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Cardiovascular Outcomes in Fontan Patients With Right vs Left Univentricular Morphology: A Multicenter Study

Nabil Dib1, Marie-A Chaix1, Michelle Samuel1

  • 1Montreal Heart Institute, Université de Montréal, Quebec, Canada.

JACC. Advances
|June 28, 2024
PubMed

Insights

Patients with a univentricular right (uRV) ventricle after Fontan palliation face higher risks of adverse cardiovascular events, including arrhythmias and death, compared to those with a univentricular left (uLV) ventricle.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Limited data exists on long-term outcomes for Fontan palliation patients based on dominant ventricle morphology.
  • Distinguishing outcomes between univentricular right (uRV) and univentricular left (uLV) ventricle morphology is crucial.

Purpose of the Study:

  • To compare the incidence of atrial arrhythmias, thromboembolic events, cardiac transplantation, and death in patients with uRV versus uLV morphology post-Fontan palliation.
  • To identify differential risks associated with dominant ventricle type following Fontan surgery.

Main Methods:

  • A multicenter retrospective cohort study involving 384 patients with total cavopulmonary connection Fontan palliation.
  • Blinded adjudication of composite outcomes (atrial arrhythmias, thromboembolic events, transplantation, death) and time-to-event analyses accounting for competing risks.

Main Results:

  • The composite outcome occurred more frequently in uRV patients (3.7 per 100 person-years) compared to uLV patients (1.7 per 100 person-years).
  • uRV morphology conferred a >2-fold higher risk of the composite outcome (HR: 2.17).
  • uRV was significantly associated with increased risk of cardiac transplantation or death (HR: 9.09) and atrial arrhythmias (HR: 2.17).

Conclusions:

  • Fontan patients with uRV morphology exhibit a higher incidence of adverse cardiovascular events compared to those with uLV morphology.
  • These events include atrial arrhythmias, cardiac transplantation, and all-cause mortality, highlighting the prognostic significance of dominant ventricle type.
Abstract

Keywords:
Fontan surgeryatrial arrhythmiathromboembolic eventsuniventricular heart

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