Thromboembolic complications after Fontan operations

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiovascular Surgery

Background:

• Thromboembolic complications are a recognized risk following the Fontan procedure.
• Limited data exists characterizing these events, particularly in relation to different Fontan modifications.
• The total cavopulmonary connection is hypothesized to have a lower risk compared to other Fontan types.

Purpose of the Study:

• To characterize thromboembolic events after Fontan operations.
• To investigate the relationship between the type of Fontan operation and the occurrence of thromboembolism.
• To assess the incidence, timing, and presentation of thromboembolic complications.

Main Methods:

• Retrospective review of 70 patients who underwent a Fontan operation between 1978 and 1994.
• Patients were categorized into three groups: total cavopulmonary connection, atriopulmonary connection, and conduit interposition.
• Follow-up data was analyzed for the development of thromboembolic complications.

Main Results:

• 14 patients (20%) experienced thromboembolic complications over a mean follow-up of 5.2 years.
• The rate of thrombosis was similar across all three Fontan modifications.
• Events occurred up to 15 years post-surgery, with a mean time to thrombosis of 6.1 years; 43% were asymptomatic.

Conclusions:

• Thromboembolic complications are a common and significant cause of morbidity after Fontan operations and their modifications.
• The timing of these complications is highly variable, ranging from the perioperative period to many years later.
• Current Fontan modifications do not appear to significantly alter the rate of thrombosis.