Predicting outcome after Fontan palliation: a single-centre experience, using simple clinical variables.

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Fontan procedure is the standard surgical treatment for single-ventricle congenital heart defects.
• While perioperative survival has improved, long-term Fontan circulation failure remains a significant clinical challenge.
• Understanding risk factors for late adverse outcomes is crucial for patient management.

Purpose of the Study:

• To characterize patients who have undergone the Fontan procedure.
• To identify simple risk factors associated with long-term outcomes after Fontan surgery.

Main Methods:

• Retrospective analysis of 73 patients with congenital heart defects who underwent the Fontan procedure.
• Data collection included patient demographics, procedure details, and long-term follow-up.
• Primary endpoint: composite of death, resuscitation, or heart transplantation.

Main Results:

• Tricuspid atresia was the most common diagnosis (41.1%).
• Ten patients (13.7%) reached the primary endpoint after a median follow-up of 16 years.
• NYHA class, atrioventricular valve regurgitation, ventricular function, oxygen saturation, and arrhythmia history were significant predictors of outcome.
• Intracardiac conduit, older age at Fontan procedure, and male gender were also associated with adverse outcomes.

Conclusions:

• Complications are frequent in the late post-Fontan period.
• Demographic and procedural factors are linked to adverse outcomes.
• Clinical and echocardiographic characteristics at follow-up showed the strongest correlation with outcomes.