Early mortality and concomitant procedures related to Fontan conversion: Quantitative analysis.

Area of Science:

• Pediatric Cardiology
• Adult Congenital Heart Disease
• Cardiac Surgery

Background:

• The Fontan palliation, a surgical procedure for single-ventricle congenital heart defects, is linked to long-term complications.
• Fontan conversion aims to mitigate these issues by updating circulatory physiology.
• However, early mortality data for Fontan conversion is limited and inconsistent.

Purpose of the Study:

• To systematically review and analyze early mortality rates associated with Fontan conversion operations.
• To identify factors influencing outcomes, such as patient demographics and surgical interventions.

Main Methods:

• A comprehensive literature search of original articles published between 1994 and 2016 was conducted.
• Data from 37 studies (1182 patients) were analyzed, focusing on demographics, arrhythmia surgery, pacemaker implantation, and early mortality.
• Meta-analysis using random and fixed effect models was employed to estimate overall mortality.

Main Results:

• Fontan conversion was performed at an average age of 21.6 years, with 71.6% undergoing concomitant arrhythmia surgery and 59.3% receiving pacemakers.
• Early mortality rates varied widely (0-21%), with pooled estimates of 5.3% (random effects) and 6.2% (fixed effects).
• Younger patients (average age <20 years) and those treated at high-volume centers showed significantly lower mortality (4.6% and 1.4%, respectively).

Conclusions:

• Fontan conversion is associated with substantial early mortality, underscoring the need for careful patient selection.
• Outcomes are center-dependent, with highly experienced centers demonstrating better results.
• Combining Fontan conversion with arrhythmia surgery, particularly in younger patients referred to experienced centers, may reduce early mortality.