Fontan conversion is a dated approach to the failing Fontan

Coats, Louise; Crossland, David; Hudson, Mark; O’Sullivan, John; Hasan, Asif

doi:10.1136/heartjnl-2016-310033

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…This is particularly the case for Fontan patients where the scale of Fontan revision surgery is similar to transplant, 47 which will remain the destination for most. 48 Decisions about very high-risk conventional options should be made in ACHD centres with the potential to offer the backup of ECMO, mechanical support, and transplant. The following cases illustrate patients who might have been accepted for transplant were ACHD cardiologists not closely involved in the transplant assessment process and thus able to suggest alternative nontransplant strategies.…”

Section: Who Should Be Referred For Consideration Of Advanced Therapy?mentioning

confidence: 99%

Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

Crossland

Bruaene

Silversides

et al. 2019

Canadian Journal of Cardiology

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There is mounting recognition that some of the most urgent problems of adult congenital heart disease (ACHD) are the prevention, diagnosis, and management of heart failure (HF). Recent expert consensus and position statements not only emphasize a specific and pressing need to tackle HF in ACHD (ACHD-HF) but also highlight the difficulty of doing so given a current sparsity of data. Some of the challenges will be addressed by this review. The authors are from 3 different centres; each centre has an established subspeciality ACHD-HF clinic and is able to provide heart transplant, multiorgan transplant, and mechanical support for patients with ACHD. Appropriate care of this complex population requires multidisciplinary ACHD-HF teams evaluate all possible treatment options. The risks and benefits of nontransplant ACHD surgery, percutaneous structural and electrophysiological intervention, and ongoing conservative management must be considered alongside those of transplant strategies. In our approach, advanced

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Section: Who Should Be Referred For Consideration Of Advanced Therapy?mentioning

confidence: 99%

Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

Crossland

Bruaene

Silversides

et al. 2019

Canadian Journal of Cardiology

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

Fernandes¹,

Silva²,

Canêo³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundThe Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment.ObjectiveTo evaluate the results of conversion from FK to TCPC.MethodsA retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05.ResultsFontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured.ConclusionsThe conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.

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Fontan conversion is a dated approach to the failing Fontan

Cited by 2 publications

References 5 publications

Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care

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

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