Perioperative and long-term management of Fontan patients

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease (CHD)
• Cardiovascular Surgery

Background:

• Fontan circulation is a palliative surgical approach for single-ventricle congenital heart disease (CHD).
• The extracardiac total cavopulmonary connection is the predominant surgical technique.
• Strict patient selection criteria and comprehensive postoperative management are essential.

Purpose of the Study:

• To review the current perioperative management protocols for Fontan circulation.
• To highlight the acute and late complications associated with the Fontan procedure.
• To discuss potential future research directions for improving patient outcomes.

Main Methods:

• Assessment of Fontan candidates using cardiac catheterization and cardiac magnetic resonance.
• Implementation of postoperative treatment protocols including antibiotic prophylaxis, diuretics, ACE inhibitors, anticoagulation, and oxygen therapy.
• Management strategies involving fluid restriction and low-fat diet.

Main Results:

• Postoperative measures aim to minimize ICU and hospital stay by preventing complications like infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury.
• Late complications include Fontan circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease.
• Cardiac transplantation is the definitive treatment, with emerging innovations in lymphatic embolization and ventricular assist devices.

Conclusions:

• Current perioperative management strategies are critical for mitigating acute and late complications in Fontan patients.
• Further research is needed to standardize perioperative protocols and enhance long-term outcomes.
• Innovations in treatment offer hope for improved management of complex CHD.