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The Fontan procedure in adults
R N Gates1, H Laks, D C Drinkwater
1Department of Surgery, University of California, Los Angeles, School of Medicine, 90095-1741, USA.
The Annals of Thoracic Surgery
|April 1, 1997
Summary
Adults undergoing the Fontan procedure experienced low operative mortality and morbidity. Careful follow-up is essential due to late arrhythmias and potential reoperations in these Fontan patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Adult Congenital Heart Disease
Background:
- The Fontan procedure is a palliative surgical option for complex single-ventricle congenital heart disease.
- Adults undergoing this procedure represent a growing population with unique long-term management challenges.
Observation:
- This study evaluated 21 adults (18-40 years) who underwent the Fontan procedure between 1982 and 1994.
- Preoperative risk factors included elevated left ventricular end-diastolic pressure, reduced ejection fraction, and pulmonary hypertension.
Findings:
- The operative mortality rate was 5%, with 30% experiencing major complications like prolonged effusions.
- At a mean follow-up of 7.4 years, New York Heart Association class improved significantly.
- Late complications included one death (5%) from ventricular arrhythmia, reoperations in 16%, and arrhythmias in 37%.
Implications:
- Properly selected adults can achieve favorable outcomes after the Fontan procedure.
- Long-term surveillance is crucial for managing late-onset arrhythmias, potential reoperations, and declining ventricular function in Fontan survivors.