Can Fontan Conversion for Patients Without Late Fontan Complications be Justified?

Fontan conversion from a classic Fontan operation such as atriopulmonary connection to total cavopulmonary connection with antiarrhythmia surgery is currently not indicated for patients without any late Fontan complications.

Thirty-two consecutive patients who underwent Fontan conversion between 1991 and 2012 were divided into 2 groups by the presence (group 1: n = 25, atrial tachyarrhythmia [AT] in 24 and protein-losing enteropathy in 4) or absence (group 2: n = 7) of late Fontan complications, and the surgical outcomes were retrospectively compared. During the study period, heart transplantation was not indicated for patients with failed Fontan circulation in Japan.

The mean follow-up period was 6.2 ± 3.7 years in group 1 and 4.6 ± 3.8 years in group 2 (p = 0.29). Overall survival rate at 10 years after conversion was 71% in group 1 and 100% in group 2 (p = 0.12). Whereas preoperative AT and protein-losing enteropathy remained after conversion in 8 patients (33%) and all 4 patients (100%), respectively, in group 1, neither were observed in group 2. Cardiac catheter examinations presurgery (n = 32) at 1 year (n = 28), and at 5 years (n = 19) after the conversion showed that the cardiac index significantly and similarly improved in both groups after the conversion, and maintained for at least 5 years.

Cardiac output similarly improved after Fontan conversion in patients with or without late Fontan complications by elimination of venous blood congestion on Fontan pathways. Although long-term follow-up is mandatory, newly onset AT was not observed after prophylactic Fontan conversion.