18 years of the Fontan operation at a single institution: results from 771 consecutive patients.

Abstract

OBJECTIVES:

The aim of this study was to evaluate Fontan peri-operative outcomes for 771 consecutive patients.

BACKGROUND:

Since the initial description by Fontan, mortality associated with the Fontan operation has declined substantially. However, postoperative effusions remain a significant challenge. Effusions are a key determinant of postoperative length-of-stay and have been shown to be associated with the development of protein-losing enteropathy and with decreased survival.

METHODS:

This study was a single-center, retrospective review of 771 patients who underwent Fontan palliation from 1992 to 2009.

RESULTS:

Patients were divided into 3 eras dictated by shift in clinical practice. Overall mortality was 3.5%, 1% since 1996. Importantly, age at Stage II palliation decreased from Era 1 to Era 3 (7.1 vs. 5.9 months; p = 0.0001), whereas age at Fontan increased (1.7 vs. 2.8 years; p = 0.0001). The proportion of patients with prolonged hospital stay (46.7% vs. 8.2% vs. 19.5%, p < 0.001) decreased substantially after Era 1. A diagnosis of hypoplastic left heart syndrome and longer operative support times were associated with prolonged pleural drainage (odds ratio [OR]: 2.17, p < 0.001; OR: 1.2, p = 0.001) and hospital stay (OR: 1.48, p = 0.05; OR: 1.34, p < 0.001). In patients who underwent invasive assessment, higher pulmonary artery pressure was associated with death (OR: 1.37, p < 0.001) and prolonged hospital stay (OR: 1.09, p = 0.019). Pulmonary arterial pressure ≥15 mm Hg was 90% specific for discriminating unfavorable outcomes.

CONCLUSIONS:

Mortality in the modern era is rare, whereas postoperative pleural drainage remains the dominant morbidity. Elevated pulmonary artery pressure seems to be a marker of unfavorable outcome. Continued investigation is warranted to determine whether medical interventions or alterations to operative strategy can alter peri-operative results and improve long-term outcomes.

• Authors: Lindsay S Rogers, Andrew C Glatz, Chitra Ravishankar, Thomas L Spray, Susan C Nicolson, Jack Rychik, Christina Hayden Rush, J William Gaynor, David J Goldberg
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 60 Issue 11 Pg. 1018-25 (Sep 11 2012) ISSN: 1558-3597 [Electronic] United States
• PMID: 22818071 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Female
• Fontan Procedure (adverse effects, mortality, statistics & numerical data)
• Heart Defects, Congenital (surgery)
• Humans
• Infant
• Male
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Treatment Outcome
• Young Adult