Fontan type operation for complex lesions. Surgical considerations to improve survival

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Physiology

Background:

• The Fontan operation is a palliative procedure for complex single-ventricle physiology.
• Patients undergoing the Fontan operation often have associated complex cardiac lesions requiring staged palliation.
• Outcomes can be influenced by pre-operative conditions and surgical techniques.

Purpose of the Study:

• To evaluate outcomes of the Fontan operation in patients with complex lesions.
• To identify factors influencing post-operative complications and long-term survival.
• To propose modifications to improve Fontan operation results.

Main Methods:

• Retrospective analysis of 49 patients undergoing Fontan operation for complex lesions.
• Division into groups based on pre-operative pulmonary blood flow (pulmonary artery banding vs. pulmonic stenosis).
• Comparison of post-operative outcomes including effusions, right atrial pressure, hospital stay, and mortality.

Main Results:

• Patients with prior pulmonary artery banding (Group I) had higher rates of effusions, elevated right atrial pressure, and longer hospital stays compared to those with pulmonic stenosis (Group II).
• Complications included atrioventricular valve patch disruption and conduit occlusion.
• Fontan takedown was required in 8% of patients due to persistent low cardiac output, with 50% mortality in this subgroup.

Conclusions:

• Early Fontan takedown for persistent low cardiac output may improve outcomes.
• Interrupted suture technique for atrioventricular valve closure and avoidance of valved conduits are recommended.
• A preliminary Glenn shunt may benefit patients with pulmonary artery banding and/or subaortic stenosis.