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Early conversion of classic Fontan conversion may decrease term morbidity: single centre outcomes.

David Blitzer1, Asma S Habib1, John W Brown1

  • 1Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.

Cardiology in the Young
|June 29, 2019
PubMed
Summary
This summary is machine-generated.

Fontan conversion can improve outcomes for adults with Fontan complications. Early conversion is recommended before severe heart failure develops, offering an acceptable risk profile for this complex procedure.

Keywords:
CHDClassic FontanFontan conversionarrhythmiaheart failure

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Adult Congenital Heart Disease

Background:

  • The classic Fontan procedure has historically led to complications in adults.
  • Total cavopulmonary connection is the current standard palliation for univentricular hearts in children.
  • Adults with Fontan-associated complications may benefit from conversion to a total cavopulmonary connection.

Purpose of the Study:

  • To evaluate the outcomes of Fontan conversion procedures in adults.
  • To determine the safety and efficacy of converting classic Fontan to total cavopulmonary connection.
  • To identify optimal timing for Fontan conversion based on patient presentation.

Main Methods:

  • Retrospective chart review of Fontan conversion procedures from July 1999 to January 2017.
  • Analysis of patient demographics, reasons for conversion, and early outcomes (mortality, heart transplant).
  • Evaluation of survival rates at 30 days, 1 year, and beyond post-conversion.

Main Results:

  • 41 patients underwent Fontan conversion, with an average age of 24.5 years.
  • Common indications included atrial arrhythmias (90.2%) and heart failure (75.6%).
  • Survival rates were high: 95.1% at 30 days, 92.7% at 1 year, and 87.8% long-term; two patients required heart transplant.

Conclusions:

  • Fontan conversion is a viable option for adults with complications from the initial Fontan procedure.
  • Early consideration for conversion is advised when atrial arrhythmias arise, rather than awaiting severe heart failure.
  • Fontan conversion can be performed with an acceptable risk profile.