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Fontan surgery failure: risk factors and experience in a Colombian reference centre
Isabel C Sánchez-Escobar1, Andrés D Aranzazu-Ceballos2, Luz E Pérez3
1Fellow Pediatric Cardiology, CardioVid Clinic, Pontifical Bolivarian University, Medellin, Colombia.
Insights
Fontan procedure failure can lead to complications like protein-losing enteropathy and plastic bronchitis. Careful patient selection is crucial for successful Fontan surgery outcomes in univentricular physiology.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- The Fontan procedure is a significant advancement in treating complex congenital heart defects.
- However, complications and failure remain limitations of this surgical approach.
- Understanding Fontan failure is critical for improving patient outcomes.
Purpose of the Study:
- To characterize clinical and hemodynamic features of Fontan failure.
- To identify risk factors associated with Fontan failure.
- To evaluate short- and long-term outcomes over a 21-year period.
Main Methods:
- Retrospective follow-up study.
- Inclusion of 15 patients diagnosed with Fontan failure.
- Data collected from a single-ventricle program between 2001 and 2022.
Main Results:
- 17 out of 108 Fontan procedures (15.7%) met failure criteria.
- Protein-losing enteropathy (58.8%) and plastic bronchitis (17.6%) were common failure types.
- Median age at failure was 4.3 years; 82.4% were male; Ebstein's anomaly was the most frequent diagnosis.
Conclusions:
- Fontan surgery is a viable option for univentricular physiology.
- Meticulous patient selection is paramount to minimize the risk of Fontan failure.
- Further research into risk stratification and management strategies is warranted.
Background:
The Fontan procedure is considered one of the most remarkable achievements in paediatric cardiology and cardiac surgery. Its final anatomical objective is a venous return through the superior and inferior vena cava. The complications inherent to this procedure and subsequent failure are its limitations.
Objective:
To describe the clinical and haemodynamic characteristics of patients with Fontan failure and define the risk factors associated with it, with its short- and long-term outcomes during a 21-year observation period.
Methods:
This is a retrospective follow-up study in which 15 patients diagnosed with Fontan failure in the single-ventricle programme of a high-complexity hospital in Medellín, Colombia, between 2001 and 2022 were included.
Results:
One hundred and eight patients were identified in whom the Fontan procedure was performed, and 17 met the failure criteria. 82.4% were men, with a median age of 4.3 years. Ebstein's anomaly was the most common diagnosis, 29.4%. All patients underwent Fontan with an extracardiac tube following the procedure. According to the type of failure, 58.8% of patients presented protein-losing enteropathy and 17.6% plastic bronchitis. During follow-up, 5.9% of patients died.
Conclusion:
Fontan surgery in our centre is an option for patients with univentricular physiology. The correct selection of the patient is essential to mitigate failure risks.
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