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30-year experience of Fontan surgery: single-centre's data.
Laurynas Bezuska1, Virgilijus Lebetkevicius2,3, Rita Sudikiene2,3
1Department of Cardiovascular Medicine, Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania. laurynas.bezuska@gmail.com.
Journal of Cardiothoracic Surgery
|August 11, 2017
Summary
This study of 80 Fontan procedure patients over 30 years shows improved outcomes, especially with extra-cardiac total cavopulmonary connection (TCPC) using expanded polytetrafluoroethylene conduits, offering excellent mid-term survival.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The Fontan procedure, first performed in 1968, has undergone numerous modifications.
- Increasing survival rates necessitate understanding long-term clinical status and morbidity in adult Fontan patients.
Purpose of the Study:
- To evaluate surgical experience and outcomes of Fontan procedures over a 30-year period.
- To compare the efficacy of different Fontan procedure variations.
Main Methods:
- Retrospective analysis of 80 patients undergoing Fontan surgery between January 1985 and January 2015.
- Categorization into four groups based on surgical technique: atrio-pulmonary Fontan, intra-atrial lateral tunnel TCPC, extra-cardiac TCPC with aortic homograft, and extra-cardiac TCPC with expanded polytetrafluoroethylene (ePTFE) conduit.
- Assessment of early and late mortality, long-term survival, postoperative morbidity, and reoperation rates.
Main Results:
- Mean follow-up was 7.4 years. Fifteen-year survival rates varied: 42% (Group I), 50% (Group II), 83% (Group III), and 94% (Group IV).
- Early complications included bleeding, Fontan circulation takedown, and acute heart failure. Late morbidities comprised arrhythmias, protein-losing enteropathy, thromboembolism, and tracheal stenosis.
- 18% of patients required redo Fontan procedures.
Conclusions:
- Fontan completion results have improved over time.
- Extra-cardiac TCPC with ePTFE conduits demonstrated excellent mid-term outcomes.
- Long-term follow-up remains crucial for assessing the durability of these improved outcomes.
