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Modified Fontan procedure for complex congenital heart disease
M J Hsieh1, P J Lin, C H Chang
1Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Insights
The Fontan procedure offers palliative care for complex congenital heart disease. While early mortality was high, outcomes improved, with most survivors achieving good functional status.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- The Fontan procedure is a critical intervention for complex congenital heart disease.
- High postoperative morbidity and mortality remain significant challenges.
- This study reviews outcomes of the Fontan procedure performed over a decade.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the Fontan procedure in a cohort of pediatric patients.
- To analyze the hospital mortality and long-term functional status of patients undergoing the procedure.
- To identify factors influencing outcomes in complex congenital heart disease repair.
Main Methods:
- Retrospective review of 35 consecutive patients undergoing the Fontan procedure between January 1980 and June 1991.
- Analysis of patient demographics, underlying cardiac conditions, surgical techniques (conduit type, anastomosis), and postoperative outcomes.
- Long-term follow-up of survivors to assess functional class (New York Heart Association) and need for reoperation.
Main Results:
- Overall hospital mortality was 23%, with a reduction to 11% in the final year of the study.
- The majority of patients (all but two survivors) achieved New York Heart Association functional class I or II postoperatively.
- Three patients required reoperation for complications such as atrioventricular valve regurgitation and conduit stenosis, with positive outcomes.
Conclusions:
- The Fontan procedure is a viable palliative option for complex congenital heart disease.
- Despite initial high mortality, outcomes demonstrated improvement over time and good functional recovery in survivors.
- Careful patient selection and surgical technique are crucial for optimizing results in Fontan palliation.
Abstract:
The Fontan procedure is frequently used for correction of complex congenital heart disease, but the postoperative morbidity and mortality rates are still high. The results in 35 consecutive patients who underwent the Fontan procedure from January 1980 to June 1991 are reviewed. The patients comprised 26 boys and nine girls aged from 1.7 to 14.8 (mean 6.8) years. The underlying diseases were univentricular heart (19 patients), tricuspid atresia (eight), complete atrioventricular canal (three patients, two of whom had straddling atrioventricular valve) and other conditions (five). Valved conduits were implanted in four patients and non-valved in 15. Direct right atrium-pulmonary artery anastomosis was performed in 16 patients. The overall hospital mortality rate was 23% (eight patients); in the final year of the review it was 11%. Follow-up of the survivors ranged from 1 to 120 (mean 25) months. All except two patients attained New York Heart Association functional class I or II. Three patients underwent reoperation for atrioventricular valve regurgitation and conduit stenosis with good results. It is concluded that the Fontan procedure is a good palliative operation for complex congenital heart disease.