A 10-year single-centre report on Fontan attrition and non-Fontan candidacy

As patients progress through single-ventricle palliation, changing haemodynamics and patient conditions can prevent progression to Fontan. We sought to determine the incidence of Fontan completion at our institution and to investigate the reasons for non-Fontan candidacy.

Patients who underwent superior cavopulmonary anastomosis from 2010 to 2020 at a single institution were included. Pre-Fontan testing was reviewed for all patients, and the primary reason for non-candidacy was determined based on a review of the electronic medical records.

Of the 427 patients included, 396 (93%) underwent Fontan or were referred for Fontan at the time of the study. Reasons for non-Fontan candidacy in the remaining 31 patients included cardiac reasons (n = 26), mainly univentricular dysfunction or atrioventricular valve regurgitation, respiratory conditions (n = 3), or miscellaneous reasons (n = 2). The patients who were non-Fontan candidates due to respiratory conditions and miscellaneous reasons are all alive without further palliation at the time of the study. There are 17 patients (17/31; 55%) in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. Non-Fontan candidates had a higher incidence of moderate or severe atrioventricular valve regurgitation prior to superior cavopulmonary anastomosis.

Thirty-one patients (31/427; 7%) were not Fontan candidates at our centre. Our results demonstrate that the reasons for non-Fontan candidacy after completion of stage 2 are broadly due to echocardiographic findings and respiratory concerns. Predicting non-Fontan candidacy prior to superior cavopulmonary anastomosis remains difficult.