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Recent results with the modified Fontan operation
1Victorian Paediatric Hospital Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia.
Insights
The modified Fontan procedure shows promising early results for complex heart conditions in children. This surgery offers low mortality and good functional outcomes for most patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
Background:
- The Fontan procedure is a palliative surgical option for complex single-ventricle congenital heart defects.
- Modifications to the Fontan procedure have aimed to improve outcomes and reduce mortality.
Purpose of the Study:
- To evaluate the early outcomes of a modified Fontan procedure in a cohort of pediatric patients.
- To assess the hospital mortality, late deaths, and functional status following the modified Fontan operation.
Main Methods:
- A retrospective review of 61 patients who underwent a modified Fontan procedure between January 1989 and December 1991.
- Analysis of patient demographics, diagnoses, operative details, mortality, and functional follow-up (NYHA class).
Main Results:
- Hospital mortality was low at 1.6%.
- Two late deaths occurred, and two late failures (requiring Fontan takedown or heart transplantation) were noted.
- 89% of patients achieved New York Heart Association (NYHA) class I or II functional status at a mean follow-up of 21.5 months.
Conclusions:
- The modified Fontan operation, with current patient selection, can be performed with low mortality.
- Early results indicate encouraging functional outcomes for the majority of patients undergoing this procedure.
Abstract:
From Jan 1989 to December 1991, 61 patients had modified Fontan procedures for a variety of lesions, including tricuspid atresia (18), mitral atresia (3), double inlet ventricle (14), isomeric hearts (4) and others (22). The hospital mortality was 1.6% (70% CL.0.2-5.3%). There were 2 late deaths. The median age at operation was 3.7 years (mean 5.6, range 1.5 to 20.3 years). There were two late failures at 2 months and 30 months after the operation, requiring take down of the Fontan in one and heart transplantation in the other. The 89% of the patients followed up are in NYHA class I or II at a mean follow up of 21.5 months (range 3-35 months). This suggests that the modified Fontan operation performed with the current patient selection criteria can be performed with a low mortality and that the early results are encouraging in the majority of the patients.