Fontan Completion for Younger than 3 Years of Age: Outcome in Patients with Functional Single Ventricle

Bezuska, Laurynas; Lebetkevičius, Virgilijus; Lankutis, Kęstutis; Sudikienė, Rita; Sirvydis, Vytautas; Tarutis, Virgilijus

doi:10.1007/s00246-015-1217-2

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…In our group, 17 patients underwent extra-cardiac TCPC younger than 3 years of age. No significant difference was noticed in mortality and morbidity compared the outcome with the older patients [ 23 ]. This data corresponds with other authors’ results.…”

Section: Discussionmentioning

confidence: 99%

30-year experience of Fontan surgery: single-centre’s data

Bezuska

Lebetkevičius

Lankutis

et al. 2017

J Cardiothorac Surg

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BackgroundThe Fontan procedure has been modified several times since it was introduced into practice in 1968. As many patients now survive to adulthood, attention is directed towards their clinical status and late morbidity. We report our surgical experience of 30 years in Fontan procedures.MethodsFrom January 1985 to January 2015, 80 patients underwent Fontan surgery. Twenty-one patients received an atrio-pulmonary Fontan (Group I), four patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), six patients received extra-cardiac TCPC with an aortic homograft (group III) and 49 patients received extra-cardiac TCPC with an expanded polytetrafluoroethylene conduit. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations.ResultsThe mean follow-up time was 7.4 ± 6.6 years. The Kaplan–Meier estimated 15-year survival rate was 42% in Group I, 50% in Group II, 83% in Group III and 94% in Group IV. The median length of stay in intensive care unit, intubation and chest drain stay time were 90 h (IQR, 46–119), 8 h (IQR, 6–16) and 18 days (IQR, 12–28) respectively. Early complications were bleeding (6), taken down of Fontan circulation (3) and acute heart failure managed by left heart bypass (1). Late-occurring morbidities included arrhythmias (6), protein-losing enteropathy (2), thromboembolism (2) and tracheal stenosis (1). Fourteen patients (18%) had redo Fontan procedures.ConclusionOur series showed improving results after Fontan completion with excellent mid-term outcome after extra-cardiac TCPC with expanded polytetrafluoroethylene conduit. The long-term result should be followed.

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Section: Discussionmentioning

confidence: 99%

30-year experience of Fontan surgery: single-centre’s data

Bezuska

Lebetkevičius

Lankutis

et al. 2017

J Cardiothorac Surg

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“…Although the optimal timing of Fontan operation is still controversial, many contemporary centers aim to complete Fontan surgery in early childhood [40–43]. Older age at Fontan operation is associated with lower exercise capacity [44,45] which could increase risk for excess weight gain.…”

Section: Discussionmentioning

confidence: 99%

High Overweight and Obesity in Fontan Patients: A 20-Year History

et al. 2015

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Background: The prevalence of obesity in long-term survivors with complex congenital heart disease may be increasing, and little is known about the timing and onset of weight gain and growth patterns in these high-risk patients. Methods and Results: Prevalence rates of overweight/obesity and longitudinal changes in body mass index (BMI) with age were determined in 606 patients with Fontan circulation seen at a tertiary care cardiology center from 1992 – 2012. The number of clinic encounters (n) was stratified by age group (n=401, 2–5y; n= 333, 6–11y; n=217, 12–19y; and n=129, >20y). Among adults, 39% were overweight/obese at last clinic visit; 22% overweight and 17% obese. Childhood anthropometric data were available for 82 adults; of which 15% (n=12/82) were overweight/obese in childhood. The likelihood of being overweight/ obese as an adult was 3 times higher if there was a BMI ≥ 85th percentile in childhood (CI 2.1–4.5, p <0.01). Overweight/obesity in adulthood was associated with lower heart failure rates (4% vs. 19%, P=0.03). Pediatric rates of overweight/obesity were comparable to national data (NHANES 2011–2012) in every age group: at 2–5y, (25 vs. 23%), 6–11y (26 vs. 34%), and 12–19y (15 vs. 35%). Systolic blood pressure was higher in overweight/obese children as young as 2–5 years of age. Conclusions: Childhood and adult survivors with Fontan circulation have high rates of overweight/obesity. Childhood obesity is a strong predictor of future adiposity and is linked to changes in systolic blood pressure at a very young age.

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“…Currently, the age of patients who have completed the Fontan procedure is younger than that in the past. For patients <15 years old, the outcomes of Fontan completion have not been related to age at operation . Saab and Aboulhosn reported that cyanotic adult single‐ventricle patients not palliated with Fontan completion preserved single‐ventricle systolic function but caused development of elevated ventricular filling pressure with increasing age.…”

Section: Discussionmentioning

confidence: 99%