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Fontan conversion: identifying the high-risk patient.

Sameh M Said1, Harold M Burkhart1, Hartzell V Schaff1

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|May 3, 2014
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Summary
This summary is machine-generated.

Fontan conversion candidates require careful selection. Older age and atrioventricular valve regurgitation increase Fontan conversion risks, suggesting cardiac transplantation may be better for some patients.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Patients with atriopulmonary Fontan connections often require conversion to total cavopulmonary connections due to arrhythmias or poor hemodynamics.
  • Identifying ideal candidates for Fontan conversion remains a challenge.

Purpose of the Study:

  • To evaluate outcomes of Fontan conversion procedures.
  • To identify predictors of mortality and factors influencing successful conversion.

Main Methods:

  • Retrospective analysis of 70 patients undergoing Fontan conversion between 1994 and 2011.
  • Analysis included patient demographics, diagnoses, pre-operative conditions (arrhythmias, valve regurgitation), surgical techniques, and outcomes.
  • Multivariate analysis was used to identify predictors of perioperative death.

Main Results:

  • Early mortality was 14%, with predictors including age >27 years, atrioventricular valve regurgitation, lack of arrhythmia surgery, and male sex.
  • Overall survival at 10 years was 67%.
  • 84% of patients achieved New York Heart Association class I or II post-conversion.

Conclusions:

  • Careful patient selection is crucial for successful Fontan conversion.
  • Concomitant arrhythmia surgery may improve survival outcomes.
  • Older age and atrioventricular valve regurgitation are associated with increased risk, and cardiac transplantation should be considered.