Earlier Fontan Candidacy Determination: A Focus on Anatomic and Physiologic Variables

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Fontan palliation for single-ventricle congenital heart disease involves debated timing and patient selection criteria.
• Current practices often use weight thresholds, potentially limiting candidacy despite individual anatomic and physiologic factors.

Purpose of the Study:

• To evaluate Fontan palliation outcomes using individualized anatomic and physiologic variables instead of a strict weight threshold.
• To assess the safety and efficacy of Fontan procedures in select low-weight patients.

Main Methods:

• Retrospective cohort study of extracardiac conduit Fontan palliation (1998-2021).
• Patients stratified by weight (<12 kg vs. ≥12 kg) after multidisciplinary evaluation.
• Comparison of pre- and post-Fontan hemodynamics, conduit size, and postoperative outcomes.

Main Results:

• No significant differences in 30-day outcomes (Fontan failure, length of stay, mortality) between weight groups.
• Patients <12 kg had higher postoperative pulmonary vascular resistance but comparable long-term survival and transplant-free survival.
• Smaller conduit size in patients ≥12 kg correlated with increased protein-losing enteropathy.

Conclusions:

• Fontan palliation is feasible and safe in select patients weighing <12 kg, supporting a strategy based on individual assessment.
• Higher pulmonary vascular resistance in smaller patients necessitates longitudinal follow-up.
• Achieving adequate conduit size is crucial for outcomes, irrespective of patient weight.