Fontan operation in five hundred consecutive patients: Factors influencing early and late outcome

Abstract

These analyses indicate that early failure has declined over the study period and that this decline is related in part to procedural modifications. A continuing late hazard phase is associated with few patient-related variables and does not appear related to procedural variables.

Late Clinical Outcomes of the Fontan Operation in Patients with Tricuspid Atresia

“…Although the immediate mortality in this series was higher than that reported in the literature 1,[10][11][12][13]16,17 , the late mortality in our group of patients was similar to that found by other authors 15,19 underwent the right atrium-pulmonary artery or Björk techniques, and found a survival rate of 15 years in about 70%, for both techniques. In our group of patients, a high mortality occurred in the immediate postoperative period.…”

“…However, if we compare mortality by decades, it decreased by 53% from the 1980s to the 1990s and the year 2000. This decrease was also observed by other authors 10,11,20,21 , proving the technical improvement inherent in to the accumulated experience and to the incorporation of new techniques. In the Boston group 11 , immediate mortality in their initial experience was 27%, rather similar to that in our group.…”

“…When we analyzed the complications that occurred according to the surgical technique used, we found that they tended to be less prevalent in Björk and fenestrated or nonfenestrated TCPC patients, although Gentles et al 11 concluded in their study that the long-term follow-up results are not directly related to the performed procedure. Cyanosis, present in 3 patients, may arise out of a deficient pulmonary flow, deriving from high pulmonary arterial resistance or decreased pulmonary perfusion pressure 1 .…”

“…On the other hand, Driscoll et al 22 reported a worse physical tolerance with increasing age, most probably due to the chronic volume and pressure overload in the single ventricular cavity. This physiopathological outcome will often culminate with the inevitable indication of a heart transplant for these patients 11 . In this sense, Fontan et al 22 also consider this operation a palliative procedure, because their patients also showed a decreased functional capacity in the long run.…”

“…Basically, a communication is established between the systemic venous return and the pulmonary arterial circulation, bypassing the right ventricle flow 2,3 . As years went by, however, a number of changes were proposed to the classical Fontan operation, such as the Kreutzer technique 4 , the Björk technique 5 , and the total cavopulmonary shunt (TCPC) [6][7][8][9] , and very few studies deal with the long-term follow-up of patients who undergo these procedures [10][11][12][13][14][15][16][17][18] .Considering that Fontan surgery is a relatively recent therapeutic procedure and that, in addition to this, some important changes were added to the original surgical technique, this study aims at evaluating late survival, as well as the complications that occurred during the long-term follow-up of patients with tricuspid atresia who underwent Fontan surgery or its variants. …”