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[Comparative results of Fontan surgery in patients with and without hypoplastic left heart syndrome]
Pedro Becker Rencoret1, Santiago Besa Bandeira2, Sergio Riveros González2
1División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
The Fontan procedure shows similar survival rates for hypoplastic left heart syndrome (HLHS) and other single ventricle conditions. However, HLHS patients experienced a longer hospital length of stay post-surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Outcomes Research
Background:
- The Fontan procedure is a staged surgical protocol for univentricular heart disease.
- Numerous patients have undergone this procedure in recent years.
Purpose of the Study:
- To evaluate perioperative outcomes and survival in hypoplastic left heart syndrome (HLHS) patients after the Fontan procedure.
- To compare these outcomes with other types of univentricular heart disease.
Main Methods:
- A retrospective analysis of 102 patients undergoing the Fontan procedure (April 1996-March 2014).
- 25 patients had HLHS (Group I), and 77 had other univentricular heart disease (Group II).
- Analysis included survival, demographics, hemodynamics, morbidity, mortality, ventilation, drains, post-operative stay, isotopes score, pacemaker use, and Fontan takedown.
Main Results:
- Intraoperative mortality was 4% for HLHS and 7.8% for other univentricular types (P=.451).
- Hospital length of stay (LOS) was significantly longer for HLHS patients (17 days) compared to others (12 days) (P=.017).
- 8-year survival was 88% for both groups; 10-year survival was 81% for the non-HLHS group.
Conclusions:
- The Fontan procedure demonstrates comparable long-term survival for HLHS and other single ventricle anatomies.
- Patients with HLHS experienced similar mortality but a longer hospital LOS compared to other groups.
Introduction:
During the last few years, numerous patients with univentricular heart disease have been treated surgically with total cavopulmonary anastomosis according to a staged surgery protocol in our institution.
Objective:
To evaluate the perioperative outcomes and survival of patients with hypoplastic left heart syndrome (HLHS) after the Fontan procedure and compare them with other types of univentricular heart disease.
Patients And Method:
A total of 102 patients underwent a Fontan procedure between April 1996 and March 2014, 25 with HLHS (group I), and 77 patients with other types of univentricular heart disease (group II). Groups survival, demographics, hemodinamic studies, morbimortality, mechanical ventilation, surgical drains, post-operative stay, isotopes score, pacemaker use, and requiriment of Fontan takedown were analyzed.
Results:
Intraoperative mortality was 4% (n=1) for group I, and 7.8% (n=6) for group II (P=.451). A difference was only found in hospital length of stay (LOS), being 17 days (6-47) for group I and 12 days (5-103) for group II (P=.017). Mean follow-up was 4.24±2.08 years for group I, and 8.7±4.67 for group II. Survival rate at 8 years for both groups was 88%, and 81% at 10 years for group II.
Conclusions:
The Fontan procedure had similar mortality, but longer LOS, in patients with HLHS compared to those with another types of single ventricle anatomy. Long term survival was comparable between both groups.
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