Extracardiac Versus Lateral Tunnel Fontan: A Meta-Analysis of Long-Term Results

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiac Surgery

Background:

• Fontan circulation's long-term impact on morbidity and mortality is increasingly recognized.
• Comparative data on arrhythmia and sinus node dysfunction between extracardiac conduit (EC) and lateral tunnel (LT) Fontan procedures remain controversial.
• Understanding long-term outcomes is crucial for optimizing single-ventricle palliation.

Purpose of the Study:

• To compare the long-term results of extracardiac conduit (EC) versus lateral tunnel (LT) Fontan procedures.
• To specifically investigate the incidence of supraventricular arrhythmia and sinus node dysfunction.
• To evaluate survival rates and thromboembolic events in both Fontan types.

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, and Cochrane Library.
• Meta-analysis was performed on 12 selected studies, encompassing 3,330 patients (1,729 EC, 1,601 LT).
• Long-term outcomes including arrhythmia, survival, and thromboembolic events were analyzed.

Main Results:

• Freedom from tachyarrhythmia was significantly higher in the EC group (92% vs. 83% at 15 years, p < 0.0001).
• No significant difference was observed in bradyarrhythmias (p = 0.7).
• Twenty-year survival was higher in the EC group (93%) compared to the LT group (89%, p = 0.007).

Conclusions:

• The extracardiac conduit (EC) Fontan procedure demonstrates a long-term survival advantage over the lateral tunnel (LT) Fontan.
• EC Fontan is associated with a significantly lower incidence of long-term postoperative arrhythmia.
• EC Fontan effectively preserves sinus node function without increasing reoperation rates.