Persistent low cardiac output after the Fontan operation. Should takedown be considered?

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Background:

• The Fontan operation is a palliative procedure for complex single-ventricle congenital heart disease.
• Persistent low cardiac output post-Fontan operation can lead to severe complications and mortality.
• Identifying optimal management strategies for Fontan failure is crucial.

Purpose of the Study:

• To evaluate the outcomes of Fontan operation shunt takedown in pediatric patients experiencing persistent low cardiac output.
• To determine the safety and efficacy of reversing the Fontan circulation in select cases.

Main Methods:

• Retrospective analysis of four patients who underwent Fontan operation takedown due to persistent low cardiac output.
• Detailed review of pre-operative, operative, and post-operative physiological parameters.
• Surgical intervention involved takedown of the atriopulmonary anastomosis and creation of an atrial septal defect.

Main Results:

• Four out of 44 patients (9%) developed persistent low cardiac output requiring shunt takedown.
• These patients presented with right atrial hypertension, ascites, severe hypotension, metabolic acidosis, and oliguria.
• Two survivors showed immediate improvement in hemodynamic parameters after takedown and atrial septostomy.
• Long-term follow-up demonstrated good health in survivors, with repeat Fontan operation as a future possibility.

Conclusions:

• Fontan operation shunt takedown is a feasible salvage procedure for pediatric patients with persistent low cardiac output.
• Early recognition and intervention are critical for improving outcomes in Fontan failure.
• Reversal of the Fontan circulation can lead to hemodynamic stabilization and long-term survival.