Identification of Risk Factors for Early Fontan Failure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• The Fontan procedure is a palliative surgery for complex single-ventricle congenital heart defects.
• Despite advancements, significant risks of morbidity and mortality persist after the Fontan procedure.
• Identifying predictors of early Fontan failure is crucial for improving patient outcomes.

Purpose of the Study:

• To identify patient characteristics across their lifespan that predict early Fontan failure.
• To define early Fontan failure as death, Fontan takedown, or heart transplant listing before hospital discharge or within 30 days post-operation.

Main Methods:

• A single-center retrospective study of 191 patients undergoing the Fontan procedure.
• Examination of patient and intervention-related characteristics from birth through the perioperative period.
• Univariable and logistic regression analysis to identify associations with early Fontan failure.

Main Results:

• The incidence of early Fontan failure was 4% (8 patients: 6 deaths, 2 Fontan takedowns).
• Neonatal balloon atrial septostomy was the only patient characteristic significantly associated with early Fontan failure.
• Patients requiring neonatal balloon septostomy had 8.5 times higher odds of early Fontan failure (CI 2.6-28.1, P < 0.001).

Conclusions:

• Neonatal balloon atrial septostomy is a significant predictor of early Fontan failure.
• Children requiring neonatal balloon septostomy face a higher risk of adverse outcomes post-Fontan procedure.
• This finding emphasizes the need for careful management and monitoring of these high-risk pediatric patients.