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The mid-term surgical results of Fontan conversion with antiarrhythmia surgery
Woo Sung Jang1, Woong-Han Kim, Kwangho Choi
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Insights
Fontan conversion surgery with antiarrhythmia procedures and permanent pacemaker implantation safely improves clinical outcomes and arrhythmias in patients with previous Fontan operations. This approach enhances functional class and reduces arrhythmia burden, offering a viable solution for long-term management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pediatric Cardiology
Background:
- The Fontan operation, a palliative procedure for single-ventricle congenital heart disease, can lead to long-term complications including arrhythmias and functional decline.
- Arrhythmias, such as atrial flutter and fibrillation, are common sequelae of the Fontan circulation.
- Re-intervention, including Fontan conversion, is sometimes necessary to address these complications and improve patient outcomes.
Purpose of the Study:
- To evaluate the mid-term surgical outcomes of Fontan conversion combined with antiarrhythmia surgery and permanent pacemaker implantation.
- To assess the impact of these combined interventions on clinical status, functional class, and arrhythmia burden.
- To determine the safety and efficacy of this approach in managing complications of the Fontan procedure.
Main Methods:
- A retrospective analysis of 31 patients who underwent Fontan conversion between January 1996 and November 2011.
- Fontan conversion involved changes in atriopulmonary connection (APC) to extracardiac conduit (ECC) or lateral tunnel configurations.
- Patients received concomitant antiarrhythmia surgery (cryoablation or maze procedures) and permanent pacemaker implantation as indicated.
Main Results:
- Eighty-three-nine percent of patients required antiarrhythmia surgery, and 74.2% received a permanent pacemaker.
- A statistically significant improvement in New York Heart Association functional class was observed post-surgery (1.77 to 1.13, P = 0.001).
- Actuarial 5-year survival was 90.0%, with freedom from arrhythmia at 5 years at 91.8%. Normal sinus rhythm was achieved or maintained in 38.7% of patients.
Conclusions:
- Fontan conversion combined with antiarrhythmia surgery and permanent pacemaker implantation is a safe and effective strategy.
- This combined approach leads to significant improvements in clinical outcomes and a reduction in arrhythmia burden.
- The procedure offers a valuable option for managing complex Fontan-associated complications, enhancing long-term quality of life.
Objectives:
We investigated the mid-term surgical results of Fontan conversion with antiarrhythmias surgery and permanent pacemaker implantation, which were complications of a previous Fontan operation.
Methods:
From January 1996 to November 2011, we performed Fontan conversion in 31 of 260 Fontan cases (M:F = 17:14, mean age = 19.0 years). The Fontan conversion from atriopulmonary connection (APC) to extracardiac conduit (ECC) was performed in 20 patients, APC to lateral tunnel in 5 and lateral tunnel to ECC in 6. The clinical outcomes and improvements of arrhythmias were analysed. The types of arrhythmias included atrial flutter in 21 patients, atrial fibrillation with flutter in 4 patients and junctional tachycardia in 3 patients.
Results:
Twenty-six patients (83.9%) required antiarrhythmia surgery (isthmus cryoablation = 9, right-sided maze = 13, bilateral maze = 4). In addition, 23 patients (74.2%) received a permanent pacemaker. The New York Heart Association functional class (NYHA Fc) was statistically improved after the surgery during the 6.5-year median follow-up duration (preoperative NYHA Fc = 1.77, postoperative NYHA Fc = 1.13, n = 15, P = 0.001). There were 4 late mortalities. Actuarial 5-year survival was 90.0 ± 5.5%. And freedom from arrhythmia was 91.8 ± 5.5%, at 5 years. Normal sinus rhythm was maintained in 12 patients (38.7%), pacing-dependent rhythm in 10 patients (32.3%) and intermittent pacing-dependent rhythm in 4 patients (12.9%).
Conclusions:
Fontan conversion with antiarrhythmia surgery and permanent pacemaker implantation is safe and improves the clinical outcome and arrhythmias.
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