Multicenter Comparison of Long-Term Outcomes: Extracardiac Conduit Fontan vs Lateral Tunnel Fontan at 15-Year Follow-Up

Abstract

Background: The extracardiac conduit (ECC) and lateral tunnel (LT) are the most prevalent strategies for the Fontan operation. We used a multicenter database to compare long-term results.

Methods: First-time LT or ECC Fontans performed after the year 2000 in the Fontan Outcome Registry using Cardiac magnetic resonance Examinations (FORCE) registry were included. Propensity score matching was used. Outcomes were assessed individually as well as in a composite outcome that included death, listing for transplantation, sustained atrial arrhythmias, emergent cardioversion, plastic bronchitis, protein-losing enteropathy, and catheter-based intervention on the Fontan pathway. Cox proportional hazards models were used to compare hazards of outcomes between ECC and LT patients.

Results: Among 3072 patients (690 LT and 1182 ECC) in the registry, 1290 patients (645 LT and 645 ECC) were identified after matching. In matched samples, the Fontan composite outcome (32.4% vs 19.8%), sustained atrial arrhythmias (15.0% vs 5.0%), emergent cardioversion, defibrillation, or arrhythmogenic cardiac arrest (2.6% vs 0.8%), and Fontan pathway catheter-based intervention (7.1% vs 3.6%) were significantly higher for LT patients (P < .05 for all). Kaplan-Meier analysis demonstrated the freedom from the composite Fontan outcome at 5, 10, and 15 years was 94.5%, 88.3%, and 79.8%, respectively, for ECC patients compared with 90.2%, 80.9%, and 68.3%, respectively, for LT patients (P < .0001). ECC patients had lower hazards for atrial arrhythmia (hazard ratio, 0.33; 95% CI, 0.20-0.54; P < .0001) and the composite Fontan outcome compared to LT patients (hazard ratio, 0.72; 95% CI, 0.54-0.96; P = .0257).

Conclusions: The ECC has substantially lower hazards for atrial arrhythmias compared with the LT Fontan, whereas other independent measures of longitudinal morbidity are similar.