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Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After
Irene Cao1, Emma Bergonzoni1, Luca Vedovelli1
1Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Insights
The Fontan operation has improved outcomes, with mortality dropping to 1.35% in the last decade. However, patients over 4 years old face higher complication risks, highlighting age as a key factor in surgical management.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Clinical Outcomes Research
Background:
- The Fontan operation, while life-saving for complex congenital heart defects, historically carries significant surgical risks.
- Despite improvements, understanding evolving outcomes and risk factors remains crucial for patient management.
Purpose of the Study:
- To evaluate the trends in mortality, complications, and reinterventions following the Fontan operation over three decades.
- To identify specific patient factors, such as age, associated with adverse outcomes.
Main Methods:
- Retrospective analysis of 897 pediatric patients undergoing the Fontan operation across 9 Italian centers (1990-2023).
- Data collected via a RedCap database, focusing on operative mortality, postoperative complications, and reintervention rates.
- Statistical analysis to assess outcomes across different decades and identify risk factors.
Main Results:
- Overall operative mortality decreased significantly, reaching 1.35% in the last decade.
- Postoperative complications occurred in 46% of patients, with early reinterventions in 7.5%.
- Age at operation greater than 4 years was linked to increased postoperative complications and need for reintervention.
Conclusions:
- The Fontan operation has demonstrated substantial improvements in immediate outcomes, particularly reduced mortality.
- While minor complications persist, major early complications and reinterventions have decreased.
- Preoperative assessment must consider age, as older children (>4 years) exhibit higher morbidity risks, necessitating tailored management strategies.
Abstract:
Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5 years (IQR 3.3-6.4), median weight 16 kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4 years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4 years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.
