Characteristics Associated with Poor Long-Term Outcomes in Patients with Fontan Palliation: A Case-Control Study

Area of Science:

• Congenital Heart Disease
• Pediatric Cardiology
• Cardiovascular Surgery

Background:

• The Fontan procedure offers palliation for single-ventricle physiology but is limited by progressive Fontan circulatory failure.
• Early identification of high-risk patients is essential for effective surveillance and management strategies.

Purpose of the Study:

• To identify peri-Fontan factors associated with mortality or the need for advanced cardiac therapies in patients who have undergone the Fontan procedure.

Main Methods:

• A retrospective matched case-control study was conducted involving patients who completed the Fontan procedure between 2000 and 2023.
• Cases were defined as patients experiencing death, ventricular assist device (VAD) implantation, or heart transplantation post-Fontan.
• Conditional logistic regression analyzed pre-Fontan hemodynamics, cardiac anatomy, and perioperative variables.

Main Results:

• Systemic right ventricular morphology (aOR 6.87), pre-Fontan Glenn/hemi-Fontan pressure > 12 mmHg (aOR 4.72), and postoperative hospital length of stay > 12 days (aOR 8.57) were independently associated with adverse outcomes.
• The median age at Fontan failure was 11.5 years, occurring 8.6 years post-procedure.

Conclusions:

• Systemic right ventricular morphology, elevated pre-Fontan pressures, and prolonged postoperative hospitalization are key predictors of long-term adverse outcomes after Fontan completion.
• These findings highlight the importance of perioperative hemodynamics and postoperative recovery in assessing long-term Fontan risk.