Fontan surgery failure: risk factors and experience in a Colombian reference centre

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.