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11 Years of the Fontan operation at a single institution: Results from 87 consecutive patients
Hebah S Al Absi1, Laszlo Kiraly2, Bassem Mora2
1Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Insights
The Fontan operation, a key treatment for single ventricle patients, showed favorable early outcomes in a UAE tertiary center. This study reports a 6% mortality rate and highlights factors like heterotaxy impacting survival.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- The Fontan procedure is the standard surgical palliation for complex single-ventricle congenital heart defects.
- Evaluating early outcomes is crucial for refining surgical techniques and patient management.
Purpose of the Study:
- To assess early morbidity and mortality rates following the Fontan operation.
- To identify potential risk factors influencing outcomes in a cohort of 87 patients.
Main Methods:
- Retrospective analysis of 87 consecutive Fontan operations performed between 2007 and 2017.
- Evaluation of early survival, intensive care unit (ICU) and hospital stay durations.
- Analysis of preoperative and intraoperative variables for their impact on outcomes.
Main Results:
- The Fontan procedure was performed at a median age of 4.2 years, with extracardiac Fontan being the preferred method.
- Early survival was 94%, with an overall mortality rate of 6%.
- Heterotaxy and decreased ventricular function were identified as significant risk factors for reduced survival.
Conclusions:
- The Fontan operation demonstrated favorable early postoperative outcomes in a tertiary care center in the United Arab Emirates.
- Reported mortality and morbidity rates are comparable to international benchmarks.
- The findings support the feasibility of performing the Fontan procedure in this region.
Abstract:
Fontan procedure is the preferred palliation for patients with single ventricles.
Objectives:
To evaluate early morbidity and mortality after Fontan operation in 87 consecutive patients, between 2007 and 2017.
Methods:
Early survival, duration of intensive care unit (ICU), and hospital stays were the main outcomes evaluated. Potential influencing factors evaluated included preoperative and intraoperative variables.
Results:
Fontan procedure was performed at a median age of 4.2 years (range, 17 months-26 years), and a median weight of 15.5 kg (range, 8-72 kg). Extracardiac Fontan was the procedure of choice. The median cardiopulmonary bypass time was 122 minutes (range, 58-550 minutes). The majority had a fenestration (75 out of 87). Postoperatively, the median duration of ICU stay and total hospital stay were (4, 1-76 days) and (16, 1-85 days), respectively. Fontan failure occurred in one patient (1%). Overall early survival was 94%, resulting in a mortality rate of 6%. Univariate analysis showed that heterotaxy (odds ratio [OR], 2.222; confidence interval [CI], 1.345-6.250; P = .003) and decreased ventricular function (OR, 2.207; CI, 1.348-6.061; P = .002) significantly decreased survival. The same analysis failed to identify any statistically significant risk factors for prolonged hospital and ICU stays.
Conclusion:
Our reported mortality and morbidity rates compared favorably with the reported rates. Therefore, Fontan operation can be performed in a tertiary care center in the United Arab Emirates with favorable early postoperative outcomes.
