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Outcomes after single-stage Fontan palliation: A propensity score-matched analysis from the Australian and New
Supreet P Marathe1, Siddharth Amboli1, Jacob Cao2
1Queensland Children's Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
Background:
Although the Fontan operation was originally performed as a single-stage procedure, staged palliation is currently the preferred approach. The current study aimed to evaluate the outcomes of the single-stage Fontan operation.
Methods:
A binational Fontan Registry (n = 1862) was analyzed to identify patients who underwent a single-stage Fontan operation. These patients were compared with staged Fontan patients in the Registry. Patients with atriopulmonary Fontan connections were excluded. The primary composite endpoint was postdischarge Fontan failure, encompassing death, heart transplantation, Fontan takedown or conversion, protein-losing enteropathy, plastic bronchitis, or New York Heart Association functional class III or IV. Other endpoints were early complications, including chylothorax, in-hospital death, time to first arrhythmia episode, time to first thromboembolic event, and first cardiac reintervention.
Results:
Patients who underwent a single-stage Fontan operation (n = 176) were compared with those who underwent a staged Fontan operation (n = 1421). The median follow-up for the entire cohort was 11.0 years (interquartile range, 5.3-17.9 years). The majority of single-stage Fontan operations were lateral tunnel (86%; n = 152), which were performed before 2006 (169 of 176; 96%). There was no difference in freedom from Fontan failure between the 2 groups (P = .23; hazard ratio, 0.90; 95% confidence interval, 0.60-1.35). Propensity score matching yielded 262 patients (131 pairs) with similar freedom from Fontan failure (P = .72). There was no difference between the 2 groups in early complications or secondary endpoints.
Conclusions:
In a large binational Fontan population, 11% of patients underwent a single-stage Fontan operation over 48 years. There was no difference in the incidence of freedom from Fontan failure, chylothorax, or reinterventions between patients who underwent a staged Fontan operation and those who underwent a single-stage Fontan operation.