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Related Experiment Videos

Surgical experience with the modified Fontan procedure.

J G Coles, S Kielmanowicz, R M Freedom

    Circulation
    |September 1, 1987
    PubMed
    Summary
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    Modifications to the Fontan procedure improved survival for patients with tricuspid atresia (TA). Incorporating the right ventricle showed a survival advantage in TA patients, while univentricular atrioventricular connection (UVH) and high atrial pressure were risk factors.

    Area of Science:

    • Pediatric Cardiology
    • Congenital Heart Disease Surgery
    • Cardiac Surgery

    Background:

    • The Fontan procedure is a palliative surgery for complex congenital heart defects.
    • Modifications aim to improve outcomes and reduce mortality.
    • Tricuspid atresia (TA) and univentricular atrioventricular connection (UVH) are common indications.

    Purpose of the Study:

    • To evaluate the outcomes of modified Fontan procedures over a 10-year period.
    • To identify risk factors for mortality and late cardiac symptoms.
    • To compare different surgical techniques for tricuspid atresia.

    Main Methods:

    • Retrospective analysis of 109 patients undergoing modified Fontan procedures.
    • Categorization by diagnosis: tricuspid atresia (TA), univentricular atrioventricular connection (UVH), and complex malformations (CM).

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  • Multivariate analysis to identify predictors of mortality and late symptoms.

    • Main Results:

    • Hospital mortality rates varied by diagnosis: 13.8% for TA, 28.9% for UVH, and 7.7% for CM.
    • Risk factors for death included UVH diagnosis, prior pulmonary artery banding (PAB), and elevated postrepair right atrial pressure.
    • Incorporating the right ventricle in TA patients was associated with improved survival compared to direct atriopulmonary connection.

    Conclusions:

    • Modified Fontan procedures incorporating the right ventricle offer a survival advantage in tricuspid atresia.
    • Univentricular atrioventricular connection, prior PAB, and elevated right atrial pressure are significant risk factors for adverse outcomes.
    • Right atrial pressure predicts serious late cardiac symptoms, highlighting its importance in long-term management.