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Related Concept Videos

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
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Surgical options after Fontan failure.

Joost P van Melle1, Djoeke Wolff2, Jürgen Hörer3

  • 1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Heart (British Cardiac Society)
|April 15, 2016
PubMed
Summary
This summary is machine-generated.

Fontan takedown surgery for failing Fontan circulation carries a high early mortality risk. Fontan conversion and heart transplantation (HTX) offer similar survival rates for late Fontan failure.

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Area of Science:

  • Cardiology
  • Congenital Heart Surgery
  • Pediatric Cardiology

Background:

  • The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
  • Failing Fontan circulation presents a significant clinical challenge, necessitating further intervention.
  • Treatment options include Fontan takedown, Fontan conversion, and heart transplantation (HTX).

Purpose of the Study:

  • To compare the surgical outcomes of Fontan takedown, Fontan conversion, and HTX in patients with failing Fontan circulation.
  • To evaluate all-cause mortality and the need for re-transplantation as primary endpoints.

Main Methods:

  • A retrospective international multicenter study involving 22 European centers.
  • Data collected from 225 patients undergoing surgery for failing Fontan circulation.
  • Patients were categorized into Fontan takedown (n=38), Fontan conversion (n=137), or HTX (n=50).

Main Results:

  • Arrhythmia was the most common indication for surgery (43.6%), with differing indications across groups.
  • Fontan takedown was primarily for early failure, while conversion and HTX addressed late failure.
  • Early mortality was high for Fontan takedown (26%). Combined mortality/HTX rates were 44.7% for takedown, 26.3% for conversion, and 34.0% for HTX.
  • No significant difference in survival was observed between Fontan conversion and HTX (p=0.13).
  • Ventricular systolic dysfunction was a key predictor of mortality or re-transplantation in conversion and HTX groups.
  • Patients with valveless atriopulmonary connections benefited more from Fontan conversion.

Conclusions:

  • Fontan takedown surgery for failing Fontan circulation, especially in the early postoperative phase, is associated with high mortality.
  • Fontan conversion and heart transplantation demonstrate comparable long-term survival outcomes for patients with late Fontan failure.
  • Ventricular systolic dysfunction is a critical factor influencing outcomes in patients undergoing Fontan conversion or HTX.