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Published on: May 2, 2025
Results of the Fontan operation with no early mortality in 248 consecutive patients
Edward Malec, Christoph Schmidt, Anja Lehner
1Department of Cardiothoracic Surgery, Division of Paediatric Cardiac Surgery, University Hospital Münster, Germany. Katarzyna.Januszewska@ukmuenster.de.
Insights
This study shows that a standardized perioperative protocol for the Fontan operation in children with single ventricle congenital heart defects leads to survival and minimal complications. Adhering to this protocol is key for successful outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Single Ventricle Physiology
Background:
- The Fontan operation is a critical palliative procedure for complex congenital heart defects.
- Modifications to the Fontan operation have improved outcomes for single ventricle physiology.
Purpose of the Study:
- To report outcomes of single ventricle patients undergoing the Fontan procedure.
- To evaluate a uniform perioperative management strategy for Fontan surgery.
Main Methods:
- 248 children with single ventricle underwent Fontan surgery between 2007-2015.
- Procedures included intra-atrial lateral tunnel (56%) and extracardiac modifications (77.4%).
- Operations were performed using normothermic cardiopulmonary bypass on a "beating heart" without aortic cross-clamp.
Main Results:
- 100% survival rate with all patients discharged home.
- 14.5% of patients were extubated in the operating room; mean ventilation time was 9.7 hours.
- Average hospital stay was 17.5 days; 4 transient seizures and 3 ischemic strokes occurred.
Conclusions:
- A consistent perioperative protocol is essential for minimizing mortality and complications.
- Standardized management strategies enhance safety and efficacy of the Fontan operation.
Background:
The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects.
Aim:
The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy.
Methods:
In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weighing 14.6 ± 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a "beating heart" without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 ± 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme.
Results:
All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 ± 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 ± 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke.
Conclusions:
Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation.
