Evolution of the Fontan procedure in a single center

Ko Bando, Mark Turrentine, Hyung Joo Park, Thomas G. Sharp, Vincent Scavo, John Brown

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background. Surgical approaches to single ventricle variants include staged, fenestrated, and completed Fontan operations. This study compares outcomes with these modifications of the Fontan operation at a single center. Methods. Preoperative risk factors and operative results were analyzed by multivariate techniques in 129 patients undergoing modified Fontan operations since March 1988. Results. Overall early and late mortality was 5.41% and 0.8%, respectively. Before 1993, completed Fontan operation using right atrial to pulmonary artery anastomoSis without fenestration was performed in the majority of patients (44 of 58; 76%). During this period, 10 of 17 patients at high risk had completed Fontan with three takedowns. In 1994, the staged hemi-Fontan and modified Fontan with a lateral tunnel anastomosis and with or without small fenestration (2.5 to 4 mm) were introduced. The majority of patients at high risk during this period underwent hemi-Fontan followed by fenestrated Fontan with no takedowns. Late atrial dysrhythmias occurred in 6 patients (4.7%), generally with larger fenestrations or right atrial to pulmonary anastomose. Three patients (2.3%) had a stroke, 2 with large (≥ 4 mm) fenestrations. Of 38 fenestrations, 32 (84%) closed spontaneously by 1 year. No protein-losing enteropathy occurred. Most patients (118 of 121) were in New York Heart Association class I/II 4.5 years postoperatively. By multivariate analysis, only Down's syndrome (p < 0.001) predicted early mortality, whereas both Down's syndrome and a systemic right ventricle decreased late survival (p < 0.006). Conclusions. Proper selection of patients modifications of the Fontan procedure resulted in excellent early and late survival with a low incidence of atrial dysrhythmia and stroke. Midterm functional outcomes were excellent. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish
Pages (from-to)1873-1879
Number of pages7
JournalAnnals of Thoracic Surgery
Volume69
Issue number6
DOIs
StatePublished - Jun 2000

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Fontan Procedure
Down Syndrome
Stroke
Protein-Losing Enteropathies
Survival
Mortality
Patient Selection
Pulmonary Artery
Heart Ventricles
Multivariate Analysis
Outcome Assessment (Health Care)
Lung
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Evolution of the Fontan procedure in a single center. / Bando, Ko; Turrentine, Mark; Park, Hyung Joo; Sharp, Thomas G.; Scavo, Vincent; Brown, John.

In: Annals of Thoracic Surgery, Vol. 69, No. 6, 06.2000, p. 1873-1879.

Research output: Contribution to journalArticle

Bando, Ko ; Turrentine, Mark ; Park, Hyung Joo ; Sharp, Thomas G. ; Scavo, Vincent ; Brown, John. / Evolution of the Fontan procedure in a single center. In: Annals of Thoracic Surgery. 2000 ; Vol. 69, No. 6. pp. 1873-1879.
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abstract = "Background. Surgical approaches to single ventricle variants include staged, fenestrated, and completed Fontan operations. This study compares outcomes with these modifications of the Fontan operation at a single center. Methods. Preoperative risk factors and operative results were analyzed by multivariate techniques in 129 patients undergoing modified Fontan operations since March 1988. Results. Overall early and late mortality was 5.41{\%} and 0.8{\%}, respectively. Before 1993, completed Fontan operation using right atrial to pulmonary artery anastomoSis without fenestration was performed in the majority of patients (44 of 58; 76{\%}). During this period, 10 of 17 patients at high risk had completed Fontan with three takedowns. In 1994, the staged hemi-Fontan and modified Fontan with a lateral tunnel anastomosis and with or without small fenestration (2.5 to 4 mm) were introduced. The majority of patients at high risk during this period underwent hemi-Fontan followed by fenestrated Fontan with no takedowns. Late atrial dysrhythmias occurred in 6 patients (4.7{\%}), generally with larger fenestrations or right atrial to pulmonary anastomose. Three patients (2.3{\%}) had a stroke, 2 with large (≥ 4 mm) fenestrations. Of 38 fenestrations, 32 (84{\%}) closed spontaneously by 1 year. No protein-losing enteropathy occurred. Most patients (118 of 121) were in New York Heart Association class I/II 4.5 years postoperatively. By multivariate analysis, only Down's syndrome (p < 0.001) predicted early mortality, whereas both Down's syndrome and a systemic right ventricle decreased late survival (p < 0.006). Conclusions. Proper selection of patients modifications of the Fontan procedure resulted in excellent early and late survival with a low incidence of atrial dysrhythmia and stroke. Midterm functional outcomes were excellent. (C) 2000 by The Society of Thoracic Surgeons.",
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