Fontan operation in the current era: a 15-year single institution experience

Abstract

Objective: Evaluate current risk factors for mortality and morbidity in patients undergoing the Fontan procedure at a single institution in the current era.

Summary background data: An emphasis on early relief of volume and pressure overload culminating in the Fontan procedure has improved patient outcomes for patients with a single ventricle.

Methods: A cross-sectional retrospective study was performed for 636 primary Fontan procedures between July 1992 and June 2007.

Results: Anatomy included left ventricular hypoplasia in 64% and right ventricular hypoplasia in 36%. A lateral tunnel (LT) was performed in 92% and an extracardiac conduit (EC) in 8%. Hospital survival was 96%. Long-term survival was 97% at a mean follow-up of 50 months (range, 0-173 months). Ventricular anatomy and preoperative hemodynamics did not predict early or late survival. Longer aortic cross clamp (XC) time was associated with decreased late survival (P = 0.01). Fontan takedown was required in 3% and protein-losing enteropathy (PLE) developed in 6%. At follow-up, 98% of patients were either NYHA class I or II and 87% were in normal sinus rhythm. Patients with chest tube drainage >2 weeks had an increased risk of PLE (P < 0.0001) and diminished short- and long-term survival (P = 0.026 and P < 0.0001, respectively).

Conclusions: The Fontan procedure can be performed with low risk regardless of ventricular anatomy. Duration of XC time is associated with survival. Prolonged CT drainage correlates with late PLE and diminished survival. There was a low prevalence of late rhythm disturbances and other complications.