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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

Insights

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.

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.
Abstract

Keywords:
CHDClassic FontanFontan conversionarrhythmiaheart failure

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