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Extending the limits for modified Fontan procedures.

J E Mayer, H Helgason, R A Jonas

    The Journal of Thoracic and Cardiovascular Surgery
    |December 1, 1986
    PubMed
    Summary
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    The original Fontan procedure selection criteria for age and venous anomalies are not strict limits. High pulmonary arteriolar resistance and pulmonary artery distortion significantly impact survival outcomes.

    Area of Science:

    • Cardiovascular Surgery
    • Pediatric Cardiology
    • Congenital Heart Disease

    Background:

    • The Fontan-Kreutzer procedure, an atriopulmonary anastomosis, initially had strict selection criteria.
    • These criteria aimed to optimize outcomes for patients with complex congenital heart disease.

    Purpose of the Study:

    • To evaluate the impact of exceeding original Fontan-Kreutzer selection criteria on patient survival.
    • To identify key factors influencing outcomes in modified Fontan procedures.

    Main Methods:

    • Retrospective analysis of 167 patients undergoing modified Fontan procedures between 1973 and 1985.
    • Assessment of patient data against original criteria: age, venous anomalies, pulmonary artery distortion, pulmonary artery pressure, and pulmonary arteriolar resistance.
    • Multivariate analysis to determine predictors of survival.

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    Main Results:

    • 65% of patients exceeded at least one original criterion.
    • Pulmonary arteriolar resistance > 2 Wood units x m² (54% survival) and pulmonary artery distortion (50% survival) negatively impacted outcomes.
    • Age and venous anomalies did not significantly affect survival; pulmonary artery pressure was not an independent predictor.

    Conclusions:

    • Original Fontan selection criteria regarding age and venous anomalies can be exceeded.
    • Elevated pulmonary arteriolar resistance and pulmonary artery distortion are significant risk factors for modified Fontan procedures.
    • Pulmonary artery pressure alone should not contraindicate a Fontan procedure if pulmonary arteriolar resistance is low.