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Persistent fenestration may be a marker for physiologic intolerance after Fontan completion.

Yasuhiro Kotani1, Devin Chetan1, Arezou Saedi1

  • 1Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

The Journal of Thoracic and Cardiovascular Surgery
|August 20, 2014
PubMed
Summary

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Persistent fenestration after extracardiac Fontan surgery is linked to worse outcomes. Open fenestrations indicate physiologic intolerance, leading to higher rates of death, Fontan failure, and complications.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease Surgery
  • Fontan Procedure Outcomes

Background:

  • Evaluating medium-term implications of fenestration status after extracardiac Fontan surgery.
  • Fenestration is routinely created unless technically difficult.

Purpose of the Study:

  • To assess the impact of fenestration status on outcomes after extracardiac Fontan surgery.
  • Identify risk factors for mortality, Fontan failure, and complications.

Main Methods:

  • Retrospective analysis of 326 patients undergoing extracardiac Fontan between 1994-2012.
  • Included 300 patients discharged with an open fenestration.
  • Primary endpoints: death and Fontan failure; Secondary: complications like venovenous collaterals, protein-losing enteropathy, arrhythmias.

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Main Results:

  • 40 patients (13%) had open fenestration at 5.05 years median follow-up; 260 had it closed.
  • Open fenestration group showed significantly higher late deaths (P < .001), Fontan failure (P = .021), and complications (P = .011).
  • Open fenestration and indeterminate ventricular morphology were risk factors for death/Fontan failure.

Conclusions:

  • Persistent fenestration indicates physiologic intolerance and is associated with increased mortality and Fontan failure.
  • Pre-Fontan hemodynamic data may lack sufficient specificity for long-term management decisions regarding fenestration.
  • Consequences of fenestration status decisions may manifest years after the initial operation.