Understanding Early Fontan Failure in Vietnam: Incidence and Clinical Predictors

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Outcomes Research

Background:

• The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
• Early Fontan failure (EFF) remains a significant concern, impacting long-term outcomes.
• Data on EFF incidence and risk factors in developing countries like Vietnam are limited.

Purpose of the Study:

• To determine the incidence of early Fontan failure (EFF) in a Vietnamese patient cohort.
• To identify preoperative, intraoperative, and postoperative risk factors associated with EFF.
• To inform strategies for preventing EFF in resource-limited healthcare settings.

Main Methods:

• A retrospective analysis of 145 consecutive patients undergoing the Fontan procedure from August 2012 to December 2019.
• Clinical evaluation, literature review, and institutional database analysis were used to identify risk factors.
• Multivariate logistic regression was employed to determine independent predictors of EFF.

Main Results:

• The incidence of EFF was 9.66%.
• Univariate analysis identified unbalanced atrioventricular septal defect, situs inversus, AV valve regurgitation, elevated pulmonary artery pressure (PAP), and pulmonary vascular resistance (PVR) as associated with EFF.
• Multivariate analysis revealed preoperative elevated PAP, intraoperative atrioventricular (AV) valve repair, and postoperative elevated PAP as independent predictors of EFF.

Conclusions:

• Early Fontan failure is relatively high in this Vietnamese series and associated with significant mortality.
• Preoperative elevated PAP, intraoperative AV valve repair, and postoperative elevated PAP are independent predictors of EFF.
• A comprehensive management strategy targeting these predictors is essential for preventing EFF, particularly in developing countries.