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Outcomes after the Fontan operation in the Middle East: A large Saudi Arabian single centre experience
Khalid Al Najashi1, Sameh Farouk1, Merna Atiyah1
1Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Insights
This study reports on Fontan operation outcomes in Saudi Arabia, showing survival rates comparable to international data. Key factors for improved outcomes include rigorous patient selection and dedicated care teams.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Fontan Procedure Outcomes
Background:
- Limited data exists on Fontan operation outcomes from Middle Eastern centers.
- This study presents findings from a large tertiary cardiac center in Saudi Arabia.
Purpose of the Study:
- To evaluate the early and late post-operative outcomes of the Fontan operation.
- To identify determinants of mortality and transplant in Fontan patients.
Main Methods:
- Retrospective analysis of 458 consecutive patients undergoing Fontan surgery between 1986 and 2015.
- Evaluation of baseline characteristics, early mortality, late survival, and risk factors.
Main Results:
- Early mortality was 3.1%. Long-term survival at 30 years was 85%.
- Survival rates in the modern era (post-1999) were 96% at 5 years and 93% at 15 years.
- Pre-1999 surgical era and prior atriopulmonary Fontan procedures were independently associated with increased risk of death or transplant.
Conclusions:
- Fontan patients in this Saudi Arabian center demonstrate outcomes comparable to published international data.
- Rigorous patient selection and specialized Fontan care teams likely contribute to successful outcomes.
Background:
Fontan outcomes data from large volume Middle Eastern Centres are lacking. We report our experience after the Fontan operation from a tertiary cardiac centre in Saudi Arabia.
Method:
All 458 consecutive patients who had Fontan surgery 1986 through 2015 at the Prince Sultan Cardiac Centre, Riyadh [PSCC], Saudi Arabia, were evaluated for baseline, early and late post-operative outcomes and their uni and multivariate determinants.
Results:
The mean age at Fontan operation was 7 years [IQR 4.8-9.0]. The most common anatomic diagnoses were tricuspid atresia (104 [23%]) and double-inlet left ventricle (81 [18%]). Only 3 patients in the present series had hypoplastic left heart syndrome [HLHS]. Early mortality [i.e. during Fontan surgical admission] was 3.1%. At late follow-, 35 (8%) patients were lost to follow up. The 1, 5, 10, 20 and 30 year survival was 96%, 94%, 93% and 85%, respectively. In the modern surgical era, 5, 10 and 15 year survival were 96%, 95% and 93% respectively. Univariate determinants of death or transplant were hypoalbuminemia, elevated NtProBNP >500, surgical era prior to 1999, the lack of Fontan fenestration, and prior atriopulmonary Fontan [APF] procedure. On multivariate analysis, surgical era before 1999 and prior APF procedure were independently associated with death or transplant.
Conclusions:
Fontan patients from this large volume Middle Eastern centre have comparable early and late mortality outcomes compared to prior published reports. Rigorous selection criteria at the time of Fontan, and Fontan specific dedicated care teams are likely contributors to this success.
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