Fontan Conversion

Abstract

Early survival after the Fontan operation has improved significantly leading to a lifetime of Fontan circulation for patients. There is a natural progression of pulmonary artery pressure during the human lifetime that is easily tolerated in two-ventricle physiology but is deleterious for single-ventricle physiology. Obstructions in the venous to pulmonary artery pathway and pulmonary venous return or ventricular outflow, atrioventricular valve dysfunction (regurgitation), pulmonary arteriovenous malformations, venous thrombosis, and the development of atrial arrhythmias can lead to reduced functional status. These complications have been demonstrated in older patients with largely atriopulmonary connections owing to time accrual and unfavorable flow characteristics. Various surgical and catheter interventions aimed at reducing morbidity and mortality have been attempted to treat these identifiable abnormalities. The purpose of this article is to review the extant literature on Fontan Conversion and to assess the lessons learned over 20 years.

Atrial fibrillation ablation without pulmonary vein isolation in an atriopulmonary Fontan circulation

“…The choice to pursue further ablation, vs performing conversion to an extracardiac total cavopulmonary circulation, depends on multiple considerations. Although rhythm control is significantly improved with conversion (similar to the success of catheter ablation1, 8), there is a significant periprocedural risk of 5%–10% mortality with a prolonged recovery time compared to ablation 9, 10, 11. In observational series, Fontan conversion (when performed early) seems to be associated with better short- and long-term outcomes 10 …”

State of the art of the Fontan strategy for treatment of univentricular heart disease

“…Fontan conversion, from APC to TCPC, can improve functional status and exercise tolerance in the failing Fontan circulation 61 . AV valve repair after Fontan completion is considered in patients with moderate to severe regurgitation, but survival following successful repair remains inferior to that of patients without prior AV regurgitation 62 , 63 .…”

Outcomes of the Conversion of the Fontan-Kreutzer Operation to a Total Cavopulmonary Connection for the Failing Univentricular Circulation

“…The removal of the atrium from the pulmonary circulation would decrease the volumetric overload reducing atrial dimensions and consequently lessening secondary outcomes. 17-26…”