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Fontan conversion to cavopulmonary connection and arrhythmia circuit cryoblation
C Mavroudis1, C L Backer, B J Deal
1Department of Surgery, Northwestern University Medical School, and The Children's Memorial Hospital, Chicago, Ill 60614, USA.
The Journal of Thoracic and Cardiovascular Surgery
|April 16, 1998
Summary
Conversion to total cavopulmonary artery connection surgery improves outcomes for Fontan patients with arrhythmias or obstructive issues. This procedure, combined with cryoablation and pacemakers, offers significant functional class improvement and arrhythmia control.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Electrophysiology
Background:
- Atriopulmonary Fontan (APF) operations are a palliative treatment for complex congenital heart disease.
- Patients with APF may develop late complications, including obstructive lesions and atrial arrhythmias.
- Conversion to total cavopulmonary connection (TCPC) is an option for symptomatic APF patients.
Purpose of the Study:
- To review surgical outcomes of converting APF to TCPC.
- To assess the efficacy of concomitant arrhythmia circuit cryoablation and atrial antitachycardia pacemaker placement.
- To evaluate improvements in functional class and arrhythmia control.
Main Methods:
- Retrospective review of 14 patients undergoing APF to TCPC conversion.
- Procedures included TCPC, cryoablation (11 patients), and antitachycardia pacemakers (10 patients).
- Patients were primarily indicated for arrhythmias (11) or obstruction (2).
Main Results:
- One perioperative death (7%) due to resternotomy complications; one reoperation for device issue.
- No long-term mortality with a mean follow-up of 1.7 years.
- All patients improved to New York Heart Association class I or II; 5 experienced postoperative arrhythmias, managed with pacemakers or medication.
Conclusions:
- TCPC conversion with cryoablation and antitachycardia pacing is feasible with low morbidity and mortality.
- The combined approach significantly improves functional capacity and controls life-threatening arrhythmias.
- This strategy offers a valuable option for managing late complications after APF Fontan operations.