardiac Fontan operation, necessitating specialized care.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- The extracardiac Fontan operation is a critical procedure for single-ventricle congenital heart disease.
- Early morbidity following this surgery poses significant challenges to patient outcomes.
Purpose of the Study:
- To identify preoperative and intraoperative risk factors associated with severe morbidity in the early period after extracardiac Fontan operation.
- To inform management strategies for high-risk pediatric patients undergoing this complex cardiac surgery.
Main Methods:
- Analysis of 140 patients undergoing extracardiac Fontan operation between November 1995 and May 2011.
- Evaluation of preoperative factors including systemic right ventricle, heterotaxia, low arterial oxygen saturation, and adult age.
- Assessment of intraoperative factors such as prolonged cardiopulmonary bypass time and cardioplegia use.
Main Results:
- Heterotaxia, systemic right ventricle morphology, and low preoperative arterial oxygen saturation were identified as independent risk factors for prolonged inotropic support and mechanical ventilation.
- These factors, along with adult age and prolonged bypass time, also increased risks for acute renal failure and prolonged pleural effusions.
- Cardioplegia use was associated with increased risks of prolonged inotropic support, mechanical ventilation, acute renal failure, and tachyarrhythmias.
Conclusions:
- Heterotaxia, systemic right ventricle, and low preoperative arterial oxygen saturation are significant risk factors for early Fontan failure.
- Patients with these conditions require tailored management protocols to optimize outcomes after extracardiac Fontan operation.
Background:
We analyzed risks for severe morbidity in the early period after extracardiac Fontan operation.
Methods:
Between November 1995 and May 2011, 140 patients (median age, 3.8 years) underwent extracardiac Fontan operation. We assumed as preoperative risk factors systemic right ventricle (n=51), heterotaxia (n=25), arterial oxygen saturation less than 75% (n=22), and adult age (>16 years, n=20) at time of surgery. Prolonged cardiopulmonary bypass time of longer than 120 minutes (n=30) and use of cardioplegia (n=26) were analyzed as intraoperative risks.
Results:
Heterotaxia was revealed as a risk factor for postoperative prolonged inotropic support, acute renal failure, prolonged mechanical ventilation, prolonged pleural effusions, and tachyarrhythmias. With the exception of pleural effusions, the same held true for right ventricle morphology. Low preoperative arterial oxygen saturation was found to be associated with an increased risk of prolonged inotropic support, acute renal failure, and prolonged mechanical ventilation. Adult age was identified as a risk factor for acute renal failure. Of the intraoperative factors, prolonged cardiopulmonary bypass time longer than 120 minutes was a risk factor for acute renal failure and prolonged pleural effusions, whereas use of cardioplegia was associated with an increased risk of prolonged inotropic support, prolonged mechanical ventilation, acute renal failure, and tachyarrhythmias. Multivariate analysis demonstrated heterotaxia, right ventricular morphology, and low preoperative arterial oxygen saturation to be independent risk factors for postoperative prolonged inotropic support and prolonged mechanical ventilation.
Conclusions:
Patients with heterotaxia, systemic right ventricle, and low preoperative arterial oxygen saturation are still at high risk for early Fontan failure after extracardiac Fontan operation and require special management for optimal outcome.
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